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PAX Buildings Proposal Form

For more information about our buildings insurance policy, including eligibility and specific benefits please click here 

Please note the following information:
  • If you do not provide all the information requested, we may be unable to provide a quotation.
  • The Insurers reserve the right to change the premium and/or terms and conditions of cover in certain circumstances. 
  • You should keep a record of all information you have given to us (a copy of a completed form will be emailed to you upon completion)
  • If you have any queries with the below application please contact the PAX team on 0800 212 4800. 
Policyholders details

Wherever we ask about Your Family we mean you, your spouse, partner, children (including foster children), parents and relatives that normally live with you.
5. Do you want to add a joint policyholder? *This question is required.
Joint Policyholders details
Correspondence address:
This question requires a valid number format.
This question requires a valid email address.
16. Have you made any Household Buildings claim(s) in the past 3 years? *This question is required.
17. Have you or your family had any insurance policy refused, cancelled, declined or declared void? *This question is required.
18. Do you or your family have any unspent convictions for any offence except for driving or speeding? *This question is required.
19. Have you or your family ever been declared bankrupt? *This question is required.
Property Details
23. Is the property built of brick, stone, concrete and roofed with slates, tiles, concrete or metal? *This question is required.
24. Is the property near a cliff or riverbank? *This question is required.
25. Is the property located in an area free from flooding in the past 5 years? *This question is required.
26. Is the property showing any sign of, or ever had any damage caused to it by subsidence, heave or landslip (e.g. cracking or bulging of walls)? *This question is required.
27. Is the property used for any trade, professional or business purposes other than clerical work undertaken by you or your family? *This question is required.
28. Is this property your permanent place of residence? *This question is required.
If no, is the property let? *This question is required.
Please note – PAX Insurance must cover your main residence in addition to your let property home. A member of the PAX team will contact you if additional information is required
29. Is the property in a good state of repair? *This question is required.
30. Is the property left unoccupied for more than 60 days in a row? *This question is required.
Is the property a weekend or holiday home? *This question is required.
Please note - PAX Insurance must provide cover for your main residence in addition to your holiday home. A member of the PAX team will contact you if additional information is required.
31. Is the property occupied solely by you or your family? *This question is required.
32. Is the property mortgaged? *This question is required.
Optional Extras
33. Do you require accidental damage cover? *This question is required.
34. Do you want to add legal expenses cover?
Up to £40,000 to pursue or defend your legal rights *This question is required.
Are you or any member of your family aware of any circumstances that could give rise to a claim or legal proceedings (including criminal prosecution or a claim relating to your employment) being pursued or bought against you? *This question is required.
Have you or any member of your family been involved in any claims or legal proceedings (including criminal prosecutions or a claim relating to your employment) in the last 3 years? *This question is required.
Premium Discount
36. The Buildings Insurance policy has a minimum £50 excess (except for subsidence, landslip and heave claims which have a £1000 excess).
Discounts are available if you accept an increased excess, please tick the appropriate box if would like to increase your excess:
0%