Client Details

Your full name

Company Name

Company Registration Number

Contact phone number

Contact email address

Email

Email enter again

Contact address

            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Have you ever been declined or removed from a warranty scheme or provider?

YesNo

Construction Details

Project name

The name or reference by which your identify this project

Project address

            Line 1
        
            Line 2
        
            Town/City
        
            County

Postcode

Planning Application Reference Number

Notice for self-builders

If you or a close family member plan to live in this property for at least 12 months, please visit www.selfbuildzone.comfor a policy better suited to your circumstances.

Is the project Phased?

YesNo

Number of Single-Unit PDH Buildings (Terraced, Bungalow, Semi-detached, Detached)

Number of Single-Unit Commercial Buildings

Multi-Unit Blocks – Residential Only

Separately detail each Block and the number of Residential Units within. Use the (+) button to add more Blocks.

Your Reference (eg. Block #1)	Number of Residential Units

Multi-Unit Blocks – Commercial Only

For commercial-only blocks, separately detail each block and the number of Commercial Units within each. Use the (+) button to add more Blocks.

Your Reference (eg. Block #1)	Number of Commercial Units

Multi-Unit Blocks – Mixed Residential and Commercial

Separately detail each Block and the Number of Residential/Commercial Units within. Use the (+) button to add more Blocks.

Your Reference (eg. Block #1)	Number of Residential Units	Number of Commercial Units

Brief description of Works

Number of storeys above ground (including ground floor)

Number of storeys below ground

Is any part of the Development on a sloping site?

YesNo

Mixed or Other - Provide details

Other - Provide details

Mixed or Other - Provide details

Is the project in an area associated with Flooding, Radon, Mining, Cheshire Brine or other Mineral Extraction?

YesNo

Project Details

Total Reinstatement Cost of the New Works

How much would it cost (in terms of materials and professional labour) to reinstate all new works of the project if you suffered a total loss (eg. fire) when nearing completion? You need to consider the cost of removing debris and professional fees in arriving at this figure.

£

Total Reinstatement Cost of the Existing Structures

How much would it cost (in terms of materials and professional labour) to reinstate the existing structure. DO NOT include the value of the land. If you have buildings insurance already in place for an existing structure, you must check that the insurance company is prepared to continue covering it while you self-build or self-manage the proposed works. Many home insurers exclude cover on properties undergoing renovation, alteration or conversion.

£

Combined area of all storeys of all buildings (square metres)

This needs to be the total floor area for all Housing Units or Premise’s inclusive of basements, plus any separately identifiable structures such as detached garages and/or outbuildings that you want to include cover for under this policy.

Only know the area in square feet? Use this converter (link opens in a new window)

Gross Development Value (GDV), if known.

£

Developer Name

Contractor's Company Name or Company Registration Number

Is there a Project Manager?

YesNo

Would you like a quote for Building Control services from our "partnered" surveyor network (Approved Inspector)?

If you are making separate arrangements for Building Control, one of our partnered surveyors will carry out a series of separate technical audits of the development for the purposes of the warranty.

By using our "partnered" surveyor network for your Building Control you will benefit from having one of our surveyors on site to carry out the Warranty and Building Control inspections at the same time.

YesNo

Other - Provide details

Building Control Reference Number

Is the project being built under a Building Notice?

This is a form of Building Regulation application intended for small works only. We suggest proceeding with caution. You will be building without a Plan Check as you have little design information or drawings. The cost of the warranty could increase using a Building Notice rather than a Full Plans application.

YesNo

Start Date of building works

Estimate if works not yet started

Completion Date for project

Estimate if work is ongoing

Optional Cover

Loss of Rent figure, per annum

£

Admin Summary

Source

Source - Approved Inspector

Status updated

OpenGi Prospect

Record the OpenGi full prospect reference upon transfer

OpenGI Live BZSS Survey Reference

Record the OpenGi survey reference after transfer

Underwriting

Target premium (ex.IPT)

Mandatory requirement

£

Policy Wording

Policy Limit of Indemnity

If different from policy standard

£

Defects Liability Period (years)

Excess in Respect of Residential Units

Excess in Respect of Commercial Units

Excess Applicable to Common Parts

Enter 0 if not applicable. Typically minimum of £1,000

Loss of Rent Excess Period (days)

--------------------------------

Written Line

%

Commission Total

%

Commission Agent

%

--------------------------------

Written Line

%

Commission Total

%

Commission Agent

%

--------------------------------

Written Line

%

Commission Total

%

Commission Agent

%

--------------------------------

Written Line

%

Commission Total

%

Commission Agent

%

--------------------------------

Written Line

%

Commission Total

%

Commission Agent

%

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Additional Information

Text in this free-type area will appear on page 2 of the indication document under the heading "Additional Information".

Agreements

Guarantee, Bond, Escrow amount

£

Cross Guarantee Company

Full business name of the cross guarantee company for use on the cross guarantee document

Cross Guarantee Company principal place of business

Full business address of the cross guarantee company for use on the cross guarantee documents

Builder Name

Full business name of the builder for use on the BCIA document

Builder's principal place of business

Full business address of the builder for use on the BCIA document

Rating Calculations

Calculation Model

StandardAXAFidelis

Base Rate

(Standard, AXA, Fidelis)

Base Adjustment

(Standard, AXA, Fidelis) Example : Basement 0.05

Description	Adjustment

Deduction for Excess

(Standard, AXA) No deduction for £1,000. Can range from 10% to 30% on commercial risks.

Loading for Indexation

(Standard, AXA, Fidelis) Usually 25% for Canopius

Loading for Stage of Build

(Standard, AXA, Fidelis) 25%, 50%, 75% or 100%

Loading where no DLP

(AXA) Typically, a minimum loading of 20% where no DLP

Loading/Discount for Custom Adjustments

(Standard, AXA, Fidelis) Enter a figure to apply a loading (or discount) to the premium. Useful for price-matching. Save notes to the quote detailing reasons for applying an adjustment.

Technical Services

Technical service subjectivities for surveyor

Subjectivity

Number of Visits

This should be used when requesting manual fees. Please note, this figure appears on the client documentation.

Specialist Surveys (BZSS use, only)

List one specialist survey per line

BZSS Coding / Grading (BZSS use, only)

Special instructions to Surveyor (BZSS use, only)

Use manually calculated inspection fees?

YesNo

---- Automatic Fees ----

BZSS Fee (auto-calculated)

Excluding VAT

£

Surveyor Fee (auto-calculated)

Excluding VAT

£

Inspection Fee to AI (auto-calculated)

This figure is not included in any calculations. It appears, as is, on the documentation to the customer detailing how much they must pay directly to the AI

* INCLUDING VAT *

£

---- Manual Fees ----

BZSS Fee (manual)

All-time, running total of BZSS fees excluding VAT.

£

Surveyor Fee (manual)

All-time, running total of surveyor fees excluding VAT.

£

Inspection Fee To AI (manual)

This figure is not included in any calculations. It appears, as is, on the documentation to the customer detailing how much they must pay directly to the AI

All-time, running total of surveyor fees paid directly to the AI * INCLUDING VAT *.

£

Insurer Referral

Referral date

Comments for Insurer (Build-Zone use only)

Technical comment (BZSS use only)

Technical referral date (BZSS use only)

Referral completed

Date issued to insurer

Insurers agreed to proceed

YesNo

Insurer agreed date

Insurer response

Proposer Summary

Registration Status

Date First Registered

Registration Renewal Date

Rules of Registration Received

Indemnity Agreement Received

Accounts Received

Project Finance

Details of lending

Phasing

Project Phasing

If the project is phased, provide details of units and phasing

Phase Number	Start Date	Expected Completion	No. / Type of Units

Housing Schedule

List all units

Unit Ref	Sale Price	Floor Area (m²)	Type of Unit	Reinstatement Cost Existing Structure	Cost of Conversion Work	Build Cost if New Build

Contractor Builder

Contractor Name

Companies House Reg No

Architect

Architect Name

Website

Companies House Reg No

Structural Engineer

Structural Engineer Name

Website

Companies House Reg No

Project Manager

Project Manager Name

Website

Companies House Reg No

System calculation fields

DO NOT MANUALLY EDIT ANY OF THE FIELDS BELOW

The values in these fields are calculated by the system.

MainPremium

'Main' Cover Group is a requirement of SchemeServe but not one we use as all Cover Group products are optional.

Nothing to be entered in this field.

£

Standard Rate

Applicable to new builds only

Damage Rate

Consequential Loss Rate

Rate applicable to existing structures

Proposer Project Rate

Generated from drop down list ProposerProjectRisk

AffiliateId

From URL

Agent Reference

From custom javascript in scheme admin

Project Bracket

Project Postcode 4 chars

Project Postcode 3 chars

Project Postcode 2 chars

Number of Additional Inspections