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IMPORTANT: Please complete this application as fully as possible and return it to Consort Insurance, together with any relevant plans, Schedules of Condition or other supporting documents.

JCT clause 21.2.1 (or equivalent) insurance

Section 1 - General details

:
£
£

Section 2 - Existing property

If the existing property is being completely demolished or the contract site has already been cleared, please proceed to SECTION 3. Otherwise, please answer the questions below:

YesNo
YesNo

Section 3 - Surrounding property

Please give a description of all surrounding property not forming part of the Contract Works:

YesNo
If Yes, please forward a copy of this to
dahlia.osuoha@consortinsurance.com
YesNo

Section 4 - Construction and extensions

Please complete DEMOLITION Section if applicable (where such demolition forms part of a contract for erection, reconstruction, alteration or repair by the insured):

Demolition

YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo

Section 5 - Declaration

The undersigned declares on behalf of all parties proposing for insurance that to the best of his/her knowledge and belief, the statements provided herein are true and complete and all material facts or circumstances have been fully disclosed. The undersigned declares and agrees that the proposal form together with any other information supplied shall form the basis of any subsequent contract of insurance and undertakes to inform the insurer of any material alteration to those facts occurring before completion of the contract of insurance.