Thatch Questionnaire
Please ensure you have read the important information at the end of this form before sending on to us.
Client Details
Customer Name(s)
Policy/Quote Ref
Risk Address/Address of Property to be Insured
Address
Postcode
Type of Property
1
Is the property: Detached
If Other, give details
Semi Detached
End Terrace
Mid Terrace
Roofing
2
What roofing material is used? (please tick)
Water Reed/Norfolk Reed
Combed Wheat/Devon Reed
Long Straw
Fibre Thatch
If Other, give details
3
When was the roof last inspected by a professional Thatcher?
4
Was any work recommended?
YES
NO
If Yes, has all the recommended work been carried out?
YES
NO
If No, please give details of the work that is outstanding and the anticipated date of completion:
5
When was the roof last re-thatched?
6
When was the ridge last renewed?
7
What is the approximate depth of the thatch?
Less than 1 metre
8
Between 1 metre & 2 metres
Greater than 2m
Does the property have a 100% thatched roof?
YES
NO
YES
NO
YES
NO
If No, what percentage is thatch?
Heating and Chimneys
9
Are chimneys ever used?
If Yes, how many chimneys are there?
10
Is/are the chimney(s) lined?
If Yes, when was the lining(s) last inspected/replaced?
11
How is the property heated? (tick all that apply)
Central Heating
Open Fires
Solid Fuel Stoves
If you have ticked Open Fires and/or Solid Fuel Stoves:
a) What type of fuel is used?
b) If the roof is less than 100% thatched are the fires/stoves situated under the area of thatched roof?
Not Applicable, roof is 100% thatched
YES
NO
c) Has the chimney been swept in the last 12 months?
YES
NO
YES
NO
d) What height is the chimney above the ridge? (tick)
Less than 1 metre
Between 1 metre & 2 metres
Greater than 2metres
e) Are spark arrestors fitted to the chimney?
Fire Precautions
12
What Fire precautions does the property benefit from? (please tick all that apply)
Fire Alarm linked to a monitoring station
Fire Extinguishers
60 minute Fire Barriers beneath the thatch
if Yes, advise type and where kept
Fire Blanket in the kitchen
Smoke Detectors (Mains)
Smoke Detectors (Battery operated)
If Other, please provide details
Fire Brigade
13
How many miles is the property from the nearest Fire Station?
Less than 5 miles
14
Is the station: a) whole time
Between 5 & 10 miles
b) day crewed
Greater than 10 miles
or c) retained
(please tick)
Water Supply
15
Is the property connected to the mains water supply?
YES
NO
16
Are there any additional sources of water available?
(e.g. lake, swimming pool, river or stream)
YES
NO
If Yes, please give details
Electrics
17
Has electrical wiring been checked in the last 6 years by a NICEIC, ECA, NAPIT, BSI or ELECSA qualified
electrician?
YES
NO
Please send a copy of the latest electrical report with this form
18
Was any work recommended by the electrician?
YES
NO
a) If Yes, has all the work been completed?
YES
NO
b) if No, please advise what is outstanding and give an indication of the expected completion date:
Additional Information
Important Information
The answers to all questions are important. You are required to take care to answer all questions accurately and honestly and not to omit any
relevant information. If you give us incorrect or incomplete information the wrong terms may be quoted, the insurers may be entitled to reject
payment of a claim or payment could be reduced. In certain circumstances your policy might be invalid, and you may not be entitled to a refund
of premium.
Please also note that upon completion of this questionnaire you may be asked to provide additional information at your own expense.
Name/Signature of person
completing form:
Dated:
Please tick, if you are an Agent completing on behalf of your client
Registered Address: 57 Ladymead, Guildford, Surrey GU1 1DB, United Kingdom. Registered in England No. 3007252.
Home and Legacy Insurance Services Limited is authorised and regulated by the Financial Conduct Authority.
A member of the British Insurance Brokers Association. Calls may be recorded for our joint protection, training and/or monitoring purposes.
Thatch Questionnaire v3 Apl 13