1. Your Quote

Are you a broker seeking a quotation on behalf of your client?

Yes

No

Broker Name(Required)

2. Declarations

Please confirm that the following statements are true & will remain for the duration of the period of insurance;

You are engaging qualified Architects, Surveyors and Consulting Engineers throughout the Self Build Project, who have appropriate Professional Indemnity Insurance.
The build/project does not undertake any work involving asbestos or asbestos containing materials.
The proposed Insured is domiciled in the Republic of Ireland
The site is not subject to any of the following ground conditions - flood, subsidence/landslide, mining, peat, sink holes & pyrite
Works are due to start in 90 days
Any Demolition must be completed by a BFSC with appropriate insurance in place
You will not need to carry out any ground stabilisation techniques on your site before you start construction (i.e. the ground does not require treatment such as vibro compaction or subsoil injection before it is suitable to build on)
There will be no piling
There will be no excavations over 3 metres in depth
Planning permission has been obtained for the works or such works are classed as an exempt development
The site location/self build project is located within the Republic of Ireland

Please confirm that all principals, partners or directors have not:

During the last five years sustained any losses or had a claim made against you (insured or otherwise) that would have been covered by the type of insurance you are applying for here
Been declined insurance, had an insurance policy terminated, been refused a renewal or had special terms imposed (increased excess, restriction of cover etc.)
Had any prosecutions or received notice of an intended prosecution.
Had any court judgements
Been declared bankrupt or insolvent
Been a director, partner or principal of a house builder or construction company that has gone into liquidation in the past

3. Proposer Details

The Insured(Required)

First Name Last Name

The Joint insured

First Name Last Name

Please enter the second insured i you need the policy to be in 2 names

Email(Required)

Phone

Broker Address

Address Line 1 Address Line 2 Town/City County Eircode/Postcode Country

Correspondence Address(Required)

Street Address Address Line 2 Town/City County Eircode / Postcode Country

Are the works being undertaken at the above address?(Required)

Yes

No

Address where works are being undertaken

Street Address Address Line 2 City/Town/Townsland County Eircode

The insured's domiciled country:(Required)

Country

General Questions (continued)

Type of Self Build Project(Required)

Reinstatement cost of existing building(Required)

(ie. the existing building's insured sum before works started)

Reinstatement cost of new works(Required)

(ie. the cost of the project)

Reinstatement cost for new build(Required)

(ie. the full rebuild cost of the completed project)

Description of the self build project(Required)

Current Stage of Works(Required)

Intended use of the project?(Required)

Will the project involve any demolition?(Required)

Yes

No

Demolition is defined as completely removing an existing structure such as an extension, outhouses, annex etc. Removal of internal walls during a renovation or knocking though an opening to an extension is not considered demolition.

What is the square footage of the project?(Required)

Will demolition works be limited to a maximum height of 5 metres?

Yes

No

Will demolition works be carried out by an insured contractor?

Yes

No

Please email a demolition method statement to info@mdrb.ie

What is the planned duration of the project? Note: 3 month extension is only available to clients where a self build policy has been in place, proof of which will be required.(Required)

5. Cover

When would you like the policy to commence?(Required)

Type of Construction(Required)

Standard* (see below)

Timber Frame

ICF

Other

*Standard Construction is defined as as block, brick, stone or concrete buildings with roofing comprising slates, tiles, concrete, metal or other coverings composed entirely of non-combustible materials and/or LPCB approved panels.

Please let us know what type of construction the project involves(Required)

The standard limit for owned and hired-in plant is €5,000. If you'd like a higher limit, please select below.(Required)

Do you require cover for caravans, site huts, containers & contents? Please select a limit.(Required)

6. Liability

Employers Liability Limit of Indemnity is €13,000,000

Please select a limit of public liability indemnity.(Required)

7. Notice of Interest

This is purely for noting interested parties on the policy and no further indemnities can be provided without prior agreement.

Name of interested party/financial institution

8. Claims History

Have you made any claims over the past 5 years?(Required)

Yes

No

Please enter details of any claims over the past 5 years, including date of loss, amount of loss and details of loss.(Required)

9. Personal Accident Cover

We can include Personal Accident for the Insured and any Immediate Family Members. Immediate Family Members shall mean the spouse, civil partner, common law partner, father, mother, grandfather, grandmother, stepfather, stepmother, son, daughter, grandson, granddaughter, stepson, stepdaughter, brother, sister, half brother, half sister or any adopted or fostered children of the Insured who live with the Insured. This is only available for clients between the ages of 18 - 65.

Do you require Personal Accident cover?(Required)

Yes

No

Personal Accident Cover Required

Please enter the details of people who require personal accident cover

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

Name

Date of Birth

10. Consent

Antispam Question(Required)

In order to prevent spam entries, we just need to ask you a question. What colour is grass?

Email

This field is for validation purposes and should be left unchanged.

Get a Quote for Self Build Insurance

Site Insurance Proposal Form

1. Your Quote

2. Declarations

3. Proposer Details

4. General Questions

General Questions (continued)

5. Cover

6. Liability

7. Notice of Interest

8. Claims History

9. Personal Accident Cover

Personal Accident Cover Required

10. Consent