Ecocover Questionnaire

Questionnaire

Caring for you and the environment

Great, you are on your way to obtaining up to a 10% discount for caring for the environment.

Simply complete this questionnaire to qualify.

We will then contact you as soon as possible by email or telephone during normal office hours to discuss with you your insurance needs and provide you with a quotation.

Home Insurance – Ecclesiastical Scheme

The Commercial Questionnaire is available here


	First Name *

	Surname *

	Business Name (if applicable)

	Your email address * (required to send the results)

	Contact telephone number *

	* Required in order to send the form

	Bronze
	(1) Do you reuse paper at home?		No Yes
	(2) Do you recycle paper at home?		No Yes
	(3) Do you recycle cans, bottles, etc?		No Yes
	(the above questions must have at least one ‘yes’ to qualify for a 5% discount. *If appropriate, please go to next section silver*)

	Silver
	(1) Do you use energy efficient lightbulbs?		No Yes
	(2) Do you turn off lights / power when not required?		No Yes
	(3) Do you compost garden waste?		No Yes
	(4) Do you turn your heating thermostat down and maintain your boiler?		No Yes
	(5) Do you car share, cycle or walk whenever possible?		No Yes
	(*the above questions must have at least one ‘yes’ to qualify for a 7.5% discount.* *If appropriate, please go to next section gold*)

	Gold
	(1) Do you have ‘A’ rated energy efficient appliances, i.e. fridge, freezer, microwave or washing machine?		No Yes
	(2) Do you have a Wind Turbine?		No Yes
	(3) Do you have a Solar Panel?		No Yes
	(*the above questions must have at least one ‘yes’ to qualify for the full discount available of 10%*)