Incident/Claim Number
Name of Occupant
Address
Phone number
Email address
Number of occupants
Special Requirements in case of evacuation (optional)
Details of any alternative accommodation (optional)
Approximate year of construction
Property type —Please choose an option—FlatApartmentBungalowTerraced houseSemi-detached houseDetached house
Suspended timber floors —Please choose an option—YesNoUnknown
Concrete floors —Please choose an option—YesNoUnknown
UPVC windows and doors —Please choose an option—YesNo
Cellar/basement —Please choose an option—YesNo
GFM 406 alarm installed Serial number if known
Carbon Dioxide alarm installed Serial number if known
Carbon Monoxide alarm installed Serial number if known
Methane alarm installed Serial number if known
Photo of the monitor/alarm location (if known)
Have the occupants been informed how the equipment installed at the property operates and what to do in the event of an alarm/emergency? —Please choose an option—YesNo
This is to certify that the above equipment has been installed in the above mentioned property and that the occupier has read and understood the information sheet provided. Please leave this field empty.