Farmers Combined Insurance - Quotation Request

Proposer's name

E-mail address

Telephone No

Farm address

Postcode

Are you an existing Rowett  Insurance client?

Yes No

(please check all that apply)

Mixed

Arable 

Milk/dairy

Beef

Poultry/eggs

Fruit

Sheep

Other

if other, please specify

Other business activities
(if none, please state 'none')

(if this cover is not required please click here)
If you do require this cover please insert the required sum insured next to the description.

Description

Sum Insured (£)

1) Agricultural Produce including growing crops and farming stock but excluding livestock and property referred to in the following items (questions 2 to 14)

2) Permanently fixed machinery and plant and accessories attached thereto.

3) Machinery, plant and implements, including power driven vehicles and implements and their accessories excluding property more specifically insured,

4) Fixed milk plant.

5)   Appliances for the hatching and rearing of poultry by artificial heat.

6) Tenants improvements, alterations and decorations belonging to you or for which you are responsible

7) Boundary walls, fences, hedges ane gates.

8) Silage

9) Hay and/or Straw

10) Roots and Potatoes stored in a building

11) Roots and Potatoes stored in the open

12) Grain in detached building used solely for drying, dressing and/or storage of grain

13) Grain in detached building

14) Growing timber

Other property not specified above

The policy will cover loss, destruction of or damage to your farm property. The list below represents the standard contingencies included. If you do not require any of this please indicate by checking the corresponding box. Please remember to check those that are NOT required

Fire

Explosion

Aircraft

Riot (including malicious damage)

Earthquake

Subterranean fire

Spontaneous combustion

Impact by any road vehicle or animal other than by those you own or control

Escape of oil

Falling trees

Do you require cover for impact caused by your own vehicles or animals?

Yes No

Do you require cover for theft?

Yes No

Have you suffered any loss or damage by any cause (whether insured or not) to any of the above property during the last 5 years?

Yes No

if 'yes' please give details including the date, nature of loss and amount of loss

About Your Farm Buildings

Is buildings cover  required?

Yes No

if yes, please provide details of your buildings and their construction together with the required sum insured below. If this cover is not required please
click here.

Building description and construction

Sum insured (£)

if you require more space please detail the information here  

The policy will cover loss, destruction of or damage to your farm property. The list below represents the standard contingencies included. If you do not require any of this please indicate by checking the corresponding box. Please remember to check those that are NOT required

Fire

Explosion

Aircraft

Riot (including malicious damage)

Earthquake

Subterranean fire

Spontaneous combustion

Escape of oil

Falling trees

Impact by any road vehicle other than by those you own or control

Do you require cover for impact caused by your own vehicles or animals?

Yes No

Do you require cover for storm or tempest?

Yes No

Do you require cover for escape of water?

Yes No

Have you suffered any loss or damage by any cause (whether insured or not) to any of the above property during the last 5 years?

Yes No

if 'yes' please give details including the date, nature of loss and amount of loss

Livestock

Is this cover required?

Yes No

If 'yes' please complete the following section. If 'no' please click here

Type

Sum Insured (£)

Maximum value of any one load (£)

Maximum number any one load

Cattle

Sheep

Pigs

Poultry

Horses

Goats

Please specify any other below (eg working dogs)

Do the above Sums Insured include the value of livestock for sale?

Yes No

If you wish to restrict the standard contingencies please check the boxes next to those NOT required:-

Fire, lightning and explosion

Aircraft

Riot (including malicious damage)

Falling trees

Impact by any road vehicle or animal other than by those you own or control

Earthquake

Do you require cover for impact caused by your own vehicles or animals

Yes No

Do you require cover for electrocution

Yes No

Do you require cover for:-

Sheep worrying by dogs

Yes No

Sheep worrying by dogs and foxes

Yes No

Theft

Yes No

Fatal injury to livestock

Yes No

Transit

Yes No

Have you suffered any loss of Livestock (whether insured or not) in the last 5 years?

Yes No

if 'yes'please provide details below included dates, nature of losses and the amounts of any losses
 

Farm Liabilities

Is this cover required?

Yes No

if 'no' please click here , if 'yes' please complete the following section

Estimated annual wages and other earnings for the next 12 months

Employees:-

Type of work

Estimate (£)

No of persons

Clerical

Farm labouring

Any other (please specify below)

Proprietors/Partners

Type of work (specify)

Estimate (£)

No of persons

What was the total actual wages paid to employees in the last financial year?

Do you wish to cover your responsibilities under Agricultural Wages Board Orders

Yes No

How many certificates of insurance do you require? (please insert number)

Is this cover required?

Yes No

if 'no' please click here , if 'yes' please complete the following section

Limit of indemnity required

select >>> £500,000 £1,000,000 over £1,000,000  

if over £1,000,000 please state limit required

Estimated annual wages, salaries and other earnings (£)

Estimated turnover for the coming year

Estimated payments to independent contractors

Total area farmed

 hectares

Do you at any time burn straw or stubble

Yes No

if 'yes' do you comply with the Local Authority regulations which apply

Yes No

If you employ independent contractors, do you check that they have Liability Insurance with an Indemnity Limit at least as high as the one you have selected?

Yes No

Do you export any products to overseas customers?

Yes No

if 'yes' name any countries and give details of products and turnover below

Countries

Products

Turnover (£)

Do you engage in any of the following activities?
Please check either yes or no, if you answer 'yes' please state the estimated annual turnover from such activity

Activity

Yes/No

Turnover (£)

Retail sales e.g. vegetables, milk, bread, honey, jams/preserves sold from farm shop

  Yes

  No

Provision of accommodation for paying guests

  Yes

  No

Letting of any land for caravan or tenting accommodation

  Yes

  No

Crop spraying for other farms

  Yes

  No

Any other 'non-farming' activity not specified above e.g. food processing (please give details below)

  Yes

  No

Frozen Food

Is this cover required?

Yes No

if 'no' please click here, if 'yes' please complete the following section

Description of freezer unit(s)

Year of Manufacture

Sum Insured on Contents (£)

Are these units free from defect?

Yes No

Are the unit motors and compressors hermetically sealed?

Yes No

if 'no' are the units under a service contract?

Yes No

At what intervals are the units examined

select >>> months years  

Have you suffered loss by any cause to any property as described at the premises or elsewhere during the last five years?

Yes No

if 'yes' please give details below including dates, nature of losses and amounts of losses
 

About the Farm Home

Is the farm home address the same as that previously entered?

Yes No

if 'no' please enter the address here

Postcode

Is the building and it's roof of standard construction?

Yes No

if 'no' please give details

Is the farm home?

select >>> Detached Semi-detached Terraced Other  

if 'other' please give details

and is it......

select >>> Owner occupied Rented - furnished Rented - unfurnished Other  

if 'other' please give details

Approximately when was the home built?

No of bedrooms

Has the home ever been damaged by flood, heave or landslip or is it in an area susceptible to such risks?

Yes No

Farm Home - Buildings Insurance

Is this cover required?

Yes No

if 'no' please click here, if 'yes' please complete the following section

Please enter Sum Insured

Level of cover

select >>> Standard Accidental Damage  

Policy excess

select >>> £50 £100 £250 other amount  

if 'other amount' please specify

Farm Buildings - Contents Insurance

Is this cover required?

Yes No

if 'no' please click here , if 'yes' please complete the following section

Level of cover

select >>> Standard Cover Accidental Damage  

Please insert Sum Insured

Please state the value of all 'high risk' items to be insured

Does the property have an intruder alarm?

Yes No

if 'yes' please provide details of the alarm and installing company below

Do you wish to extend the cover to include:

Family Legal Protection?

Yes No

Caravan(s)/Mobile Home(s)?

Yes No

if you have answered 'yes' to caravan(s)/mobile home(s) please provide information on these below

Make and Model

Type

Year of Make

Estimated Value (£)

select >>> Static Tourer  

select >>> Static Tourer  

select >>> Static Tourer  

Do you wish to include  cover for domestic animals?

Yes No

if 'yes' please provide details below, if 'no' please click here

Type and Breed

Date of Birth

Replacement Cost

Your Insurance History (Farm Home)

Have you made a claim in the last 5 years or had a claim made against you?

Yes No

if 'yes' please give details here including dates, whether related to buildings or contents and the amount of the claim

If you currently hold home insurance are you entitled to a no claims discount?

Yes No

if 'yes' how many claim free years does this represent?

 years

Farm Motor

You will soon be able to obtain a quote for your farm vehicles on this request form as well. At the present time however, please answer the final three questions here then click 'send', you will then be offered a link to take you to our separate request form for agricultural vehicles.

Insurance required from

Renewal date of present insurance (if applicable)

Preferred Payment Method

choose >>> Credit Card Debit Card Cheque Direct Debit