FARMERS COMBINED INSURANCE

Proposer's Name

Email address (required)

Address

Postcode

Telephone No

Date of Birth

Company or trading name

Business address

Postcode

Telephone No

Fax No (optional)

(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')

Is buildings cover  required?

Yes No

Building description and construction

Sum insured (£)

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

Theft

Storm

Escape of Water*

*Escape of water only available for heated buildings

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

Is this cover required?

Yes No

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

Sheep worrying

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

Is this cover required?

Yes No

Type of work

Estimate (£)

No of persons

Clerical

Farm labouring

Any other (please specify below)

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

Limit of indemnity required

select >>> £5 Million £10 Million  

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

Countries

Products

Turnover (£)

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

Is this cover required?

Yes No

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  

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

Is this cover required?

Yes No

Please enter Sum Insured

Level of cover

select >>> Standard Accidental Damage  

Policy excess

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

if 'other amount' please specify

Is this cover required?

Yes No

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

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

Type and Breed

Date of Birth

Replacement Cost

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

Yes No

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

Renewal Date of present insurance (if applicable)

Insurance required from

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