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Commercial Farms...


Please make sure you answer all the questions especially your contact details.

 

Insured's details -

Insured Name:

Trading Name:

Postal Address:

Email Address:

Telephone No:

Details of the property

Location of farm (full address)

Type of Farm Activities (full description)

Do any farming activities include: Pig Farming, Deer Farming, Poultry Farming, Aquaculture, Plant Nurseries, Feedlots, Forestry or Turf farming?
Yes  No

Do any farming activities include: Horse breeding, Horse Training, Riding Schools or Agisting other peoples horses?
Yes  No

Is the farm(s) likely to be unattended for more than 90 consecutive days?
Yes  No

Does the insured conduct any activities other than farming (e.g. processing, manufacturing, consulting or other business services)?
Yes  No

Are Farm Buildings used for any purposes other than farming or residential purposes?
Yes  No

Are any Farm Buildings subject to National Trust classification?
Yes  No

Are the Farm Buildings well maintained and structurally sound?
Yes  No

Are there any Farm Buildings at this situation that are not to be insured?
Yes  No

Do any of the Farm Buildings contain Expanded Polystyrene Foam (EPS) in their construction?
Yes  No

Are there any other relevant facts relating to the risk to be insured which you should disclose to enable a true assessment of your application?
Yes  No

 

Home Insurance -
Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Home Building sum insured

Home Contents sum insured

Construction of home

Year Building built (approx)

Is the Building watertight, well maintained, structurally sound & secure?
Yes    No

Is the Building subject to a Demolition Order?
Yes    No

Is the property connected to town water?
Yes    No

Are there other houses on the property to be insured?
Yes    No

 


Farm Property Insurance -

Farm Buildings & Property    (insuring fire, explosion, impact damage, vandalism, storm damage & earthquake).

Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Total value of farm buildings (excluding houses)

$

Total value of farm contents

$

Total value of Farm Machinery (excluding Farm Motor - refer below)

$

Total value of Livestock (animals which are used for Farm Business)

$

Total value of Farm Fencing

$

Wool Sum Insured

$

Grain Sum Insured

$

Trellis Sum Insured

$

Solar Panels Sum Insured

$

Greenhouses

$

Wind Turbines

$

Hay Sum Insured $


Business Interruption -

(insuring loss of income resulting from a farm property loss).

Is this cover required?    Yes    No

If YES, what is the annual turnover for all Farm activities $


Farm Motor Vehicles / Farm Machinery-

covering fire, theft & accidental damage for trucks, tractors, mobile machinery, motor cycles etc.

Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Description of vehicle Category of vehicle Registered? Sum Insured

$

$

$

$

$

$

$

Are there other farm vehicles to be insured?    Yes    No

If Yes, we will collect this information separately.


Theft -

of farm contents (excluding Farm Motor or Livestock)

Is this cover required?    Yes    No

If Yes, please fill in the sums insured required below:

Sum insured for Farm Property Theft    


Public Liability -

Is this cover required?    Yes    No

If Yes, please select a sum insured:   

Do you undertake farm contracting work where the combined turnover exceeds $100,000 in a typical year? Yes    No
Do you spend more than $75,000 per annum, for all Situations combined, on contractors? Yes    No
Do you require cover for farm accommodation (including bed and breakfast) at any Situation? Yes    No
Do you allow any visitors to ride horses, or offer horse riding facilities or horse riding activities to visitors? Yes    No
Do you export to the USA, Canada or any of their protectorates? Yes    No
Do you have an Aircraft Landing Area? Yes    No
Is your property used or leased for any purpose other than primary production? Yes    No
Will you hold public entertainment functions for public gatherings of over 100 people at any Situation? Yes    No
Will you sell directly to the public (e.g. cellar door sales or a farm stall), or at a farm market?

Yes    No

How do you rate the condition of boundary fencing?

Number of situations to be insured?

Size of farm (in hectares)

Annual Turnover

Farm activities:

 

Contractors...

Do you employ contractors or sub-contractors? Yes    No

If you answered "YES", what duties do they perform?

What is the estimated annual payments to these contractors?
Do they have their own Public Liability cover? Yes   No
Do they have their own Workers Compensation cover? Yes   No

 

Labour Hire...

Do you use labour from labour hire companies?

Yes    No

If you answered "YES", what duties do they perform?

What is the estimated annual payments for labour hire?
$

 

Your History....

Have you or anyone to be insured under this policy:

Sustained a loss, damage, injury or liability in the last 5 years, whether insured or not? Yes     No
Had insurance declined, renewal refused or terminated by any insurer? Yes     No
Ever been declared bankrupt or gone into liquidation? Yes     No
Ever received any threats to life or property Yes     No
Ever had a criminal conviction, or have any charges currently pending? Yes     No


Type the above number:



Declaration...

By submitting this Declaration, the Applicant acknowledges:
  • they are authorised by each of the other Applicants to make this Declaration,
  • the contents of the Declaration are true and complete,
  • they are under a continuing obligation to immediately inform the insurer of any change in the particulars or statements contained in this Declaration or in the accompanying documents up until the contract is entered into,

Name of person making this declaration: