Please Enter All Required Fields Marked* Broker*
Current Insurer*
Your Telephone*
Your Email*
Target (£)*
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Client Details Client's Full Name*
Trading Name*
Correspondence Address*
Postcode*
Telephone*
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Cover Details Start Date For Cover*
Deadline Date For Quote
Risk Address/Additional Premises (If Different From Above)
Postcode
Telephone
Are You The Holding Broker?*Yes No
Full Business Description Including Diversification*
Claims In The Last 5 Years
Any Other Relevant Information
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Farm Building Perils Flea Flea And Storm All Except Storm All
Description Including Construction
Sum Insured
HeatingHeated Unheated
Cover Option
Add Another BuildingYes
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Farm Contents Standard Perils: Fire, Aircraft, Explosion, Lightning, Earthquake, Riot/Malicious Damage, Subterranean Fire, Fire Caused By Its Own Spontaneous Combustion, Electrocution of Livestock, Impact (Including Own Vehicle), Falling Trees.
Machinery, Plant & Implements Sum InsuredTheft Storm Reinstatement
Hay & Straw Sum InsuredTheft Storm Reinstatement
Grain Sum InsuredTheft Storm
Silage & Roots Sum InsuredTheft Storm
All Other Produce Sum InsuredTheft Storm
Deadstock Sum InsuredTheft Storm
Dairy Equipment Sum InsuredTheft Storm Reinstatement
Walls, Gates & Hedges Sum InsuredTheft
All Agricultural Produce Sum InsuredTheft Storm
Grain Drying Plant Sum InsuredTheft Storm Reinstatement
Growing Timber (Flea Only) Sum Insured
Poultry - Heated Sum InsuredTheft Storm
Poultry Unheated Sum InsuredTheft Storm
Poultry Appliances Sum InsuredTheft Storm
Portable Hand Tools Sum InsuredTheft Storm Reinstatement
Livestock Including MYDS?Yes No
Sum InsuredTheft Storm
Other Please SpecifyTheft Storm
Yes No
Cattle Sum InsuredTransit Only Straying & Transit Straying & Transit Including Own Premises
Sheep Sum InsuredTransit Only Straying & Transit Straying & Transit Including Own Premises
Pigs Sum InsuredTransit Only Straying & Transit Straying & Transit Including Own Premises
Horses Sum InsuredTransit Only Straying & Transit Straying & Transit Including Own Premises
Sheepdogs (Over £500) Sum InsuredTransit Only Straying & Transit Straying & Transit Including Own Premises
Livestock Worrying Total Value Of Sheep Owned
Total Value Of Cattle Owned
Total Value Of Poultry Owned
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Business Money Annual Carryings
Cash In Safe Overnight (If Over £1000, Safe Details Will Be Required)
Cash Passports
Personal Accident/AssaultYes No
Goods In Transit Excluding Livestock And Solent In Respect Of Your Own Agricultural Produce Carried By Your Own Vehicle.
Maximum Load Limit (£)
Number Of Vehicles
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Business Interruption (Revenue Including Additional Cost Of Working) Indemnity Limit12 Months 24 Months 36 Months
Pigs Annual RevenueTheft Storm Fatal Injury Fatal Injury Including Mysterious Disappearance
Poultry Annual RevenueTheft Storm Fatal Injury Fatal Injury Including Mysterious Disappearance
Other Livestock Annual RevenueTheft Storm Fatal Injury Fatal Injury Including Mysterious Disappearance
Arable/Cereal Annual RevenueTheft Storm Fatal Injury Fatal Injury Including Mysterious Disappearance
Other Please Specify
Annual RevenueTheft Storm Fatal Injury Fatal Injury Including Mysterious Disappearance
Business Interruption (Additional Cost Of Working Only) 12 Month Indemnity Limit
Additional Cost Of Working (£)
Rent Receivable (£)
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Employers Liability £10 Million Limit Of Indemnity
Farm/Estate/Casual Worker Annual Wage Roll
Clerical/Domestic Annual Wage Roll
Agricultural Contracting Annual Wage Roll
Grooms/Market Gardeners/Nurserymen Annual Wage Roll
Other Annual Wage Roll
Is Agricultural Wages Board Cover Required?Yes No
Public Liability Acreage
Total Annual Farm Turnover (£)
Limit Of Indemnity Required£1 Million £2 Million £5 Million
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Agricultural Contracting Turnover
£1 Million Limit Of Indemnity
£2 Million Limit Of Indemnity
£5 Million Limit Of Indemnity
Rent Receivable Turnover
£1 Million Limit Of Indemnity
£2 Million Limit Of Indemnity
£5 Million Limit Of Indemnity
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Step 10Livery DIY/Full Number Of Horses Turnover
£1 Million Limit Of Indemnity
£2 Million Limit Of Indemnity
£5 Million Limit Of Indemnity
Other Please Specify
Turnover
£1 Million Limit Of Indemnity
£2 Million Limit Of Indemnity
£5 Million Limit Of Indemnity
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Personal Accident Person 1 Named Of Insured
Date Of Birth
Occupation
Height
Weight
Death Cover (£10,000 Per Unit)
Permanent Disability Cover (£10,000 Per Unit)
Loss Of Digits Cover (Max 1 Unit)
Sickness (£50 Per Week Per Unit)
Accident Only (£50 Per Week Per Unit)
Person 2 Named Of Insured
Date Of Birth
Occupation
Height
Weight
Death Cover (£10,000 Per Unit)
Permanent Disability Cover (£10,000 Per Unit)
Loss Of Digits Cover (Max 1 Unit)
Sickness (£50 Per Week Per Unit)
Accident Only (£50 Per Week Per Unit)
Person 3 Named Of Insured
Date Of Birth
Occupation
Height
Weight
Death Cover (£10,000 Per Unit)
Permanent Disability Cover (£10,000 Per Unit)
Loss Of Digits Cover (Max 1 Unit)
Sickness (£50 Per Week Per Unit)
Accident Only (£50 Per Week Per Unit)
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Step 12Uncollected Milk Cover Required
Maximum Number Of Animals At Milk At Any One Time
Number Of Days Compensation Required7 Days 15 Days 30 Days
Amount Of Compensation Per Cow Per Day Required£5 £7.50
Do You Require Cover For Contamination Of Own Milk?Yes No
Frozen Bovine Semen/Liquid Flasks/Nitrogen Total Value Of All Flasks, Nitrogen & Semen (Limit Any One Straw £100)
Accidental Damage To Oil, Fertiliser Tanks & Contents Total Value Of Fertiliser & Fuel
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Office Contents (All Risks Cover) General Office Contents Value
Other - Please Specify
Other Value
Private House Buildings Property 1 Address
Sum Insured
OccupancyInsured Occupied Family Occupied Long-Term Let Holiday Let Unoccupied
CoverStandard Accidental Damage
Property 2 Address
Sum Insured
OccupancyInsured Occupied Family Occupied Long-Term Let Holiday Let Unoccupied
CoverStandard Accidental Damage
Property 3 Address
Sum Insured
OccupancyInsured Occupied Family Occupied Long-Term Let Holiday Let Unoccupied
CoverStandard Accidental Damage
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Private House Contents Property 1 Sum Insured
CoverStandard Accidental Damage
Property 2 Sum Insured
CoverStandard Accidental Damage
Property 3 Sum Insured
CoverStandard Accidental Damage
Valuables & Personal Effects Property 1 Unspecified Items Sum Insured
Specified Items (List Items Over £1,000)
Riding Tack Sum Insured (Personal Use Only)
Property 2 Unspecified Items Sum Insured
Specified Items (List Items Over £1,000)
Riding Tack Sum Insured (Personal Use Only)
Property 3 Unspecified Items Sum Insured
Specified Items (List Items Over £1,000)
Riding Tack Sum Insured (Personal Use Only)
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Personal Money & Credit Cards Property 1
Property 2
Property 3
Personal Freezer Contents Property 1
Property 2
Property 3
Pedal Cycles Total Sum Insured (Max £750 Per Cycle)
Trailer Caravan Make
Model
Age (Must Be Less Than 15 Years)
Sum Insured
Yes No
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