Farm combined insurance quote

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Broker *
Current insurer *
Your telephone *
Your email *
Target (£) *
Client's full name *
Trading name 
Correspondence address *
Postcode *
Telephone *
Start date for cover *
Deadline date for quote 
Risk address/ additional premises (if different from above) 
Postcode 
Telephone 
Are you the holding broker? *        
Full business description including diversification *
Claims in last 5 years 
Any other relevant information 
Perils                 
Description including construction Sum insured Heating Cover option
Heated Unheated
Heated Unheated
Heated Unheated
Heated Unheated
Heated Unheated
Heated Unheated
Standard perils: Fire, Aircraft, Explosion, Lightning, Earthquake, Riot/Malicious Damage, Subterranean Fire, Fire caused by its own spontaneous combustion, Electrocution of Livestock, Impact (inc own vehicle), Falling Trees.
Item Sum insured Theft Storm Reinstatment
Machinery, Plant and Implements
Hay and Straw  
Grain  
Silage and Roots  
All other produce  
Deadstock  
Dairy equipment
Walls, gates and hedges    
All agricultural produce  
Grain drying plant
Growing timber (FLEA ONLY)      
Poultry - Heated  
Poultry - Unheated  
Poultry appliances - Heated  
Other (please specify)  
Portable hand tools
Livestock - including MYDS? Yes No  
Is Livestock grazed on moorland, unfenced or common land?         
If yes, give details 
By violent, external, accidental and visible means.
Item Sum insured Transit only Straying & transit Straying & transit
including own premises
Cattle
Sheep
Pigs
Horses
Sheepdogs (over £500)
Sheep - Total value of sheep owned 
Cattle - Total value of cattle owned 
Poultry - Total value of poultry 
Annual carryings 
Cash in safe overnight (if over £1,000 safe details will be required) 
Cash passports 
Personal accident / assault         
Excluding livestock, and solely in respect of your own agricultural produce carried by your own vehicle.
Maximum load limit (£) 
Number of vehicles 
Indemnity limit             
Standard perils: Fire, Aircraft, Explosion, Lightning, Earthquake, Riot/Malicious Damage, Subterranean Fire, Fire caused by its own spontaneous combustion, Electrocution of Livestock, Impact (inc own vehicle but excluding growing crops and livestock).
Item Annual revenue (£) Theft Storm Fatal injury Fatal injury
including mysterious
disappearance
Pigs
Poultry
Other livestock
Arable / cereal
Dairy
Other (please specify)
12 Month Indemnity Limit.
Additional cost of working (£) 
Rent receivable (£) 
£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 occupation 
Other annual wage roll 
Is agricultural wages board cover required?         
Acreage 
Total annual farm turnover (£) 
Limit of indemnity required             
Diversification Turnover £1 million
Limit of Indemnity		 £2 million
Limit of Indemnity		 £5 million
Limit of Indemnity
Agricultural Contracting
Rent Receivable
Livery DIY/Full No of horses
Other (please specify)
Other (please specify)
Excludes pre-existing conditions.
  Person 1 Person 2 Person 3
Name of insured
Date of birth
Occupation
Height
Weight
  Number of units Number of units Number of units
Death cover
(£10,000 per unit)
Permanent disability cover
(£10,000 per unit)
Loss of digits cover
(max 1 unit)
sickness and sickness
(£50 per week per unit)
Accident only
(£50 per week per unit)
Cover required 
Maximum number of animals at milk at any one time 
Number of days compensation required             
Amount of compensation per cow per day required         
Do you require cover for contamination of own milk?         
Total value of all flask, nitrogen and semen
(Limit any one straw £100) 
Total value of fertiliser and fuel 
General office contents 
Other (please specify) 
Other value 
Address Sum insured Occupancy Cover



Standard Accidental damage



Standard Accidental damage



Standard Accidental damage
Location Sum insured Cover
Property 1 Standard Super (including Accidental Damage)
Property 2 Standard Super (including Accidental Damage)
Property 3 Standard Super (including Accidental Damage)
Cover Property 1 Property 2 Property 3
Unspecified items sum insured
Specified items (list items over £1,000)





























Riding tack sum insured
(personal use only)
Property 1 
Property 2 
Property 3 
Property 1 
Property 2 
Property 3 
Total sum insured
(max £750 per cycle) 
Make 
Model 
Age (must be less than 15 years) 
Sum insured 
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