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1300 446 787

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Rural Questionnaire

Rural Questionnairebarksupport2018-07-24T03:50:16+11:00
  • Who This Enquiry Is For

  • RURAL QUESTIONNAIRE

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Farm Size and Turnover
  • Farm Situation (s)
  • Farm NameNumber/LotStreet/Road NameStatePostcodeSize (hectares) 
  • CLAIMS & HISTORY (Last 5 Years)
  • Date of claimType of loss or Damage (Eg. Fire, Water Damage etc)Amount ($) 
  • LOCATION

  • Farm Building Description (Eg machine shed, hay shed, etc)Construction/DetailsYear BuiltSum Insured ($) 
  • FARM CONTENTS
  • Item NameSum Insured ($) 
  • FARM THEFT
  • FARM MACHINERY & ELECTRONIC EQUIPMENT BREAKDOWN
  • DescriptionSize (Kw/Hp)Sum Insured 
  • FARM LIABILITY

  • DescriptionAnnual Turnover ($) 
  • Wages/Labour Hire & Contractors/Sub-Contractor Payments
  • Wages
  • Number of employees
  • LABOUR HIRE
  • Nature of WorkPrevious 12 Months ($ )Next 12 Months ($) 
  • CONTRACTORS / SUBCONTRACTORS
  • Nature of WorkPrevious 12 Months ($ )Next 12 Months ($) 
  • MISCELLANEOUS FARM LIABILITY
  • FARM INTERRUPTION

  • FARM TRANSIT

  • FARM VEHICLES

  • MakeModelYearDescriptionSum Insured $RegoNCB 
  • YearTypeDescriptionSum Insured $Rego 
  • YearTypeMakeModelDescriptionSum Insured $RegoNCB 
  • FARMHOUSE BUILDING/CONTENTS

  • Description($) 
  • VALUABLES & PERSONAL EFFECTS

  • Description($) 
  • This field is for validation purposes and should be left unchanged.
Save and Continue Later

About Us

Insurance Advisors commencing operations in 1980 and providing financial security and protection for over 6,000 clients.

Consolidated Insurance Agencies Pty Ltd
AFSL 245584
ABN 50 006 524 081

Contact info

insure@ciainsurance.com.au
332 South Rd, Hampton East. 3188
Mon – Fri, 9am – 5 pm

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