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Rural Questionnaire
Rural Questionnaire
barksupport
2018-07-24T03:50:16+11:00
Who This Enquiry Is For
For us to provide the best response to your inquiry please complete the following
*
This inquiry is for an existing business with current insurance
This inquiry is for an existing business without insurance
This inquiry is for a new business
RURAL QUESTIONNAIRE
Contact Name
*
Email
Phone
Current Insurer
*
Insured Name (Include all Entities and their Interest)
*
Inception Date
*
Date Format: MM slash DD slash YYYY
Expiry Date
*
Date Format: MM slash DD slash YYYY
Full Business Description (including all activities)
*
Farm Size and Turnover
Total hectares / acres
Annual turnover: past 12 months
Farm Situation (s)
Localities List:
Farm Name
Number/Lot
Street/Road Name
State
Postcode
Size (hectares)
CLAIMS & HISTORY (Last 5 Years)
Claims List:
Date of claim
Type of loss or Damage (Eg. Fire, Water Damage etc)
Amount ($)
LOCATION
Locations List:
Farm Building Description (Eg machine shed, hay shed, etc)
Construction/Details
Year Built
Sum Insured ($)
Fencing Sum Insured ($)
Hay or Grain Sum Insured ($)
Cattle Sum Insured ($)
Sheep Sum Insured ($)
FARM CONTENTS
Miscellaneous Farm Tools & Equipment Sum Insured($)
Specified Items:
Item Name
Sum Insured ($)
FARM THEFT
Theft of Farm Contents ($)
FARM MACHINERY & ELECTRONIC EQUIPMENT BREAKDOWN
Blanket Cover (Ex motors >15kw/20hp)
Not Required
$10K
$20K
$30K
$40K
$50K
Deterioration of Stock - Sum Insured ($)
Specified Machinery List:
Description
Size (Kw/Hp)
Sum Insured
FARM LIABILITY
Limit of Indemnity
$5 Million
$10 Million
$20 Million
Any formal contracts in place?
Yes
No
Overnight Accommodation/B&B?
Yes
No
Annual Turnover ($)
Contract Harvesting?
Yes
No
Annual Income ($)
Attend Farmers Market?
Yes
No
How often do you attend?
Weekly
Fortnightly
Monthly
Agistment?
Yes
No
Annual Income ($)
Other activities list:
Description
Annual Turnover ($)
Landing Strips?
Yes
No
How many landing strips?
Are they used by Third Parties?
Yes
No
Are they maintained in accordance with Civil Aviation guidelines CAAP 92-1(1)?
Yes
No
Wages/Labour Hire & Contractors/Sub-Contractor Payments
Wages
Previous 12 Months ($)
Next 12 Months ($)
Number of employees
Previous 12 Months
Next 12 Months
LABOUR HIRE
Labour Hire List:
Nature of Work
Previous 12 Months ($ )
Next 12 Months ($)
CONTRACTORS / SUBCONTRACTORS
Contractors / Subcontractors List:
Nature of Work
Previous 12 Months ($ )
Next 12 Months ($)
MISCELLANEOUS FARM LIABILITY
Do you conduct Aerial Spraying?
Yes
No
Do you allow third parties to access any dams on your properties?
Yes
No
Do you grow any GMO crops?
Yes
No
Type of crops
Do you export/import directly any goods?
Yes
No
Provide value & details of exports/imports & to and from which countries (including Annual Turnover)?
FARM INTERRUPTION
Loss of Farm Income (Revenue) ($)
Increased Costs of Working (including Agistment) ($)
Indemnity Period
FARM TRANSIT
Cover: Fire, Flood, Collision or overturning of the conveying vehicle
$5,000
$10,000
$20,000
$50,000
FARM VEHICLES
Sedans / Wagons / Utes < 2.5t List:
Make
Model
Year
Description
Sum Insured $
Rego
NCB
Agricultural Equipment & Mobile Plant Vehicle List:
Year
Type
Description
Sum Insured $
Rego
Trucks / Utes >2.5t Vehicle List:
Year
Type
Make
Model
Description
Sum Insured $
Rego
NCB
FARMHOUSE BUILDING/CONTENTS
Address
City / Town
State
Postcode
Year Built
Construction
Re-wired in last 25 years
Yes
No
Type of Occupancy (homestead, holiday home, etc)
Unoccupied for how many days/months?
Heritage Listed
Yes
No
Building ($)
Contents ($)
Specified contents list:
Description
($)
VALUABLES & PERSONAL EFFECTS
Valuables and personal effects list:
Description
($)
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.
