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Please complete the following form to receive your personal quotation using the TAB key to move between questions, this should only take a couple of minutes. For assistance please use the 'help' and 'about' buttons above.

Farmers Combined Insurance - Quotation Request
Proposer's name
E-mail address
Telephone No
Farm address
Postcode
Type of farm	Mixed	Arable
(please check all that apply)	Milk/dairy	Beef
	Poultry/eggs	Fruit
	Sheep	Other
if other, please specify
Other business activities (if none, please state 'none')
FARM PROPERTY DAMAGE (if this cover is not required please click here) If you do require this cover please insert the required sum insured next to the description.
Description		Sum Insured (�)
1) Agricultural Produce including growing crops and farming stock but excluding livestock and property referred to in the following items (questions 2 to 14)
2) Permanently fixed machinery and plant and accessories attached thereto.
3) Machinery, plant and implements, including power driven vehicles and implements and their accessories excluding property more specifically insured,
4) Fixed milk plant.
5) Appliances for the hatching and rearing of poultry by artificial heat.
6) Tenants improvements, alterations and decorations belonging to you or for which you are responsible
7) Boundary walls, fences, hedges ane gates.
8) Silage
9) Hay and/or Straw
10) Roots and Potatoes stored in a building
11) Roots and Potatoes stored in the open
12) Grain in detached building used solely for drying, dressing and/or storage of grain
13) Grain in detached building
14) Growing timber
Other property not specified above
The policy will cover loss, destruction of or damage to your farm property. The list below represents the standard contingencies included. If you do not require any of this please indicate by checking the corresponding box. Please remember to check those that are NOT required
Fire
Explosion
Aircraft
Riot (including malicious damage)
Earthquake
Subterranean fire
Spontaneous combustion
Impact by any road vehicle or animal other than by those you own or control
Escape of oil
Falling trees
Do you require cover for impact caused by your own vehicles or animals?	Yes	No
Do you require cover for theft?	Yes	No
Have you suffered any loss or damage by any cause (whether insured or not) to any of the above property during the last 5 years?	Yes	No
if 'yes' please give details including the date, nature of loss and amount of loss
About your farm buildings
Is buildings cover required?	Yes	No
if yes, please provide details of your buildings and their construction together with the required sum insured below. If this cover is not required please click here.
Building description and construction		Sum insured (�)










if you require more space please detail the information here
The policy will cover loss, destruction of or damage to your farm property. The list below represents the standard contingencies included. If you do not require any of this please indicate by checking the corresponding box. Please remember to check those that are NOT required
Fire
Explosion
Aircraft
Riot (including malicious damage)
Earthquake
Subterranean fire
Spontaneous combustion
Escape of oil
Falling trees
Impact by any road vehicle other than by those you own or control
Do you require cover for impact caused by your own vehicles or animals?	Yes	No
Do you require cover for storm or tempest?	Yes	No
Do you require cover for escape of water?	Yes	No
Have you suffered any loss or damage by any cause (whether insured or not) to any of the above property during the last 5 years?	Yes	No
if 'yes' please give details including the date, nature of loss and amount of loss
Livestock
Is this cover required?	Yes	No
If 'yes' please complete the following section. If 'no' please click here
Type	Sum Insured (�)	Maximum value of any one load (�)	Maximum number any one load
Cattle
Sheep
Pigs
Poultry
Horses
Goats
Please specify any other below (eg working dogs)


Do the above Sums Insured include the value of livestock for sale?	Yes	No
If you wish to restrict the standard contingencies please check the boxes next to those NOT required:-
Fire, lightning and explosion
Aircraft
Riot (including malicious damage)
Falling trees
Impact by any road vehicle or animal other than by those you own or control
Earthquake
Do you require cover for impact caused by your own vehicles or animals	Yes	No
Do you require cover for electrocution	Yes	No
Do you require cover for:-
Sheep worrying by dogs	Yes	No
Sheep worrying by dogs and foxes	Yes	No
Theft	Yes	No
Fatal injury to livestock	Yes	No
Transit	Yes	No
Have you suffered any loss of Livestock (whether insured or not) in the last 5 years?	Yes	No
if 'yes'please provide details below included dates, nature of losses and the amounts of any losses

Farm Liabilities
Part One - Employers Liability, Is this cover required?		Yes	No
if 'no' please click here , if 'yes' please complete the following section Estimated annual wages and other earnings for the next 12 months
Employees:-
Type of work	Estimate (�)	No of persons
Clerical
Farm labouring
Any other (please specify below)

Proprietors/Partners
Type of work (specify)	Estimate (�)	No of persons



What was the total actual wages paid to employees in the last financial year?
Do you wish to cover your responsibilities under Agricultural Wages Board Orders	Yes	No
How many certificates of insurance do you require? (please insert number)
Part Two - Public and Products Liability, is this cover required?		Yes	No
if 'no' please click here , if 'yes' please complete the following section
Limit of indemnity required
if over �1,000,000 please state limit required
Estimated annual wages, salaries and other earnings (�)
Estimated turnover for the coming year
Estimated payments to independent contractors
Total area farmed	hectares
Do you at any time burn straw or stubble	Yes	No
if 'yes' do you comply with the Local Authority regulations which apply	Yes	No
If you employ independent contractors, do you check that they have Liability Insurance with an Indemnity Limit at least as high as the one you have selected?	Yes	No
Do you export any products to overseas customers?	Yes	No
if 'yes' name any countries and give details of products and turnover below
Countries	Products	Turnover (�)



Do you engage in any of the following activities? Please check either yes or no, if you answer 'yes' please state the estimated annual turnover from such activity
Activity	Yes/No		Turnover (�)
Retail sales e.g. vegetables, milk, bread, honey, jams/preserves sold from farm shop	Yes	No
Provision of accommodation for paying guests	Yes	No
Letting of any land for caravan or tenting accommodation	Yes	No
Crop spraying for other farms	Yes	No
Any other 'non-farming' activity not specified above e.g. food processing (please give details below)	Yes	No

Frozen Food
Is this cover required?	Yes	No
if 'no' please click here, if 'yes' please complete the following section
Description of freezer unit(s)	Year of Manufacture	Sum Insured on Contents (�)




Are these units free from defect?	Yes	No
Are the unit motors and compressors hermetically sealed?	Yes	No
if 'no' are the units under a service contract?	Yes	No
At what intervals are the units examined
Have you suffered loss by any cause to any property as described at the premises or elsewhere during the last five years?		Yes	No
if 'yes' please give details below including dates, nature of losses and amounts of losses

About the Farm Home
Is the farm home address the same as that previously entered?	Yes	No
if 'no' please enter the address here
Postcode
Is the building and it's roof of standard construction?	Yes	No
if 'no' please give details
Is the farm home?
if 'other' please give details
and is it......
if 'other' please give details
Approximately when was the home built?
No of bedrooms
Has the home ever been damaged by flood, heave or landslip or is it in an area susceptible to such risks?	Yes	No
Farm Home - Buildings Insurance
Is this cover required?	Yes	No
if 'no' please click here, if 'yes' please complete the following section
Please enter Sum Insured
Level of cover
Policy excess
if 'other amount' please specify
Farm Buildings - Contents Insurance
Is this cover required?	Yes	No
if 'no' please click here , if 'yes' please complete the following section
Level of cover
Please insert Sum Insured
Please state the value of all 'high risk' items to be insured
Does the property have an intruder alarm?	Yes	No
if 'yes' please provide details of the alarm and installing company below

Do you wish to extend the cover to include:
Family Legal Protection?	Yes	No
Caravan(s)/Mobile Home(s)?	Yes	No
if you have answered 'yes' to caravan(s)/mobile home(s) please provide information on these below
Make and Model	Type	Year of Make	Estimated Value (�)



Do you wish to include cover for domestic animals?	Yes	No
if 'yes' please provide details below, if 'no' please click here
Type and Breed	Date of Birth	Replacement Cost



Your Insurance History (Farm Home)
Have you made a claim in the last 5 years or had a claim made against you?	Yes	No
if 'yes' please give details here including dates, whether related to buildings or contents and the amount of the claim

If you currently hold home insurance are you entitled to a no claims discount?	Yes	No
if 'yes' how many claim free years does this represent?	years
Farm Motor
You will soon be able to obtain a quote for your farm vehicles on this request form as well. At the present time however, please answer the final three questions here then click 'send', you will then be offered a link to take you to our separate request form for agricultural vehicles.
Insurance required from
Renewal date of present insurance (if applicable)
Preferred Payment Method

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