Date of Birth

    Risk Address (Farm address)

    Type of Farm

    Size of Farm

    Claims experience (date of claim(s), type of claim(s), is the claim settled? How much?):

    Stock cover if required

    Outbuildings (if any) rebuild cost:

    Farm machinery (year, make, model & value)?

    Employees? If so, How many, Full or part-time, Wages per annum & turnover)

    If a farmhouse exists, please answer the following;

    Building sums insured?

    Contents sums insured?

    How many bedrooms?

    Year of construction?

    Primary heating source?

    Alarm on property (is this monitored) ?