Name

Email

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) ?