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Axiom Insurance - Business solutions Chinchilla, Toowoomba, Bell

Your Insurance Broker for Chinchilla, Toowoomba and Bell in Queensland. Delivering a range of Insurance products for Business, Commercial and Domestic.

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Rural Questionnaire

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This field is for validation purposes and should be left unchanged.
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*
MM slash DD slash YYYY
Expiry Date*
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 ($)
VALUABLES & PERSONAL EFFECTS
Valuables and personal effects list:
Description ($)
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FARM INSURANCE
CROP INSURANCE
COMMERCIAL BUSINESS INSURANCE
PROFESSIONAL INDEMNITY
BODY CORPORATE INSURANCE
MANAGEMENT AND CYBER LIABILITY
FINANCIAL SERVICES GUIDE
CODE OF PRACTICE

Chinchilla
113 Heeney Street, Chinchilla QLD 4413
PO Box 894
Tel: 07 4668 9196
Email: admin@axiominsurance.com.au

Toowoomba
106 Campbell Street,
Toowoomba QLD 4350
PO Box 962
Tel: 07 4638 8600
Email: admin@axiominsurance.com.au

Bell
32 Dennis Street, Bell QLD 4408
Tel: 07 4663 1000
Email: admin@axiominsurance.com.au

Goondiwindi
34 Marshall Street, Goondiwindi QLD 4390
PO Box 7
Tel: 07 4671 4296
Email: admin@axiominsurance.com.au

Axiom Insurance Broker Pty Ltd (AFSL 478428) ABN 37606463585

General advice on this website has been prepared without taking into account your objectives, financial situation or needs. Before acting on the advice, consider its appropriateness. Consider our disclosure documents, which include our FSG and Product Disclosure Statements (PDS) for some products.

Farm Name	Number/Lot	Street/Road Name	State	Postcode	Size (hectares)

Date of claim	Type of loss or Damage (Eg. Fire, Water Damage etc)	Amount ($)

Farm Building Description (Eg machine shed, hay shed, etc)	Construction/Details	Year Built	Sum Insured ($)

Item Name	Sum Insured ($)

Who This Enquiry Is For

RURAL QUESTIONNAIRE

Farm Size and Turnover

Farm Situation (s)

CLAIMS & HISTORY (Last 5 Years)

LOCATION

FARM CONTENTS

FARM THEFT

FARM MACHINERY & ELECTRONIC EQUIPMENT BREAKDOWN

FARM LIABILITY

Wages/Labour Hire & Contractors/Sub-Contractor Payments

LABOUR HIRE

CONTRACTORS / SUBCONTRACTORS

MISCELLANEOUS FARM LIABILITY

FARM INTERRUPTION

FARM TRANSIT

FARM VEHICLES

FARMHOUSE BUILDING/CONTENTS

VALUABLES & PERSONAL EFFECTS