Who This Enquiry Is ForFor us to provide the best response to your inquiry please complete the following*This inquiry is for an existing business with current insuranceThis inquiry is for an existing business without insuranceThis inquiry is for a new businessRURAL QUESTIONNAIREContact Name*Email*PhoneCurrent 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 TurnoverTotal hectares / acresAnnual turnover: past 12 monthsFarm Situation (s)Localities List:Farm NameNumber/LotStreet/Road NameStatePostcodeSize (hectares) CLAIMS & HISTORY (Last 5 Years)Claims List:Date of claimType of loss or Damage (Eg. Fire, Water Damage etc)Amount ($) LOCATIONLocations List:Farm Building Description (Eg machine shed, hay shed, etc)Construction/DetailsYear BuiltSum Insured ($) Fencing Sum Insured ($)Hay or Grain Sum Insured ($)Cattle Sum Insured ($)Sheep Sum Insured ($)FARM CONTENTSMiscellaneous Farm Tools & Equipment Sum Insured($)Specified Items:Item NameSum Insured ($) FARM THEFTTheft of Farm Contents ($)FARM MACHINERY & ELECTRONIC EQUIPMENT BREAKDOWN Blanket Cover (Ex motors >15kw/20hp)Not Required$10K$20K$30K$40K$50KDeterioration of Stock - Sum Insured ($)Specified Machinery List:DescriptionSize (Kw/Hp)Sum Insured FARM LIABILITYLimit of Indemnity$5 Million$10 Million$20 MillionAny formal contracts in place?YesNoOvernight Accommodation/B&B?YesNoAnnual Turnover ($)Contract Harvesting?YesNoAnnual Income ($)Attend Farmers Market?YesNoHow often do you attend?WeeklyFortnightlyMonthlyAgistment?YesNoAnnual Income ($)Other activities list:DescriptionAnnual Turnover ($) Landing Strips?YesNoHow many landing strips?Are they used by Third Parties?YesNoAre they maintained in accordance with Civil Aviation guidelines CAAP 92-1(1)?YesNoWages/Labour Hire & Contractors/Sub-Contractor Payments WagesPrevious 12 Months ($)Next 12 Months ($)Number of employeesPrevious 12 MonthsNext 12 MonthsLABOUR HIRELabour Hire List:Nature of WorkPrevious 12 Months ($ )Next 12 Months ($) CONTRACTORS / SUBCONTRACTORSContractors / Subcontractors List:Nature of WorkPrevious 12 Months ($ )Next 12 Months ($) MISCELLANEOUS FARM LIABILITYDo you conduct Aerial Spraying?YesNoDo you allow third parties to access any dams on your properties?YesNoDo you grow any GMO crops?YesNoType of cropsDo you export/import directly any goods?YesNoProvide value & details of exports/imports & to and from which countries (including Annual Turnover)?FARM INTERRUPTIONLoss of Farm Income (Revenue) ($)Increased Costs of Working (including Agistment) ($)Indemnity PeriodFARM TRANSITCover: Fire, Flood, Collision or overturning of the conveying vehicle$5,000$10,000$20,000$50,000FARM VEHICLESSedans / Wagons / Utes < 2.5t List:MakeModelYearDescriptionSum Insured $RegoNCB Agricultural Equipment & Mobile Plant Vehicle List:YearTypeDescriptionSum Insured $Rego Trucks / Utes >2.5t Vehicle List:YearTypeMakeModelDescriptionSum Insured $RegoNCB FARMHOUSE BUILDING/CONTENTSAddressCity / TownStatePostcodeYear BuiltConstructionRe-wired in last 25 yearsYesNoType of Occupancy (homestead, holiday home, etc)Unoccupied for how many days/months?Heritage ListedYesNoBuilding ($)Contents ($)Specified contents list:Description($) VALUABLES & PERSONAL EFFECTSValuables and personal effects list:Description($) CAPTCHANameThis field is for validation purposes and should be left unchanged.