Rural Questionnaire

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Rural Questionnaire

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*
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 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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Comments
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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