Farm Insurance Quote


Please Fill in the following:


Full Name

Postal Address

Telephone No

E-mail Address

Date of Birth

Type of Farming
BeefDairyTillageMarket Gardening

 

Other:


 
Total Land Area

Address of each land and number of acres/hectares


Land Address 1

Land Address 2

Land Address 3

Land Address 4

Land Address 5

Select Current Insurer

AvivaFBDZurichNo previous insurer

 

Other:


Renewal Date

Any Convictions or Pending Prossecution
NOYES*

* If YES please specify:


Are you memeber of ICA
NOYES

 
Are you memeber of ICBF
NOYES

 
Are you memeber of IFA
NOYES

 
Do you require GENERAL FARM STOCK (Excluding Livestock)
NOYES*

* If YES, Please specify type of stock and sum insured (value required) :


 
Do you require cover for OUTBULIDINGS
NOYES*

* If YES, please specify:

Construction Type- constructed of brick, stone, concrete, slates, tiles, metal or slabs composed entirely of mineral ingredients- If other please state:

 
Do you require storm damage for farm buildings
NOYES

 

Do you require cover for a FARMHOUSE

NOYES*

* If YES, please choose:

 
Number of Bedrooms

 
Number of Stories

 
Year Built

 
Is dwelling built of brick, stone or concrete and roofed with slates, tiles or concrete?
NOYES

 
Any part of roofed with mineral felt on timber
NOYES*

If YES, please state percentage of entire roof area


 
Is this your permanent residence and occupied by you and your family only?
NOYES

 
Building Sum Insured

 
Contents

 

Do you require Livestock cover?

NOYES*

If YES, please specify:

 
DAIRY
Number of animals
Maximum value any one animal
 
SHEEP
Number of animals
Maximum value any one animal
 
PIGS
Number of animals
Maximum value any one animal
 
HORSES
Number of animals
Maximum value any one animal
 
BEEF
Number of animals
Maximum value any one animal
 
POLURTY
Number of animals
Maximum value any one animal
   
Do you require Bulk Milk Storage?
NOYES

 
Do you require business interruption?
NOYES*

If YES, what is Business interruption


 
Employers Liability - Do you have employee’s/ household members/ volunteers working with you?
NOYES*

*If YES, please specify

FULL TIME EMPLOYEES
Number of full time employees
Annual Wage Roll
 
FAMILY & HOUSEHOLD MEMBERS- FULL TIME
Number Family & Household Members – Full Time
Annual Wage Roll
 
VOLUNTARY HELPERS
Number of Voluntary Helpers
 
PART TIME EMPLOYEES
Number of part time employees
Annual Wage Roll
 
FAMILY & HOUSEHOLD MEMBERS- PART TIME
Number Family & Household Members – Part Time
Annual Wage Roll
 

Do you require cover for Agricultural/ Special Type vehicles?

NOYES*

*If YES, please specify

Vehicle 1
Vehicle Type
Year
Value
Cover Required: TPO/TPFT/COMP

 
Vehicle 2
Vehicle Type
Year
Value
Cover Required: TPO/TPFT/COMP

 
Vehicle 3
Vehicle Type
Year
Value
Cover Required: TPO/TPFT/COMP

 
Vehicle 4
Vehicle Type
Year
Value
Cover Required: TPO/TPFT/COMP

 
Do you require personal accident?
NOYES

To allow us to stop spaming of online forms we require you to enter the following text into the verification field below.