Farm Insurance Please complete the following enquiry form for a Farm Insurance Quotation. Cover Details Please enable JavaScript in your browser to complete this form.NameEircode of your dwelling/farm *D.O.B *Type of Farming *Current Insurer *Renewal date *Is there a written safety statement, in accordance with the Safety, Health and Welfare at Work Act, 2005? *-YesNoClaims in the last 5 years *-YesNoIf yes, provide details:Convictions of any nature at any point in time (other than spent convictions) *-YesNoIf yes, provide details:Section 1 - Farmhouse & ContentsEircode of your buildingAmount of buildings cover requiredAmount of home contents cover requiredAmount of cover for personal effects & Jewellery by accidental meansIs the premises occupied by you and members of your household as your main house?-YesNoAre the premises occupied solely for private residential purposes?-YesNoIs the premises of standard construction, i.e. built of brick, stone, concrete & roofed 100% with slate or tile-YesNoIf no, please give detailsOther DetailsD.O.BOccupationAre at least two smoke detectors fitted in the property?-YesNoIs the property in a Neighbourhood watch or Community Alert area?-YesNoMonitored burglar alarm (to IS199) fitted to the property?-YesNoYear of constructionNumber of bedroomsNumber of bathroomsHow is your dwelling heated?Have you lived at the property for 5 years or more?-YesNoWho are your private car insurers?Please give details of any claims you have made in the last 5 years on this or any other propertyContact DetailsName *Telephone *Email *Other Contact DetailsSection 2 - General Farm PropertyAgricultural Produce (including feeding stuff)Growing cropsFarm Implements & machineryBulk Milk Tanks/Milking EquipmentTool(s) TheftDiesel TheftOther - please specifyOutbuildings (excluding slatted units)Slatted unitsStorm Cover: if this cover is required we may require photographs and further details-YesNoSection 3 - LivestockNumber of animalsTotal value of livestockSection 4 - LiabilityTotal acreage including rented landAny Sand pits or Quarries: *-YesNoHorses & Ponies012345Family: Number (part time)Family: Number (full time)Family: Annual WagesNon Family: Number (part time)Non Family: Number (full time)Non Family: Annual WagesSection 5 - Agricultural & Forestry VehiclesVehicle 1Make/ModelYearValueCover requiredVehicle 2Make/ModelYearValueCover requiredVehicle 3Make/ModelYearValueCover requiredEmailSubmit
