• What you will need to complete the form

  • Please have the following information available before you begin:

    • Current insurer
    • renewal premium
    • renewal date
    • Employer reference number and Wageroll paid out to employees if applicable
    • Information of any lakes, ponds and watercourses
    • Details of any public footpaths on the land
    • rebuild value of any buildings to be insured
    • replacement value of any contents to be insured
    • Value of any livestock to be insured
    • details of any claims made in the last 5 years including date, nature of the claim and payments made

  • Duty of disclosure of Material Facts (Duty of Presentation)

    A material fact is an important fact about you or your circumstances. Fair presentation means that you must have disclosed all material facts, matters and circumstances which you know, which could influence an insurer's or underwriter's decision to accept your insurance. This also applies to facts that you ought to know. You must disclose sufficient information to make the insurers aware that they need to make further enquiries. They can then choose to accept or decline your insurance. If they accept, they may apply certain terms. The duty of fair presentation is a significant obligation placed upon you under the contract of insurance. If you fail to meet this obligation, insurers can take various actions in accordance with the Insurance Act 2015.
  • Date of birth*
     / /
  • Format: 00000 000000.

  • Do you already hold insurance?*
  • Please advise your renewal date*
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  • Is a joint policy required?*
  • Date of birth*
     / /
  • Is there anyone else who needs to be named on the policy?*
  • Date of birth*
     / /
  • Is the risk address the same as the correspondence address?*
  • Do any directors take a wage roll or dividend?*
  • Does any one director have over a 25% stake in the business?*
  • Please provide DOB: *
     - -
  • Do you need to add any other directors?*
  • Please provide DOB: *
     - -
  • Do you need to add any other directors?*
  • Please provide DOB: *
     - -
  • From what date is cover required?*
     / /
  • Do you make an income from your smallholding or hobby farm?*
  • Are there any lakes / ponds / watercourses on the land?*
  • Are there any public footpaths or public rights of way on the land?*
  • What level of public liability cover do you require?*
  • Do you require environmental impairment liability cover?*

  • Property

  • Do you require cover for a domestic property?*
  • Please select the best description of the home*
  • Is the property listed?*
  • Does the property have more than 25% flat roof?*
  • Is accidental damage cover required for the property?*
  • Do you require cover for the contents of the property?*
  • Is accidental damage cover required for contents?*
  • Do you need to add cover for an additional domestic property?*
  • Please select the best description of the home*
  • Is the property listed?*
  • If you have noted any non-standard building materials, does this exceed 25% of the overall construction?*
  • Does the property have more than 25% flat roof?*
  • Is accidental damage cover required for the property?*
  • Do you require cover for the contents of the property?*
  • Is accidental damage cover required for contents?*
  • Do you require cover for any greenhouses?*

  • Outbuildings

  • Do you require cover for any outbuildings?*
  • Are all outbuildings in a good state of repair, in active use, checked regularly and have no planned building works?*
  • Would you like flood cover included for your outbuildings?*
  • Do you require cover for accidental damage to underground pipes?*

  • Outbuilding 1

  • Does the construction of the outbuilding contain composite panels?*
  • Do you need to add another outbuilding?*

  • Outbuilding 2

  • Does the construction of the outbuilding contain composite panels?*
  • Do you need to add another outbuilding?*

  • Outbuilding 3

  • Does the construction of the outbuilding contain composite panels?*
  • Do you need to add another outbuilding?*

  • Outbuilding 4

  • Does the construction of the outbuilding contain composite panels?*
  • Do you need to add another outbuilding?*

  • Outbuilding 5

  • Does the construction of the outbuilding contain composite panels?*
  • Do you need to add another outbuilding?*

  • Outbuilding 6

  • Does the construction of the outbuilding contain composite panels?*

  • Additional cover options

  • Do you require cover a B&B?*
  • Please advise the level of public liability cover you would like for your B&B*
  • Do you have any camping or caravaning pitches?*
  • Would you like any additional facilities you provide covered? e.g. shower/toilet facilities*
  • Do you have any holiday cottages or commercially let caravans?*
  • Do you offer DIY horse livery?*
  • Do you require cover for incidental full livery? (i.e. occasionally looking after the DIY livery horses when owners are on holiday)*
  • Do you have any commercial fishing lakes?*
  • Do you require cover for livestock contract rearing?*
  • Do you need cover for livestock?*
  • Rows
  • Would you like to include cover for dog worrying?*
  • Do you require cover for walls, gates, hedges and fences?*
  • Do you require cover for any of the following:*
  • Is your quad bike road registered?*
  • Is your tractor road registered?*
  • Would you like your quote to include cover for any of the following:*

  • Employees

  • Do you have any employees or voluntary helpers? Please note that you are legally required to arrange Employers' Liability for paid employees and for paid self-employed persons working under your direction.*

  • Further information

  • Have there been any claims made in the last 5 years?*
  • How would you prefer to be contacted by Cliverton?*
  • Would you like to receive news and updates from Cliverton?*

  • Data Protection Act

    By accepting your insurance policy, you consent to us using the information we hold about you for the purposes of providing insurance and handling claims. This may involve processing sensitive personal data about you where it is necessary (for example health information or criminal convictions). This may mean we have to give some details to third parties involved in providing insurance cover. These may include insurance carriers, third party claims adjusters, fraud detection and prevention services, reinsurance companies and insurance regulatory authorities. Where such personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates. This consent must cover both the disclosure of such information to us and its use by us as set out above. The information provided will be treated in accordance with the UK Data Protection Act 2018. You have the right to apply for a copy of your information (for which we may charge a small fee) and to have any inaccuracies corrected.

  • Declaration

    By signing this document you are confirming that all the information provided is correct and true. If any of the information within the documents provided is incorrect, you must advise us as soon as possible. We reserve the right to change the terms and conditions, premium, or withdraw this quotation if any information changes or is found to be incorrect.
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