Smallholding

Title*
Name*

First nameLast name
Date of birth*

DayMonthYear
Telephone*
Please enter a valid phone number.Format: 00000 000000.
Email*

Confirmation EmailConfirm email
Correspondence address*

Address line 1

Address line 2

City

Postcode
Do you already hold insurance?*

YesNo
If yes, please advise your current insurance provider*
What is the renewal premium provided by your current insurer? *
Please advise your renewal date*

MonthDayYear
Date
Is a joint policy required?*

YesNo
Title*
Name*

First nameLast name
Date of birth*

DayMonthYear
Is there anyone else who needs to be named on the policy?*

YesNo
Title*
Name*

First nameLast name
Date of birth*

DayMonthYear
Is the risk address the same as the correspondence address?*

YesNo
Risk address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select the option which best describes your business:*
Please advise your trading as name: *
Please advise your limited company name:*
Please advise how many directors you have:*
Do any directors take a wage roll or dividend?*

YesNo
If yes, please provide total wage roll or dividend:*
Does any one director have over a 25% stake in the business?*

YesNo
If yes, please provide full names:*

First NameLast Name
Please provide DOB: *

DayMonthYear
Date
Do you need to add any other directors?*

YesNo
If yes, please provide full names:*

First NameLast Name
Please provide DOB: *

DayMonthYear
Date
Do you need to add any other directors?*

YesNo
If yes, please provide full names:*

First NameLast Name
Please provide DOB: *

DayMonthYear
Date
How many acres does the land comprise of?*
From what date is cover required?*

DayMonthYear
Do you make an income from your smallholding or hobby farm?*

YesNo
If yes, please advise your total income*
What activities will be taking place on the land e.g. keeping of own livestock?*
Are there any lakes / ponds / watercourses on the land?*

YesNo
Please provide details*
Are there any public footpaths or public rights of way on the land?*

YesNo
Please provide details*
What level of public liability cover do you require?*

£1m£2m£5m£10m
Do you require environmental impairment liability cover?*

YesNo
Property
Do you require cover for a domestic property?*

YesNo
Please select the best description of the home*

Private dwellingAnnexe/additional residential propertyHoliday letFixed mobile home
Is the property listed?*

YesNo
Please describe the construction of the property noting any non-standard materials e.g. thatch, timber, cob. *
Does the property have more than 25% flat roof?*

YesNo
What is the rebuild value of the property?*
Is accidental damage cover required for the property?*

YesNo
Do you require cover for the contents of the property?*

YesNo
Please state the total replacement value of all contents?*
Please list separately any items of contents that are individually worth more than £2,500:*
Is accidental damage cover required for contents?*

YesNo
Do you need to add cover for an additional domestic property?*

YesNo
Please select the best description of the home*

Private dwellingAnnexe/additional residential propertyHoliday letFixed mobile home
Is the property listed?*

YesNo
Please describe the construction of the property noting any non-standard materials e.g. thatch, timber, cob. *
If you have noted any non-standard building materials, does this exceed 25% of the overall construction?*

YesNo
Does the property have more than 25% flat roof?*

YesNo
What is the rebuild value of the property?*
Is accidental damage cover required for the property?*

YesNo
Do you require cover for the contents of the property?*

YesNo
Please state the total replacement value of all contents?*
Please list separately any items of contents that are individually worth more than £2,500:*
Is accidental damage cover required for contents?*

YesNo
Do you require cover for any greenhouses?*

YesNo
If yes, please provide the rebuild value:*
Outbuildings
Do you require cover for any outbuildings?*

YesNo
Are all outbuildings in a good state of repair, in active use, checked regularly and have no planned building works?*

YesNo
Would you like flood cover included for your outbuildings?*

YesNo
Do you require cover for accidental damage to underground pipes?*

YesNo
Outbuilding 1
Please describe outbuilding 1*
Please state the materials used within the construction of the outbuilding:*
Please state the estimated percentage of timber materials in the construction: *
Does the construction of the outbuilding contain composite panels?*

YesNo
Please state the rebuild value of outbuilding 1*
Do you need to add another outbuilding?*

YesNo
Outbuilding 2
Please describe outbuilding 2*
Please state the materials used within the construction of the outbuilding:*
Please state the estimated percentage of timber materials in the construction: *
Does the construction of the outbuilding contain composite panels?*

YesNo
Please state the rebuild value of outbuilding 2*
Do you need to add another outbuilding?*

YesNo
Outbuilding 3
Please describe outbuilding 3*
Please state the materials used within the construction of the outbuilding:*
Please state the estimated percentage of timber materials in the construction: *
Does the construction of the outbuilding contain composite panels?*

YesNo
Please state the rebuild value of outbuilding 3*
Do you need to add another outbuilding?*

YesNo
Outbuilding 4
Please describe outbuilding 4*
Please state the materials used within the construction of the outbuilding:*
Please state the estimated percentage of timber materials in the construction: *
Does the construction of the outbuilding contain composite panels?*

YesNo
Please state the rebuild value of outbuilding 4*
Do you need to add another outbuilding?*

YesNo
Outbuilding 5
Please describe outbuilding 5*
Please state the materials used within the construction of the outbuilding:*
Please state the estimated percentage of timber materials in the construction: *
Does the construction of the outbuilding contain composite panels?*

YesNo
Please state the rebuild value of outbuilding 5*
Do you need to add another outbuilding?*

YesNo
Outbuilding 6
Please describe outbuilding 6*
Please state the materials used within the construction of the outbuilding:*
Please state the estimated percentage of timber materials in the construction: *
Does the construction of the outbuilding contain composite panels?*

YesNo
Please state the rebuild value of outbuilding 6*
Additional cover options
Do you require cover a B&B?*

YesNo
Please advise the level of public liability cover you would like for your B&B*

£1m£2m£5m
Please state the turnover from your B&B*
Do you have any camping or caravaning pitches?*

YesNo
Please state the number of pitches *
Would you like any additional facilities you provide covered? e.g. shower/toilet facilities*

YesNo
If yes, please provide the construction and rebuild values*
Do you have any holiday cottages or commercially let caravans?*

Holiday cottageCaravanNo
If you have selected either holiday cottages or caravans, please state number of properties. *
Please provide turnover from either your holiday cottages or caravans*
Do you offer DIY horse livery?*

YesNo
If yes, please state how many:*
Do you require cover for incidental full livery? (i.e. occasionally looking after the DIY livery horses when owners are on holiday)*

YesNo
If yes, please state how many:*
Do you have any commercial fishing lakes?*

YesNo
If yes, please state how many rods:*
Do you require cover for livestock contract rearing?*

YesNo
If yes, please provide your turnover from this activity *
Do you need cover for livestock?*

YesNo

If other, please state the species:*
Would you like to include cover for dog worrying?*

YesNo
Do you require cover for walls, gates, hedges and fences?*

Yes up to £2,500Yes up to £5,000No cover required
Do you require cover for any of the following:*

Quad bike/ATVHired in plantSmall tools e.g. chainsaw, strimmer, portable hand toolsMachinery and implements e.g. harrow, topper, rotavatorHorse/livestock trailerAgricultural produce, deadstock and feedstuffsPortacabinsCaravans and mobile homesSaddlery & tack (max £10,000)Contents of tack roomContents of commercial premisesAgility equipment and show jumpsTractor(s)N/A
Is your quad bike road registered?*

YesNo
Please advise the full value of all quadbikes/ATVs:*
Is your tractor road registered?*

YesNo
Please advise what you use your caravan for e.g. holiday let, storage, accommodation or welfare facility *
What type of plant are you hiring in? *
What is the value of the plant you are hiring? *
What are the total hiring charges? *
Please advise the total value of all small tools:*
Please advise the total value of all machinery and implements:*
Please advise the total value of all horse and livestock trailers:*
Please advise the total value of all agricultural produce, deadstock and feedstuffs:*
Please advise the total value of all portacabins:*
Please advise the total value of all caravans and/or mobile homes:*
Please advise the total value of all saddlery and tack:*
Please advise the total value of contents in the tack room (not including saddlery or riding tack):*
Please advise the total value of contents on your commercial premises:*
Please advise the total value of all agility equipment:*
Please advise the total value of your tractor(s):*
If yes, please advise the amount and replacement value of each*
Would you like your quote to include cover for any of the following:*

Farm property in transit (maximum £3,000 per vehicle)Loss of money (commercial)Business all risks (e.g. deterioration of chilled stock, mobile phones, laptops)Additional Public Liability extensions: (e.g. farmers markets, holiday lets, livery yards, camp site, B&B)Business interruptionN/A
If you have selected farm property in transit, what is the maximum number of vehicles you will use at any one time? *
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.*

YesNo
Please state the employee or voluntary helpers activities *
Please state the annual wageroll*
Please state the Employee Reference Number (ERN) (if applicable)*
Is there any other information you would like to provide?*
Further information
Have there been any claims made in the last 5 years?*

YesNo
If yes, please provide as much detail as possible. *
Have there been any breaks in cover or significant periods of time where no insurance has been held on the property? If yes, please provide details. *
How would you prefer to be contacted by Cliverton?*

PhoneEmail
How did you hear about Cliverton? *
If 'other' please state where: *
Would you like to receive news and updates from Cliverton?*

YesNo
Should be Empty:

Rows	Total value:
Cattle
Sheep
Goats
Horses
Donkeys
Pigs
Poultry
Alpacas
Working dogs
Other

Property

Outbuildings

Outbuilding 1

Outbuilding 2

Outbuilding 3

Outbuilding 4

Outbuilding 5

Outbuilding 6

Additional cover options

Employees

Further information