Title
*
Please Select
Dr
Miss
Ms
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Telephone
*
Please enter a valid phone number.
Email
*
Confirmation Email
Confirm email
Correspondence address
*
Address line 1
Address line 2
City
Postcode
Do you already hold insurance?
*
Yes
No
If yes, please advise your current insurance provider
*
What is the renewal premium provided by your current insurer?
*
Please advise your renewal date
*
-
Month
-
Day
Year
Date
Is a joint policy required?
*
Yes
No
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Is there anyone else who needs to be named on the policy?
*
Yes
No
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Is the risk address the same as the correspondence address?
*
Yes
No
Risk address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please select the option which best describes your business:
*
Please Select
Limited Company
Trading As
Sole Trader
Owner
Other
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?
*
Yes
No
If yes, please provide total wage roll or dividend:
*
Does any one director have over a 25% stake in the business?
*
Yes
No
If yes, please provide full names:
*
First Name
Last Name
Please provide DOB:
*
-
Day
-
Month
Year
Date
Do you need to add any other directors?
*
Yes
No
If yes, please provide full names:
*
First Name
Last Name
Please provide DOB:
*
-
Day
-
Month
Year
Date
Do you need to add any other directors?
*
Yes
No
If yes, please provide full names:
*
First Name
Last Name
Please provide DOB:
*
-
Day
-
Month
Year
Date
How many acres does the land comprise of?
*
From what date is cover required?
*
/
Day
/
Month
Year
Do you make an income from your smallholding or hobby farm?
*
Yes
No
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?
*
Yes
No
Please provide details
*
Are there any public footpaths or public rights of way on the land?
*
Yes
No
Please provide details
*
What level of public liability cover do you require?
*
£1m
£2m
£5m
£10m
Do you require environmental impairment liability cover?
*
Yes
No
Property
Do you require cover for a domestic property?
*
Yes
No
Please select the best description of the home
*
Private dwelling
Annexe/additional residential property
Holiday let
Fixed mobile home
Is the property listed?
*
Yes
No
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?
*
Yes
No
What is the rebuild value of the property?
*
Is accidental damage cover required for the property?
*
Yes
No
Do you require cover for the contents of the property?
*
Yes
No
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?
*
Yes
No
Do you need to add cover for an additional domestic property?
*
Yes
No
Please select the best description of the home
*
Private dwelling
Annexe/additional residential property
Holiday let
Fixed mobile home
Is the property listed?
*
Yes
No
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?
*
Yes
No
Does the property have more than 25% flat roof?
*
Yes
No
What is the rebuild value of the property?
*
Is accidental damage cover required for the property?
*
Yes
No
Do you require cover for the contents of the property?
*
Yes
No
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?
*
Yes
No
Do you require cover for any greenhouses?
*
Yes
No
If yes, please provide the rebuild value:
*
Outbuildings
Do you require cover for any outbuildings?
*
Yes
No
Are all outbuildings in a good state of repair, in active use, checked regularly and have no planned building works?
*
Yes
No
Would you like flood cover included for your outbuildings?
*
Yes
No
Do you require cover for accidental damage to underground pipes?
*
Yes
No
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:
*
Please Select
0 - 25%
26 - 40%
41-65%
66-100%
Does the construction of the outbuilding contain composite panels?
*
Yes
No
Please state the rebuild value of outbuilding 1
*
Do you need to add another outbuilding?
*
Yes
No
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:
*
Please Select
0 - 25%
26 - 40%
41-65%
66-100%
Does the construction of the outbuilding contain composite panels?
*
Yes
No
Please state the rebuild value of outbuilding 2
*
Do you need to add another outbuilding?
*
Yes
No
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:
*
Please Select
0 - 25%
26 - 40%
41-65%
66-100%
Does the construction of the outbuilding contain composite panels?
*
Yes
No
Please state the rebuild value of outbuilding 3
*
Do you need to add another outbuilding?
*
Yes
No
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:
*
Please Select
0 - 25%
26 - 40%
41-65%
66-100%
Does the construction of the outbuilding contain composite panels?
*
Yes
No
Please state the rebuild value of outbuilding 4
*
Do you need to add another outbuilding?
*
Yes
No
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:
*
Please Select
0 - 25%
26 - 40%
41-65%
66-100%
Does the construction of the outbuilding contain composite panels?
*
Yes
No
Please state the rebuild value of outbuilding 5
*
Do you need to add another outbuilding?
*
Yes
No
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:
*
Please Select
0 - 25%
26 - 40%
41-65%
66-100%
Does the construction of the outbuilding contain composite panels?
*
Yes
No
Please state the rebuild value of outbuilding 6
*
Additional cover options
Do you require cover a B&B?
*
Yes
No
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?
*
Yes
No
Please state the number of pitches
*
Would you like any additional facilities you provide covered? e.g. shower/toilet facilities
*
Yes
No
If yes, please provide the construction and rebuild values
*
Do you have any holiday cottages or commercially let caravans?
*
Holiday cottage
Caravan
No
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?
*
Yes
No
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)
*
Yes
No
If yes, please state how many:
*
Do you have any commercial fishing lakes?
*
Yes
No
If yes, please state how many rods:
*
Please Select
1
2
3
4
5
6
7
8
9
10
Do you require cover for livestock contract rearing?
*
Yes
No
If yes, please provide your turnover from this activity
*
Do you need cover for livestock?
*
Yes
No
Please advise which species of livestock you require cover for and the total value:
*
Total value:
Cattle
Sheep
Goats
Horses
Donkeys
Pigs
Poultry
Alpacas
Working dogs
Other
If other, please state the species:
*
Would you like to include cover for dog worrying?
*
Yes
No
Do you require cover for walls, gates, hedges and fences?
*
Yes up to £2,500
Yes up to £5,000
No cover required
Do you require cover for any of the following:
*
Quad bike/ATV
Hired in plant
Small tools e.g. chainsaw, strimmer, portable hand tools
Machinery and implements e.g. harrow, topper, rotavator
Horse/livestock trailer
Agricultural produce, deadstock and feedstuffs
Portacabins
Caravans and mobile homes
Saddlery & tack (max £10,000)
Contents of tack room
Contents of commercial premises
Agility equipment and show jumps
Tractor(s)
N/A
Is your quad bike road registered?
*
Yes
No
Is your tractor road registered?
*
Yes
No
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?
*
If yes, please detail the type, number 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 interruption
N/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.
*
Yes
No
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?
*
Yes
No
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?
*
Phone
Email
How did you hear about Cliverton?
*
Please Select
Google search
The Ark magazine
The Country Smallholder magazine
Facebook
TikTok
Instagram
Family or friend
RBST
Other
If 'other' please state where:
*
Would you like to receive news and updates from Cliverton?
*
Yes
No
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