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
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 your domestic property?
*
Yes
No
Please select the best description of the home
*
Private dwelling
Holiday home
Holiday let
Fixed mobile home
Is your home listed?
*
Yes
No
Please describe the construction of your home
*
What is the rebuild value?
*
Is accidental damage cover required for your home?
*
Yes
No
Do you require cover for the contents of your domestic property?
*
Yes
No
What is the replacement value of all contents?
*
Is accidental damage cover required for your 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 construction of outbuilding 1. If the construction is of mixed materials, please provide the percentage of each material.
*
Please state the percentage of timber materials in the construction:
*
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 construction of outbuilding 2. If the construction is of mixed materials, please provide the percentage of each material.
*
Please state the percentage of timber materials in the construction:
*
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 construction of outbuilding 3. If the construction is of mixed materials, please provide the percentage of each material.
*
Please state the percentage of timber materials in the construction:
*
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 construction of outbuilding 4.If the construction is of mixed materials, please provide the percentage of each material.
*
Please state the percentage of timber materials in the construction:
*
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 construction of outbuilding 5. If the construction is of mixed materials, please provide the percentage of each material.
*
Please state the percentage of timber materials in the construction:
*
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 construction of outbuilding 6. If the construction is of mixed materials, please provide the percentage of each material.
*
Please state the percentage of timber materials in the construction:
*
Please state the rebuild value of outbuilding 6
*
Do you require cover for any equipment?
*
Yes
No
What is the replacement value?
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, do you require cover for incidental full livery? (i.e. occasionally looking after the DIY livery horses when owners are on holiday)
*
Yes
No
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
If yes, please detail species and maximum value per species.
*
If yes, would you like 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
Machinery & implements
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
N/A
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
SUBMIT
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