From what date is cover required?
*
/
Day
/
Month
Year
Please select the option which best describes your business:
*
Please Select
Limited Company
Trading As
Sole Trader
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Address
*
Address line 1
Address line 2
City
Postcode
Email
*
Confirmation Email
Confirm email
Telephone
*
Please enter a valid phone number.
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 the risk address the same as the correspondence address?
*
Yes
No
Please provide the full risk address
How many acres does the land comprise?
*
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
Is there a ménage or riding arena on the land?
*
Yes
No
Please provide details
What level of public liability cover do you require?
*
£2m
£5m
£10m
Do you require cover for your domestic property?
*
Yes
No
Is the property built of brick or stone with a tile or slate roof?
Yes
No
What is the rebuild value?
Do you require cover for the contents of your domestic property?
Yes
No
What is the replacement value?
Do you require cover for any outbuildings?
*
Yes
No
What are the outbuildings made of?
What is the rebuild value?
Do you require cover for any equipment?
*
Yes
No
What is the replacement value?
Do you have any employees or voluntary helpers?
*
Yes
No
Please state the annual wageroll
Have there been any claims made in the last 5 years?
*
Yes
No
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
SUBMIT
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