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Farm insurance

Please complete this form so we can provide you with the most accurate quote possible.

Name of insured
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Date of birth
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Situation/s
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Postal address
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Contact number
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Email
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Farm size
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Farm type
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Any activities other than farming
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In the last five years has the insured:

Had insurance declined, cancelled, proposal rejected, renewal refused, special conditions or excess imposed?
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Suffered a loss or damage whether you claimed or not, or had any claims against you
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Been charged or convicted of a criminal offence?
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Please provide full details:
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Have you ever been declared bankrupt?
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Been liable for any civil offence or pecuniary penalty exceeding $5,000?
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Have you ever been involved in a company or business which has become insolvent or subject to any form of insolvency administration?
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Preferred contact method

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Current premium per
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Additional Comments
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Spam Check(*)
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Please type the two words into the box above and then select the 'SUBMIT' button.