Bresland - 2017 Crop Proposal - WA Farmers

Bresland Insurance Group is a Corporate Authorised Representative (No. 1246722) of Insurance Advisernet Australia Pty Ltd, AFSL 240549
2017 Crop Proposal Form
General Details
Insured Name *
Contact Number *

Address *

Street Address
Street Address Line 2
Town	State
Postcode	Country

Property Details
Number of Properies *
Property Name *
Closest Town *
Latitude *
Longitude *
Property Name - 2 *
Closest Town - 2 *
Latitude - 2 *
Longitude - 2 *
Risk Details
Policy Type *

Final Revision After Harvest
Cover Type *

Hail & Fire Fire Only
Decreasing Excess *

Yes No
Existing Damage *

Yes No
Details
Sharefarmed *

Yes No
How many ?
Percentage Owned
Percentage Insuring
SF Name
SF Address
SF Phone
Crop Details
Planting Schedule *

Please click here to download our CSV Crop template, complete and upload below
CSV File Upload

Upload a File

Cancel of

Insurance History
Any insurance policy declined or cancelled, renewal refused, special condition applied? *
If yes, give details (Year, Name of Insurer(s), Reason):
In the last 5 years, how many incidents of Hail, has the Insured Property experienced? *
Total amount paid in crop claims in the last 5 years ? *
Declaration

As you have Crop on more than 2 properties to insure unfortunately you cannot proceed online.

Please click on the Request Callback button below and one of our Crop Insurance specialists will call you to complete your application over the phone.

Thankyou your request has been received and we will be calling in the next 24 hours.

Your faithfully,

Bresland Insurance Group
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