Farm Insurance Quote Form
Insured Name
*
Contact name
*
Email
*
Retype email
*
Risk Address of the Property to be insured
*
If more than one address please add other addresses below
Risk Address of the Property to be insured
Only Complete if more than one address
Suburb
*
Post Code
*
State
*
Please Select
NSW
QLD
VIC
WA
SA
NT
TAS
Birth Date Of Oldest Insured
*
Please select a day
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Day
Please select a month
January
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December
Month
Please select a year
2025
2024
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1921
1920
Year
Prefer Pay Monthly or Annual payments
Please Select
Annual
Monthly
Please provide some details about the Home Building this is required to calculate your insurance premiums
Home Building Wall Construction
*
Frame Construction
*
Roof Construction
*
Floor Construction
*
Approximate year built
*
Property Size in Acres
*
Security Protection
*
Deadlocks on all External doors
Key Operated Window Locks on all Windows
Bars or Grills on all Windows
Local Alam
Back to Base Alarm
No Security
Normal Key Locks only
Are you the Owner and Occupier of the Building
Yes - Owner Occupied
Yes- Holiday Home
No - Landlord
No - Tenant
No - Unoccupied
Please Provide some Details around the Sums insured and Cover Required (We require this to calculate your premium)
Building Sum Insured
Contents Sum insured
Unspecified Valuables Cover
Specified Valuables Cover
If you insure Farm Buildings, Fencing, Machinery or other Items Please provide details below
Current Limit of Liability for Farming Activities
*
HISTORY DETAILS ( if you answer yes to any of the below questions please provide further information in free text box below)
Has the insured or any Directors had any claims in the last 5 years
*
Please Select
YES
NO
Has any Driver had any driving convictions of any kind in the last 5 years
*
Please Select
YES
NO
Has the insured or any Directors had any criminal convictions in the last 10 years
*
Please Select
YES
NO
Has the insured or any Directors had a claim refused, insurance declined or any special conditions imposed in the last 5 years
*
Please Select
YES
NO
Is the insured or any Directors aware of any circumstance that may lead to a claim
*
Please Select
YES
NO
CURRENT INSURER
Expiry Date of current Insurance or date to start cover
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
DISCLOSURE OF DRIVING CONVICTIONS
ANY OTHER INFORMATION PLEASE USE THIS TEXT BOX
ANY OTHER INSURANCE YOU WANT QUOTES ON SUCH AS BUSINESS,MOTOR, LANDLORDS, WORKERS COMPENSATION PLEASE USE THIS TEXT BOX
DUTY OF DISCLOSURE ( Please ensure all details are correct as answers on this form will be used to obtain quote and or cover and if incorrect or not disclosed information this could affect a claim being paid)
Submit
Should be Empty: