Affinity Insurance Services PL Farm Insurance Survey

• Client or Farm Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Farm Information

• Click to add a new location

Farm Location
• Location Address (GPS) - (requires 3g or wifi access)
  Address

• Location of Address (Manual)

• Size of location in acres

• List all activities at this location

• Has this location ever flooded? If so when or average frequency.

• Are any of the following located at or undertaken at any of these locations

  Select airstrips or landing areas farm stay or accomodation incl camp sites concerts, weddings, conferences or other events horse riding for guests or visitors motor cycle riding for guests or visitors

  • airstrips or landing areas
  • farm stay or accomodation incl camp sites
  • concerts, weddings, conferences or other events
  • horse riding for guests or visitors
  • motor cycle riding for guests or visitors

• Annual Income or Turnover

• Number of staff including directors if pty ltd

• If the farm employs staff or is a pty ltd company you should check that the farm owner has a workers compensation insurance policy. This may not be required in some instances such as NSW paying under 7,500 in wages or in QLD if only directors

Home Property / Residence Section

• Buildings, contents and property primarily used for domestic non-farming purposes should be insured in thissection

• Click here to add a new home building

Home building location
• Address of home location (GPS) - (3G or WiFi is required)
  Address

• Address of location (manual)

• How is this home location occupied?

  owner occupied

  family members of the owner

  occupied by employees

  occupied by tenants

• Is the property leased by a managing agent

• Is there a current lease in place?

• What is the term of the average lease in months?

• If the property is under a month to month lease this may affect the outcome of any loss of rent or rent default

• Construction of Roof

  Select Concrete Tiles Clay /terracotta Tiles Colourbond/Steel Iron Timber Shingles or other Timber

  • Concrete Tiles
  • Clay /terracotta Tiles
  • Colourbond/Steel
  • Iron
  • Timber Shingles or other Timber

• Construction of Walls

  Select Brick Veneer Double Brick Stonework Concrete Fibro-Cement metal or colourbond Cladding or Hardiplank (aluminium) Asbestos Weatherboard (timber) sandwhich panel

  • Brick Veneer
  • Double Brick
  • Stonework
  • Concrete
  • Fibro-Cement
  • metal or colourbond
  • Cladding or Hardiplank (aluminium)
  • Asbestos
  • Weatherboard (timber)
  • sandwhich panel

• Construction of floor

  Select Timber on Piers Timber on raised poles Timber Flooring on Concrete Slab concrete slab concrete ground floor timber upper floor

  • Timber on Piers
  • Timber on raised poles
  • Timber Flooring on Concrete Slab
  • concrete slab
  • concrete ground floor timber upper floor

• Year the building was built

• Is the building older than 40 years?

• If over 40 years when was the building last rewired

• If over 40 years when was the building last replumbed

• Building replacement value

• Home building calculator (requires 3G or WiFi). Located in quotes, home building section
  
  www.affinityinsurance.net.au

• Unspecified Personal Contents replacement value

• Specified Personal Contents (include value)

• Unspecified Valuables Cover

  1000 per item up to 1000 per claim

  1000 per item up to 3000 per claim

  1000 per item up to 5000 per claim

• Specified Valuables (include description and value of each item) - a valuation less than 3 years old will be required for each item

• Valuables cover option

  Australia Wide

  World Wide

• Photo of this home building

  Media

• What is your preferred Excess?

  $100

  $250

  $500

  $1000

  $2500

Farm Property Section

• Property used primarily for the farm (non-domestic) use should be insured in this section

• Add a farm location

Farm location

• Which location number from the general section is this property located on

• Farm Buildings

Farm building

• Description of this building (stables, dairy, machinery shed, hay shed, tool shed, etc)

• Construction of building

  steel

  iron

  brick or stone

  timber or weatherboard

  sandwhich panel or eps

• What type of fire protection is located inside or within 10m outside this building?

  Select extinguisher fire blanket single source fire sprinklers dual source (backup) fire sprinklers high capacity fire hose low capacity garden hose

  • extinguisher
  • fire blanket
  • single source fire sprinklers
  • dual source (backup) fire sprinklers
  • high capacity fire hose
  • low capacity garden hose

• What type of security or crime prevention is on this building?

  none

  deadlocked or padlocked

  local alarm

  back to base alarm

  cctv

• What is the age of this building

• Replacement value, new for old including demolition costs of this building

• If you wish to insure contents specific to this shed, list the replacement value of the contents here. Note: Some policies will allow combined farm contents cover for all sheds as it is likely contents will movefrom shed to shed.

• Photo of this farm building (front)

  Media

• Photo of this location (side or rear)

  Media

• Photo of this building internal

  Media

• Do any insured farm buildings at this location contain EPS or sandwhich panels? (add photo)

  yes

  no

• General unspecified farm contents at this location in any building

• Unspecified farm improvements at this location such as silos, tanks, dips and pens, replacement value. Buildings and improvements over $5000 per item should be specified above

• Solar power (excludng home roof top systems for domestic use) or other power generators. List type and replacement value

• Describe all uninsured farm buildings / improvements or structures that are at this location. (add a photo if on site)

Farm property cover - mobile plant and machinery

• Registered Vehicles and high value machinery can be better insured as comprehensive farm motor vehicles. This section primarily covers fire and defined events damage but no damage whilst in use. See the farm motor section of this document.

Add a farm location

• Farm mobile machinery cover, defined events with no cover for damage whilst in use. Click to add a machine.

Machine

• Year make and model

• Value

• Unspecified Farm Machinery - defined events only no cover for damage When in use.

Farm property cover - hay livestock and fencing

• Add a farm location

Location number

• Harvested Crops - hay, grain, seeds

• Stock of trees - describe variety and value

• Vines - describe variety and value

• Milk in Storage or Vats at this location, total storage value

• Livestock - Cover for mass livestock against fire and defined events, note some policies will cover more than fire such as lightning or impact, if theft or accidental death is required see the Livestock and Breeders section of this document.

Livestock Type

• Type of livestock (cattle, sheep, horse etc)

• Breed of animal (Cotswold, aussie down, angus, jersey etc)

• Number of head to be insured of this breed

• Value per head in $aud

• Is cover required for drought relief? (up to 15,000)

• Fencing - this type of cover is fire and defined events designed to cover 100% of the property fencing, under insurance typically applies to this insurance type. If client requires a fixed amount of cover, this is called first loss basis fencing, see below.

Fence type

• Describe fence construction (3 wire star post, brick, timber rail and post etc)

• Is this fence a boundary fence or internal fence

  boundary fencing

  internal fencing

• Length of fencing in meters

• Replacement cost per Meter

• Fencing first loss only cover, sum insured required?

• What is your preferred Excess for all farm property?

  $100

  $250

  $500

  $1000

  $2500

Farm Interruption Cover

• Gross income sum insured

• Increased cost of working cover following a farm property claim?

• Maximum Benefit period

Farm Motor Vehicles and Trailers

• This section of cover functions as a normal motor vehicle policy is designed for registered vehicles or high value machinery requiring a comprehensive style policy.

• Has the client had any motor vehicle claims in the p ast 5 years whether at fault or not at fault? If yes, describe all claims with year, name of insurer and amount claimed.

Motor Vehicle click here to add a vehicle

• Year make and model (include variant such as GXL or 5054E).

• List all accessories

• List all modifications

• What is the estimated value of this vehicle?

• Which location above or what postcode is the vehicle kept at

• How is the vehicle stored over night?

  in a garage

  in a shed

  In an opensided carport or shed

  on the property in the open air

  on the street

• What no claim bonus applies to this vehicle?

  Select rating 1 or above 60% rating 2 or above 50% rating 3 or above 40% rating 4 or above 20% rating 5 or above 10% rating 6 or none

  • rating 1 or above 60%
  • rating 2 or above 50%
  • rating 3 or above 40%
  • rating 4 or above 20%
  • rating 5 or above 10%
  • rating 6 or none

• Is this vehicle under finance? If so, type of finance and name of financier.

• Drivers of this vehicle

• Unrestricted (anyone) over 30 years of age

• Unrestricted (anyone) under 30 years of age

• Add a specified driver

Driver

• Name

• Date of birth

• Number of years driving or year first licensed

• In the past 5 years has this driver had any driving convictions such as speeding fines, dui, red lights other than parking fines? If yes, describe the date, conviction and the penalty that applied.

• Optional covers for farm motor vehicles, tick those covers that the client requires

• Agreed value based on the value above

• Protected no claim bonus

• Excess free Windscreen option

• Hire car

• What is your preferred Excess for this vehicle?

  $400

  $500

  $600

  $750

Farm Liability

• What limit of indemnity is required?

  $5,000,000

  $10,000,000

  $20,000,000

  higher

• Please check the box if any of the following are undertaken at or from any location

• Farm Stay or Accomodation

• Horse Riding for visitors

• Processing or manufacturing produce into goods, including but no limited to packaged meats, cheese, smallgoods, jams etc

• Sale of produce or products at markets or a retail outlet owned by the insured

• Consulting

• Any other business or service

• Aerial crop spraying

• Air strip including emergency air strips at any location

• Do you wish to provide further information on these activities, such as whether they are insured seperately.

Machinery (pump) Breakdown

• Add a specified machinery unit

Machinery

• Describe type of pump (submersible, irrigation, drinking water etc)

• Capacity in kw

• Replacement value

• Add media

  Media

• Unspecified motors under 4kw

• Unspecified submersible pumps under 4kw

• If there are any Computer controlled equipment such as automation units or temperature controls, or if a breakdown might cause loss of income, a seperate stand alone equipment breakdown engineering policy such as vero or allianz breakdown should be considered.

Bloodstock and breeders cover

• Add a specified insured animal

Animal number

• Breed

• Age of animal

• Colour

• Describe brandings or markings

• Photo if available

  Media

• Value

• Theft cover

• Loss of use Cover

• Infertility cover

• Unborn foal extension of cover

• Tick if this a syndicate animal

• Semen and Embryo Section of cover

• Number of containers

• Number of ampoules or straws per container

• Maximum value per container

• Annual turnover (income) from sale of semen and embryos

General

• Would you like monthly payments

• Is cover for stock, equipment, or livestock in transit required for transits outside of the farm? If yes, list maximum transport value

• Is cover for loss of income required for injury or sickness to the farmer or immediate family of the farmer? If sole trader or partnership farm, Consider accident and illness cover, or referring client to a financial planner for a life insurance policy.

• Does the farmer require you to arrange workers compensation insurance? This is compulsory in most states if thr farm employs staff even if on a casual basis.

• What is the annual wages paid to employees

• If WA or NT, is cover required for directors? If yes, what are the directors wages?

• Trade Credit Insurance in case your main (top 5) customers do not pay or are insolvent​

• List the top 5 customers of the farm

• List the total value of debtors outstanding by more than 14 days

• Management Liability Insurance can cover allegations of breaches in workplace health & safety laws, pollution control laws, employment laws and trade practices laws, it doesn’t cover wilful misconduct but will defend you for allegations. It is only available to Companies and not to sole traders orpartnerships.
  

• Is cover required for Management liability insurance

• Completion time

  Date

• Broker signature

  Sign

• Client signature

  Sign