Affinity insurance services pl farm insurance survey checklist
Farm insurance risk survey and fact finder
What does this form include?
This form contains 116 sections:
Click to add a new 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
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
Buildings, contents and property primarily used for domestic non-farming purposes should be insured i
Click here to add a new home building
Address of home location (GPS) - (3G or WiFi is required) Address
Address of location (manual)
Home Property / Residence Section
- How is this home location occupied?
Construction of Roof
Construction of Walls
Construction of floor
Year the building was built
Is the building older than 40 years?
Building replacement value
Home building calculator (requires 3G or WiFi). Located in quotes, home building sectionwww.affinityi
Unspecified Personal Contents replacement value
Specified Personal Contents (include value)
Specified Valuables (include description and value of each item) - a valuation less than 3 years old will be required for each item
Photo of this home building
Property used primarily for the farm (non-domestic) use should be insured in this section
Add a farm location
Which location number from the general section is this property located on
Farm Buildings
Description of this building (stables, dairy, machinery shed, hay shed, tool shed, etc)
Farm Property Section
What type of fire protection is located inside or within 10m outside this building?
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)
Photo of this location (side or rear)
Photo of this building internal
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)
Registered Vehicles and high value machinery can be better insured as comprehensive farm motor vehicl
Farm mobile machinery cover, defined events with no cover for damage whilst in use. Click to add a ma
Year make and model
Value
Unspecified Farm Machinery - defined events only no cover for damage When in use.
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 m
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 fencin
Describe fence construction (3 wire star post, brick, timber rail and post etc)
Farm property cover - hay livestock and fencing
- Is this fence a boundary fence or internal fence
Length of fencing in meters
Replacement cost per Meter
Fencing first loss only cover, sum insured required?
Gross income sum insured
Increased cost of working cover following a farm property claim?
Maximum Benefit period
This section of cover functions as a normal motor vehicle policy is designed for registered vehicles
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.
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
Farm Motor Vehicles and Trailers
- How is the vehicle stored over night?
What no claim bonus applies to this vehicle?
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
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
Farm Liability
- What limit of indemnity is required?
Please check the box if any of the following are undertaken at or from any location
Do you wish to provide further information on these activities, such as whether they are insured seperately.
Add a specified machinery unit
Describe type of pump (submersible, irrigation, drinking water etc)
Capacity in kw
Replacement value
Add 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 i
Add a specified insured animal
Breed
Age of animal
Colour
Describe brandings or markings
Photo if available
Bloodstock and breeders cover
- 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.
Management Liability Insurance can cover allegations of breaches in workplace health & safety laws, p
Completion time Date
Broker signature
Client signature
Use this template