Web Site General Questions Situation of Risk Motor Vehicle Details Insured Name Mailing Address Date of Birth Have you ever had insurance declined or special conditions imposed? Yes No Have you had any claims in the last 5 years? Yes No Have you ever been convicted of a crime or declared bankrupt? Yes No General Questions Situation of Risk Motor Vehicle Details Situation of Risk Occupation Property Size (ha) Domestic Buildings & Contents? Yes Other Buildings? Yes Fencing? Yes Farm Contents Farm Consumables Hay Wool Mobile Farm Machinery Farm Liability? Yes Livestock & Working Dogs General Questions Situation of Risk Motor Vehicle Details Motor Vehicle? Yes Machinery Breakdown? Yes Business Interruption? Yes Farm Theft? Yes Personal Income? Yes Road Transit? Yes Additional Information Send a copy to (email address)
