Farm Proposal _ECOAG11695.indd 1 13/11/ :02

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Damian Bryant
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1 Farm Proposal

2 Farm proposal Policy Numbr Nam of Proposr in full: PLESE NSWER LL QUESTIONS IN CPITL LETTERS Dat of irth Phon Postal ddrss: usinss or occupation: (if mor than on, stat all) usinss for th purpos of this insuranc (Plas stat natur of farming ngagd in.g., f, Dairy, Tillag, Markt Gardning or othr) Situation of proprty to b insurd (if diffrnt from Postal ddrss) FOR OFFICE USE ONLY Priod of insuranc FROM Tim TO Rnwal Dat ra/ranch ra/ranch Numbr gncy gncy No. & Chk Ltrs Spcial nots: l l l viva Insuranc Limitd ( w, us, our ) is your insurr. s this is a packag product, plas choos at last on of th sctions from -3 for accptanc. Th insuranc will not b in plac until w hav accptd th proposal. W hav th right to turn down any proposal. l For your and our protction, w may rcord and monitor phon calls. viva Insuranc Limitd is rgulatd by th Cntral ank of Irland PF.04..3

3 Gnral Qustions Plas answr all qustions in CPITL LETTERS (To b answrd by th proposr) r you at prsnt insurd in rspct of any of th prils or contingncis to which this proposal applis? If so, stat class of insuranc and nam of insurr. If Plas giv dtails (a) Do you now hold a Farm Insuranc Policy? (b) Hav you prviously hld a Farm Insuranc Policy? To th bst of your knowldg and blif hav you or any othr prson(s) matrial to this risk (a) n convictd of any offnc of any natur or is any proscution pnding? (b) n rfusd any insuranc, rnwal or had any spcial trms or conditions imposd by any insurr? (c) n involvd in any accidnt or loss or hav any claims bn mad against you or thm in th last fiv yars? (d) Dfctiv vision or haring or suffring at any tim from diabts, fits, any hart complaint, any othr disas or physical infirmity? 3 Hav you or any othr prson(s) matrial to this risk (a) Evr bn dclard bankrupt or bn th subjct of bankruptcy procdings? (b) Had an intrst in any company which has bn th subjct of liquidation procdings or mad any arrangmnt with crditors? (c) Evr had an intrst in any company which has bn th subjct of rcivrship, xaminrship, administration or any quivalnt procdings or arrangmnts with crditors? 4 r you involvd in poultry raring or cattl daling on a commrcial basis? 5 Do you hold livstock auctions on your farm? 6 Do you tak in paying visitors? If Ys, plas stat th maximum numbr applicabl at any on tim, and whthr this activity is carrid out on a sasonal basis only or all yar round. 7 Is any othr party (.g. building socity or bank) intrstd in th proprty proposd for insuranc? 8 Do you ngag in othr agri-linkd activitis? 9 Is your machinry proprly guardd and othrwis in good condition? 0 Is thr a sand-pit or quarry on your land? r all filds abutting th public road and nighbouring farms proprly fncd? Hav you prpard a writtn safty statmnt, in accordanc with th Safty, Halth and Wlfar at Work ct, 005? If not you should do so immdiatly in th intrst of safty and to avoid proscution. To assist you, th information booklt Guidlins on Safty Statmnts is obtainabl from th Halth and Safty uthority or any Tagasc offic. 3 Hav you any othr insuranc with viva? (if Ys, plas giv dtails) 4 r you a mmbr of ithr of th following organisations (Plas Indicat) ICMS ICS REMINDER Proprty should b insurd for its full valu. Option of Sction and ach itm of Sction Nos. and 3 will b subjct to avrag that is if th sum insurd at th tim of loss is lss than th valu of th proprty insurd, you bar a proportionat shar of th loss.

4 Sction Farmhous and Contnts Do you rquir covr? (Th hous must b ownd and occupid by you.) Dscription of farmhous Plas indicat scop of covr rquird by ticking th appropriat box. UILT OF OPTION : HomCovr th complt Insuranc Packag for your hom uildings/contnts/frozn Foods ROOFED WITH Do you rquir ll Risks covr? SUM INSURED 5% of th sum insurd on uildings Limit any on rticl -,300 OR SUM INSURED 0% of th sum insurd on uildings Limit any on articl -,000 Spcific itms (up to a maximum of 4) C D Dscription Is th farmhous fittd with an alarm systm conforming to EN503? Valu Plas spcify th sum insurd on uildings Minimum of 75,000 Th sum insurd should b basd on rbuilding costs plus an amount sufficint to includ rchitcts and Survyors Fs (usually.5% of th valu of th uildings) Plas indicat th sum insurd on Contnts (Option only) i.. 50%, 40% or 30% of uildings sum insurd abov OPTION : Th conomic altrnativ i.. Rstrictd covr Fir, lightning, xplosion, aircraft and arthquak Sum Insurd on Contnts 50% of uildings % Is th farmhous fittd with two smok dtctors? r you agd 50 or ovr? Is th farmhous spcially xposd to th risk of, or has it any history of damag by storm, flood, watr, subsidnc, landslip and/or ground hav? If Ys giv dtails Is th dwlling lft unoccupid:- (i) (ii) for sixty conscutiv days in any on priod of insuranc? rgularly on a daily basis? Do you wish to includ TV or Radio rial ovr 8 mtrs high? Hight of mast mtrs Farmhous () and Contnts Do you rquir covr? (Th hous must b ownd by you and occupid by a mmbr of your immdiat family.) Plas indicat scop of covr rquird by ticking th appropriat box. OPTION : HomCovr th complt Insuranc Packag for your hom uildings/contnts/frozn Foods Dscription of farmhous UILT OF ROOFED WITH Do you rquir ll Risks covr? SUM INSURED 5% of th sum insurd on uildings Limit any on rticl -,300 OR SUM INSURED 0% of th sum insurd on uildings Limit any on articl -,000 Spcific itms (up to a maximum of 4) C D Dscription Is th farmhous fittd with an alarm systm conforming to EN503? Valu Plas spcify th sum insurd on uildings Minimum of 75,000 Th sum insurd should b basd on rbuilding costs plus an amount sufficint to includ rchitcts and Survyors Fs (usually.5% of th valu of th uildings) Plas indicat th sum insurd on Contnts (Option only) i.. 50%, 40% or 30% of uildings sum insurd abov OPTION : Th conomic altrnativ i.. Rstrictd covr Fir, lightning, xplosion, aircraft and arthquak Sum Insurd on Contnts 50% of uildings % Is th farmhous fittd with two smok dtctors? r you agd 50 or ovr? Is th farmhous spcially xposd to th risk of, or has it any history of damag by storm, flood, watr, subsidnc, landslip and/or ground hav? If Ys giv dtails Is th dwlling lft unoccupid:- (i) (ii) for sixty conscutiv days in any on priod of insuranc? rgularly on a daily basis? Do you wish to includ TV or Radio rial ovr 8 mtrs high? Hight of mast mtrs

5 Sction Gnral Farm Proprty FIRE, LIGHTNING, EXPLOSION, IRCRFT, RIOT, CIVIL COMMOTION, MLICIOUS DMGE, IMPCT, ERTHQUKE ND SUTERRNEN FIRE Do you rquir covr? Plas spcify Sum Insurd in rspct of ach itm ROOTS and POTTOES not stord in buildings SILGE in opn or in dtachd buildings or in towrs of incombustibl construction and usd for no othr purpos GRICULTURL PRODUCE and FRMING STOCK, including hay straw and growing crops but xcluding livstock and th aformntiond N.. gricultural produc within 0 mtrs of a chimny in us - unlss in buildings which ar compltly nclosd - is not covrd POULTRY RERING HOUSES POULTRY FRM IMPLEMENTS and MCHINERY your proprty or for which you ar rsponsibl xcluding powr drivn vhicls, implmnts and thir accssoris if and so far as thy ar othrwis insurd UILDINGS OF LL FRM OUTUILDINGS - (xcpt as spcially mntiond blow), constructd of brick, ston, concrt, slats, tils, mtal or slabs composd ntirly of incombustibl minral ingrdints N.. Giv dtails blow of any outbuildings of construction othr than that outlind abov or of any buildings for which sparat insuranc is rquird. Insrt sums insurd in rspct of such outbuildings or Nil if covr is to b xcludd. DESCRIPTION ND PURPOSE FOR WHICH USED UILT OF ROOFED WITH VLUE C D E F TOTL OF LL FRM OUTUILDINGS Plas giv dtails of any othr proprty not spcifid abov. TOTL 8 Fir rigad chargs ar includd (up to a maximum of 0,000) across sctions, or 5 if insurd. Sction 3 Livstock SIC COVER PPLICLE:- Do you rquir covr? Loss of or injury to livstock as a rsult of Fir Lightning Explosion ircraft and Earthquak DDITIONL COVER OPTIONS Fatal injury to livstock: C D E causd by Elctrocution s a rsult of accidntal violnt xtrnal and visibl mans: (i) whilst th animals ar on your prmiss xcluding th first 500 of ach and vry loss (ii) or whilst th animals ar straying from your prmiss, bing drivn or ld on foot on any public thoroughfar (iii) or as a rsult of accidntal poisoning (iv) or accidntal dath to livstock as a rsult of collaps of slattd units as a rsult of accidntal violnt and visibl mans whilst In Transit on any public thoroughfar in suitabl vhicls including loading and unloading and attndanc at any sal or show on land within th Rpublic of Irland or Northrn Irland rsulting dirctly from Dog ttack or Worrying by Dogs (Shp only) Plas spcify sums insurd and othr dtails for ach catgory of livstock to b insurd. asic Covr is mandatory for ach catgory insurd, you should thrfor indicat additional covrs chosn by inputting C D or E as rquird in dditional Covr Options column. Not Covr E only prmittd whn all othr additional covr options C and D ar also chosn. Catgory No. of Maximum Valu any Sum dditional Covr nimals on nimal* Insurd Options Cattl Shp Pigs Horss Not: in rspct of Fatal ccidnt Covr C (i) only, th limit of our Liability is 3,000 for any on animal and th maximum amount payabl in rspct of any on vnt and in any on priod of insuranc is,000. For all othr Fatal ccidnt covrs th limit for any on animal is 6,500.

6 Sction 4 Liabilitis EMPLOYERS LIILITY Do you rquir covr? Schdul of Rmunration ll prsons mployd must b includd. For th purposs of calculating th prmium, board and lodgings must b assssd at th actual valus but not lss than th figurs providd by th agricultural wags (minimum rats) ordr. Plas complt th following dtails in full, xcluding mmbrs of your family and houshold. NUMER WGES INCLUDING PRSI ORD ND LODGINGS ND LL OTHER LLOWNCES TOTL FULL TIME PRT TIME LL OTHER PERSONS HIRED OR ORROWED Y THE PROPOSER TOTL Do you rquir mmbrs of your family and/or houshold to b includd If Ys plas complt th following dtails in full. Do you rquir covr? FMILY ND/OR NUMER WGES INCLUDING PRSI ORD ND LODGINGS ND TOTL HOUSEHOLD MEMERS LL OTHER LLOWNCES FULL TIME PRT TIME TOTL 3 Plas stat total wags tc. paid to mploys ngagd in agricultural contract work. N.. gricultural Contractors as a trad ar not accptabl. 4 Do any of your mploys: If Ys giv dtails (a) Work in a sandpit or quarry? (b) Us circular saws or othr machinry drivn by mchanical powr? (othr than agricultural vhicls) PULIC LIILITY Stat (a) Total acrag including con acrag (b) Total numbr of horss/ponis if any and purposs for which thy ar kpt Do you rquir covr? Sction 5 gricultural & Forstry Vhicls Vhicl(s) REGISTERED LETTERS ND NUMER OR ENGINE NUMER DESCRIPTION, INCLUDING MKER S NME ND TYPE YER OF MNUFCTURE DTE OF PURCHSE Y PROPOSER PROPOSER S ESTIMTE OF PRESENT VLUE INCLUDING CCESSORIES ND SPRE PRTS* PLESE STTE COVER REqUIRED I.E. COMPREHENSIVE, THIRD PRTY FIRE & THEFT, THIRD PRTY ONLY Trailr(s)/Implmnt(s) Third party attachd covr automatically applis; if you nd gratr covr you must giv full dtails of all trailrs DESCRIPTION IDENTIFICTION MRKS PROPOSER S ESTIMTE OF PRESENT VLUE INCLUDING CCESSORIES ND SPRE PRTS* PLESE STTE COVER REqUIRED I.E. COMPREHENSIVE, THIRD PRTY FIRE & THEFT, THIRD PRTY ONLY *In th vnt that th Vhicl is damagd byond conomic rpair, w will calculat th valu of th vhicl at th tim of th loss on th basis of th currnt markt valu (for a vhicl of th sam mak and modl) or whr applicabl th limit of th valu (sum insurd) placd by you on th vhicl as shown on th policy schdul, whichvr is lss. Plas not: W will not pay for loss or damag ovr th currnt markt valu vn if th sum insurd on th policy schdul may b gratr.

7 Sction 5 gricultural & Forstry Vhicls (contd.) 3 Drivr(s) Giv th following dtails in rspct of all prsons who to your knowldg may driv NME GE OCCUPTION STTE PERIOD OF REGULR DRIVING ON FULL IRISH LICENCE GIVE DETILS IF CONVICTED DURING THE PST 5 YERS OF NY OFFENCE IN CONNECTION WITH NY MOTOR VEHICLE OR IF NY PROSECUTION IS PENDING RECORD OF CCIDENTS DURING PST 3 YERS OF DRIVING NUMER COST HVE NY INSURERS REFUSED HIS / HER MOTOR INSURNCE OR IMPOSED SPECIL TERMS? GIVE DETILS OF NY DISESE OR PHYSICL INFIRMITY OR DEFECTIVE VISION OR HERING 4 Will th vhicl(s) b usd for:- nything othr than agricultural and forstry purposs? If Ys giv dtails 5 Will you us your vhicl(s) outsid th Rpublic of Irland? 6 If you hav chosn Third Party Fir & Thft Do you rquir Windscrn Covr option? 7 Has a Statutory safty fram bn fittd to all vhicls? 8 Is any vhicl implmnt or trailr to b usd at any tim for (a) hir or rward? (b) trflling? (c) haulag of trs on th road? 9 Do you rquir th drivrs fatal accidnt bnfit? i.. 6,000 in th vnt of accidntal dath of any prson authorisd to driv undr th Policy, occurring whilst a drivr of any motor vhicl insurd undr this sction. Sction 6 ulk Milk Storag Installations Covr vailabl (plas not covr can only b chosn in conjunction with covr ) Do you rquir covr? ccidntal damag to storag installation. Plas complt th following dtails:- Manufacturr Capacity in GE* Maintnanc Contract Sum Insurd Gallons in Forc (ys/no)** *N-maximum ag 0 yars **N-Maintnanc Contract must b in forc and provid for a minimum of twic yarly inspctions Dtrioration of milk containd in abov installation(s). Plas complt following dtails:- How oftn is your milk collctd? Maximum valu of milk stord at any on tim Sction 7 usinss Intrruption Covr Options Do you rquir covr? Loss of Gross Incom and Incras in Cost of Working in th vnt of th farming activity bing intrruptd as a rsult of a claim insurd undr Sction (Gnral Farming Proprty):- Sum Insurd (i.. Gross Incom) OR dditional Expnditur in consqunc of a claim insurd undr Sction, which is ncssary to maintain th farming activity on th pr-loss scal:- Sum Insurd (i.. dditional Expnditur) Priod for which indmnity is rquird? months following dat of loss/damag.(if longr than months thn sums insurd should b adquat to catr for th priod slctd) Sction 8 Tax Lgal Protction This sction provids covr for ccountants Fs and Expnss and Lgal Costs and Expnss to rprsnt you in an in-dpth invstigation by Rvnu Commissionrs into your businss accounts. Limit of Indmnity 50,000. Do you rquir covr?

8 Sction 9 Prsonal ccidnt Not covr only availabl for you or a mmbr of your family and whr th Occupation of th prson to b insurd is that of: Farmr, Spous, or Farmr and gricultural Contractor (whr contracting constituts lss than 50% of th dutis). Do you rquir covr? Summary of Covr: On Unit (up to 0 units pr prson can b chosn). odily injury rsulting in: Dath or loss of on or mor limbs or ys or Prmannt and Total Disablmnt.... 3,900 Tmporary Total Disablmnt pr wk Inability from ngaging in usual occupation for a priod of up to 04 wks from th dat of injury. aftr first wk of disablmnt Tmporary Partial Disablmnt... 5 pr wk Inability from attnding to a substantial and ssntial part of usual occupation for a priod of up to 6 wks aftr first wk of disablmnt from th dat of th injury. Vouchd Mdical Expnss... up to 650 To th bst of your knowldg and blif hav you or any of th prsons proposing: Nam of Prson to b Insurd Dutis (dscrib in full) Dat of irth No. of Units / / / / / / / / (a) (b) ny physical or othr dfct or waknss of any kind Had any injuris, disass or illnss OR If, plas giv FULL dtails. Important You must tll us any othr facts which ar likly to affct whthr w agr to provid covr, or how w assss th risks proposd for insuranc, including but not limitd to: a) Prvious insuranc claims b) ny convictions, offncs or proscutions pnding of any natur (for xampl, but not limitd to, fraud, thft, pnalty points, driving convictions, or th handling of stoln goods) c) Mdical dtails or history (whn this information is spcifically rqustd undr a sction) and d) Th main usr of th vhicl or any vhicl modifications (applicabl to motor risks only) If you ar not sur whthr you should tll us about somthing, plas tll us anyway. This is for your own protction bcaus, if you do not giv us all th information w nd, your policy may not provid you with th covr you nd, a claim may not b paid, th policy may b dclard invalid and void or may b canclld, and you may ncountr difficulty trying to purchas insuranc lswhr. You should also b awar that failur to hav proprty insuranc in plac could lad to a brach of th trms and conditions attaching to any loan scurd on that proprty. Warning: s it is an offnc undr th Road Traffic ct to mak any fals statmnt or withhold information to gt a crtificat of insuranc, you should mak sur that you answr all qustions fully and accuratly. If th proposr is a firm or a privat company, you must rad and answr th qustions as though thy also apply to ach individual partnr or mmbr. Undr th third EU Non-lif Dirctiv w must giv you th following information bfor you buy your policy. Th law that applis to th contract - Undr th rlvant Europan and Irish laws, w viva Insuranc Limitd and you, th proposr, ar fr to choos th law that will apply to th contract. W propos that Irish law will apply to th contract. W, viva Insuranc Limitd, will provid th insuranc undr this policy. Complaints procdur - W aim to giv xcllnt srvic to all our customrs; howvr, w rcognis that things may occasionally go wrong. W will do our bst to dal with your complaint as ffctivly and quickly as possibl. If you arrangd your policy covr through an intrmdiary or brokr thn you should initially dirct your complaint to thm. If th complaint is not rsolvd to your satisfaction you can contact viva Insuranc Limitd at You can also writ to th ranch Managr - Irland, viva Insuranc Limitd, On Park Plac, Hatch Strt, Dublin or you can contact th following Insuranc Irland s Insuranc Information Srvic, 39 Molsworth Strt, Dublin Phon: Fax: Wbsit: iis@insurancirland.u Th Financial Srvics Ombudsman urau, 3 rd Floor, Lincoln Hous, Lincoln Plac, Dublin Phon: LoCall: Fax: Wbsit: nquiris@financialombudsman.i You will not los your right to tak lgal action if you contact ithr of th abov. DT PROTECTION - viva Insuranc Limitd ( w, us or our ), as data controllr, will kp th information you provid about yourslf and about third partis confidntial. W may us it to advis on, provid and administr insuranc products and financial srvics providd by us or othr viva companis and somtims with our affiliats and/or commrcial partnrs, in ordr to comply with lgal obligations imposd on us. W may shar th information both insid and outsid of th Europan Economic ra, in confidnc, for ths purposs with agnts or srvic providrs w hav appointd, privat invstigators, rgulatory organisations, othr insuranc and financial srvics companis (dirctly or via a cntral rgistr), othr viva group companis, thos to whom w outsourc crtain businss oprations and as rquird by law. W will procss this information and stor it on our computr and manual rcord systms. To assist in prvnting, dtcting and/or protcting our customrs and ourslvs from thft and fraud, w may us your information to mak sarchs of our or othr viva companis rcords. If you giv us fals information or fail to disclos information and w suspct fraud, w will rcord this. W also participat in industry databass such as thos opratd by Insuranc Irland for th purpos of sharing of information among insuranc companis as a chck against non-disclosur. From tim to tim, w may rcord your tlphon calls for vrification and training purposs. If you would lik a copy of th dtails w hold about you, plas writ to th Rgulation and Complianc Managr, viva Insuranc Limitd, On Park Plac, Hatch Strt, Dublin. Plas nclos th corrct f ( 6.35). You also hav th right to corrct any rrors in th information hld about you, block crtain uss or objct to th procssing of your prsonal data. Important: Som of th qustions on this form may ask for dtails about your halth and convictions and th halth and convictions of third partis matrial to this risk plas do not snd us any gntic tst rsults. This information is important for undrwriting and claims purposs and will rmain confidntial. y signing th dclaration blow, you ar giving us prmission to procss ths dtails for th abov purposs, including chcking with third partis or accssing Stat or othr official rcords to vrify whthr th dtails you hav givn ar accurat and complt. y signing blow, you ar confirming that you hav fully xplaind to ach prson who rquirs this insuranc covr why w askd for this information and what w will us it for. You ar also confirming ach prson has agrd to this. ONLY SIGN THE FOLLOWING DECLRTION IF YOU FULLY UNDERSTND, ND HVE MET, LL OF THE OVE REqUIREMENTS. Dclaration I/W confirm that, all th dtails, answrs and information givn in this proposal ar tru, accurat and complt. I acknowldg that this proposal will form th basis of my/our contract with viva Insuranc Limitd. I/W confirm that I/w am/ar giving my/our prmission to you to us th information I/w hav givn on this form for th purposs st out in th Data Protction sction abov. Your Signatur: Dat: / / W would lik to us your dtails to provid you with information about othr financial or insuranc products, srvics and spcial offrs ithr from us or othr viva group companis, or products, srvics and spcial offrs which any mmbr of th viva Group may arrang with a third party. Your dtails may also b usd for this purpos (for up to months) aftr your policy has casd. Plas tick hr if you do not wish to rciv such information from us. Your choic will not affct any of th srvics w provid to you, now or in th futur. ECOG (S) viva Insuranc Limitd, trading as viva, is authorisd by th Prudntial Rgulation uthority in th UK and is rgulatd by th Cntral ank of Irland for conduct of businss ruls. Rgistrd ranch Offic in Irland no Rgistrd ranch ddrss On Park Plac, Hatch Strt, Dublin. Rgistrd in Scotland No 6. Rgistrd Offic Pithavlis, Prth, PH 0NH.

Combined Motor Trade Proposal. Important Information Please read and keep safe

Combined Motor Trade Proposal. Important Information Please read and keep safe Combind Motor Trad Proposal Important Information Plas rad and kp saf Rtirmnt Invstmnts Insuranc Combind Motor Trad Insuranc Proposal Policy Numbr PLEASE ANSWER ALL QUESTIONS IN BLOCK CAPITALS 1 Nam of