Important information Who is Rural Affinity? Rural Affinity Insurance Agency Pty Ltd (ABN 72 119 838 854 AFS Licence No. 302182) is an underwriting agent. In transacting this insurance, Rural Affinity is acting as an agent for Great Lakes Reinsurance (UK) PLC. Who is the Insurer? This insurance is underwritten by Great Lakes Australia, an authorised Australian insurer, regulated by the Australian Prudential Regulation Authority ( APRA ). Great Lakes Australia is a branch of Great Lakes Reinsurance (UK) PLC (ARBN 127 740 532, ABN 18 964 580 576, AFS Licence No. 318603), which is a limited liability company incorporated in England and Wales and a wholly owned subsidiary of the Munich Reinsurance Company. The Munich Re Group is one of the largest insurance groups in the world. Great Lakes Australia has strong financial security characteristics. However, please note that ratings can vary from time to time. You can check Great Lakes Australia s current rating at the following website: Standard & Poors: www.standardandpoors.com Great Lakes Australia can be contacted as follows: 143 Macquarie Street, Sydney, NSW, 2000 PO Box H35 Australia Square, Sydney, NSW, 1215 (02) 9272 2050 reception@gla.com.au www.gla.com.au Great Lakes Australia is a party to the General Insurance Code of Practice.You can access the Code at www.codeofpractice.com.au or via the Great Lakes Australia website. Privacy Statement We and Rural Affinity are committed to the safe and careful use of Your personal information in the manner required by the Privacy Act 1988 (Cth), the Australian Privacy Principles and the terms of this PDS. We and Rural Affinity collect Your personal information in order to assess Your application for insurance and, if Your application is accepted, to administer and manage Your insurance policy and respond to any claim that You make. To do this, Your personal information may need to be disclosed to reinsurers and service providers and related entities who carry out activities on Our and Rural Affinity s behalf, such as assessors and facilitators, some of whom may be located in overseas countries. Our and Rural Affinity s contractual arrangements generally include an obligation for these reinsurers, service providers and related entities to comply with Australian privacy laws. By providing Us and Rural Affinity with Your personal information, You consent to the disclosure of Your personal information to reinsurers, service providers and related entities in overseas countries to enable Us and Rural Affinity to assess Your application, to administer and manage Your insurance policy and to respond to any claim that You make. If You consent to the disclosure of Your personal information to overseas recipients, and the overseas recipient handles Your personal information in a way other than in accordance with the Australian privacy laws, We and Rural Affinity may not be responsible for the handling of Your personal information by the overseas recipient. If You choose not to provide Your personal information and/or choose not to consent and/or withdraw Your consent to the disclosure of Your personal information to overseas entities at any stage, We and/or Rural Affinity may not be able to assess Your application or administer and manage Your insurance policy and respond to any claim that You make. Our and Rural Affinity s privacy policies explain how You may access personal information that each of us holds, how to seek correction of Your personal information, how to make a complaint about the handling of Your personal information and how complaints are handled. If You require more information, You can access the Great Lakes Australia Privacy Policy and Privacy Statement at www.munichre.com/io/gla/en/privacy_statement.aspx and Rural Affinity s Privacy Policy and Privacy Statement at ruralaffinity.com.au/privacy_statement Dispute resolution We view seriously any complaint made about Our products or services and will deal with it promptly and fairly. If You have a complaint please first try to resolve it by speaking to the relevant member of Our staff. If the matter is still not resolved, please then contact Our Internal Disputes Resolution Officer on (02) 9496 9300. If the complaint relates to the insurance cover We will work with Great Lakes Australia to resolve the complaint. We will, provided We have sufficient information, complete the review within 15 working days. Where We are unable to do so, We will agree a new timeframe for responding to You. In any case, We will provide You with an update every 10 working days. If You are a natural person or a small business, and You are not satisfied with the final decision, You may wish to contact the Financial Ombudsman Service (FOS). The FOS is a free independent external disputes resolution service provided to customers to review and resolve complaints where We have been unable to satisfy Your concerns. For further details you can visit their website www.fos.org.au or contact them: GPO Box 3, Melbourne, VIC, 3001 1300 78 08 08 info@fos.org.au Rural Affinity Insurance Agency Agency RAFPFORM0314 1
Cooling-off Period You have a cooling-off period that allows You to cancel Your Policy within 21 days of it being issued if You tell Us within this period. If You have not made any claims on Your Policy, We will refund in full the premium You have paid. Your Duty of Disclosure Before You enter into a contract of insurance with Us, the Insurance Contracts Act 1984 requires You to provide Us with the information We need to enable Us to decide whether and on what terms Your proposal for insurance is acceptable and to calculate how much premium is required for Your insurance. You will be asked various questions when You apply for this policy. When You answer these questions, You must: 1. give Us honest and complete answers, 2. tell Us everything You know, and 3. tell Us everything that a reasonable person in the circumstances would be expected to tell Us. What You do not need to tell Us You do not need to tell Us about any matter: 1. that diminishes Our risk, 2. that is of common knowledge, 3. that We know or should know as an insurer, or 4. that We tell You We do not need to know. Who does the duty apply to? Everyone who is insured under this policy must comply with the duty. What happens if You or they do not comply with the duty? If You or they do not comply with the relevant duty, We may cancel the policy or reduce the amount We pay if You make a claim. If fraud is involved, We may treat the policy as if it never existed and pay nothing. Rural Affinity Insurance Agency Agency RAFPFORM0314 2
Intermediary details Intermediary name Contact number Contact name Fax number Contact details of insured Insured name Contact name ITC Contact number Fax number Email address Mobile number Address ABN Period of Cover From To Information relating to all sections of the policy In the past 5 years, have You: 1. Made any claim for loss, damage or liability? Yes No If Yes, please provide details: INSURER AMOUNT DATE DESCRIPTION Rural Affinity Insurance Agency Agency RAFPFORM0314 3
2. Had any insurance declined or cancelled, proposal rejected, renewal refused, claim rejected or any special conditions imposed on Your policy? Yes No If Yes, please provide details: 3. Or any partner(s) or director(s) become insolvent or subject to any form of insolvency or administration (such as liquidation or receivership)? Yes No If Yes, please provide details: 4. Been convicted of any criminal offence (other than minor traffic infringements)? Yes No If Yes, please provide details: Information relating to all sections of the policy Situation NO SITUATION eg. Waroo ADDRESS eg. RMB 1234, Dubbo NSW 2830 PROPERTY SIZE (ha) eg. 1500 ha FARMING BUSINESS eg. Mixed Farming 1 2 3 4 5 Rural Affinity Insurance Agency Agency RAFPFORM0314 4
Other business If cover is to be provided for any business (other than described above) please provide details, including the nature of the business and estimated gross turnover (eg. contract harvesting $50,000). Interested parties Are the interests of any other party to be noted on any of the property insured under this policy? Yes No If Yes, please provide details: PROPERTY INSURED INTERESTED PARTY eg. ABC Bank ADDRESS OF INTERESTED PARTY NATURE OF INTEREST eg. Mortgagee, Lessor Rural Affinity Insurance Agency Agency RAFPFORM0314 5
Section 1._DOMESTIC BUILDINGS/DOMESTIC CONTENTS The fresh approach to farm insurance SITUATION NO. PROPERTY DESCRIPTION eg. Main homestead BUILDING SUM INSURED CONTENTS SUM INSURED BUILDING CONSTRUCTION ESTIMATED YEAR OF CONSTRUCTION NO. OF BEDROOMS WALLS ROOF Is any Property to be unoccupied for a period in excess of 90 consecutive days? Yes No If Yes, please detail Is the power connected to all buildings? Yes No If No, please detail Have any of the Properties undergone renovations since 1960 (eg, re-stumping, rewiring, re-roofing)? Yes No If Yes, please detail SPECIFIED CONTENTS AND VALUABLES For Domestic Contents there are limits on the Sum Insured for certain items (refer to page 16 of the PDS). If cover is required for a Sum Insured greater than these limits, please provide details below: SITUATION DESCRIPTION SUM INSURED Excess $250 (standard) $500 $750 $1,000 Flood Do You wish to insure against loss, damage or destruction caused by Flood? The most We will pay in the Period of Cover is $20,000. (N.B Additional premium will apply.) Rural Affinity Insurance Agency Agency RAFPFORM0314 6
The fresh approach to farm insurance Section 2. FARM PROPERTY & MACHINERY Farm Buildings, Farm Contents and Other structures (including stock yards, free standing grain or feed silos, windmills, water tanks and power/telephone lines and poles). SITUATION NO. DESCRIPTION eg. Machinery shed, windmill BUILDING CONSTR. eg. Brick / Iron, Wood / Iron TYPE OF COVER (R) Replacement (I) Indemnity SUM INSURED ACCIDENTAL DAMAGE YES / NO EST. YEAR OF CONSTR. Do any of Your Farm Buildings have sandwich panelling greater than 10%? Yes No If Yes, please provide details: Is Hay stored in any of the Farm Buildings? Yes No If Yes, please provide details: www.ruralaffinity.com.au ABN 72 119 838 854 AFS Licence No. 302182 Rural Affinity Insurance Agency Agency RAFPFORM0314 7
Section 2. FARM PROPERTY & MACHINERY (continued) Self Propelled Agricultural Machinery or Vehicles SITUATION NO. DESCRIPTION OF MACHINE / VEHICLE eg. Tractor AUTOMATIC FIRE SUPPRESSION YES / NO SUM INSURED Livestock, Fencing, Farm Produce and Farm Trees etc SITUATION NO. DESCRIPTION eg. Fencing, Livestock, Farm Trees, Hay etc (include Length of Fencing, Number of Head, Number of Units, etc) SUM INSURED Excess $250 (standard) $500 $750 $1,000 Optional Benefits 1. Do You require cover for Increased costs? (This covers the additional expenses that are not normally incurred to maintain the Farming Business at the same level of productivity as the 12 months before a loss or damage). Yes No If Yes, please select a Sum Insured : 2. Do You require cover for Loss of stored semen? Yes No Note: Cover is limited to $75 per straw and $5,000 during the Period of Cover. 3. Do You require cover for Unspecified Farm Buildings? Yes No Note: Cover is limited to $20,000 during the Period of Cover. 4. Do You require cover for Unspecified Farm Machinery? Yes No Note: Cover is limited to $5,000 per item during the Period of Cover. Rural Affinity Insurance Agency Agency RAFPFORM0314 8
Section 3. FARM MOTOR Do any Vehicles to be insured have any existing hail damage? Yes No Do any Vehicles to be insured have any unrepaired damage? Yes No Do You carry out any commercial carrying operations not associated with the Farming Business? Yes No Have any regular drivers to be covered under this policy been charged in the last 5 years ( or have charges pending ) for: a) dangerous or culpable driving Yes No b) reckless driving causing death? Yes No c) driving under the influence of drugs or alcohol? Yes No d) refusing to provide a breath test? Yes No If You have answered Yes to any of the above questions, please provide details: Rural Affinity Insurance Agency Agency RAFPFORM0314 9
Section 3. FARM MOTOR (continued) The fresh approach to farm insurance Utes and Sedans VEHICLE MAKE eg. Toyota MODEL eg. Landcruiser YEAR REGISTRATION NUMBER TYPE OF COVER 1. Comprehensive 2. Fire & Theft 3. Fire, Theft & Third Party 4. Third Party only EXCESS FREE WINDSCREEN CLAIMS PER VEHICLE (one per Period of Cover) YES / NO SITUATION WHERE GARAGED BASIS OF SETTLEMENT Agreed Value / Market Value ACCESSORIES & VALUE SUM INSURED Rural Affinity Insurance Agency Agency RAFPFORM0314 10
Section 3. FARM MOTOR (continued) The fresh approach to farm insurance Farm Vehicles DESCRIPTION eg. Ford Tractor YEAR REGISTRATION NUMBER TYPE OF COVER 1. Comprehensive 2. Fire & Theft 3. Fire, Theft & Third Party 4. Third Party only SITUATION NO. WHERE GARAGED ACCESSORIES & VALUE SUM INSURED Is any vehicle used for contracting? Yes No If Yes, please provide details: Rural Affinity Insurance Agency Agency RAFPFORM0314 11
Section 4. FARM LIABILITY Total number of full time employees (including proprietors) Sum Insured $5m $10m $20m What is Your estimated gross turnover from farm contracting activities? $ Nature of contracting Note: If gross turnover exceeds $100,000 during the Period of Cover, You must advise Rural Affinity. Do You require cover for farm hosting activities? (eg. farmstay) Yes No If Yes: Estimated annual gross turnover $ Number of rooms Note: No cover is provided for abseiling, aquaplaning, flying in any air vessel, motor cycling, quad biking, power boating, water skiing, rock climbing, mountaineering, horse riding or equestrian activity. Optional Benefits Do You require cover for aerial crop spraying? Yes No Note: The Sum Insured for aerial crop spraying is $500,000 and an Excess of $5,000 applies. Do You require cover for milk tanker contamination? Yes No Note: The Sum Insured for milk tanker contamination is $25,000 and an Excess of $250 applies. Section 5. LAND TRANSIT Sum Insured $ Do You require cover for accidental damage? Yes No Excess $250 (standard) $500 $750 $1,000 Section 6. FARM THEFT Sum Insured for Theft of Your Farm Contents or specified items $ Do You have any specified items that are to be insured? Yes No If Yes, please provide details below: SPECIFIED ITEM - DESCRIPTION SUM INSURED Excess $250 (standard) $500 $750 $1,000 Optional Benefit Do you require Theft of money? Yes No If Yes, please nominate Sum Insured for Theft of Money $ Rural Affinity Insurance Agency Agency RAFPFORM0314 12
Section 7. MACHINERY BREAKDOWN 1. Blanket Cover Shearing Plant Yes No If Yes, number of stands Dairy Plant Yes No If Yes, size of vat 2. Pumps and Motors (below 20Hp) DIESEL / PETROL ABOVE GROUND / SUBMERSIBLE SIZE (Kw/Hp) NUMBER 3. Specified Items DESCRIPTION SIZE (Kw/Hp) SUM INSURED Optional Benefit Do You require cover for refrigerated goods? Yes No Note: The Sum Insured for deterioration of refrigerated goods is $5,000 and an Excess of $250 applies. Declaration I/We Agree that when this proposal is accepted by Rural Affinity, cover is bound and I/We agree to pay the premium quoted Have received a copy of the Farm Pack Product Disclosure Statement and agree to accept the insurance subject to the terms and conditions and limitations of this Policy Have read and understood the Privacy information and consent to the collection, storage, use and disclosure of personal information of all persons covered in this Proposal Form. Where personal information has been provided on someone else s behalf, that person has consented to this provision Have read and understood the Duty of Disclosure information and other Important information and I/We realise that if I/we have not complied with the Duty of Disclosure, any claims may not be met. Declare everything on this proposal to be true and correct and I/We have not withheld any relevant information. Your signature Date Rural Affinity Insurance Agency Agency RAFPFORM0314 13