Mannion Insurance Farm Quotation Sheet "*" indicates required fields Name* Postal Address* Address of Property to be Insured.(If different to Postal Address) Date of Birth* DD slash MM slash YYYY Contact Number* Joint Policy Holder (if applicable) Date of Birth (if applicable) DD slash MM slash YYYY Renewal/Cover Date* DD slash MM slash YYYY Current Insurer* Have you ever been refused insurance or have any special terms imposed? Yes No Have you ever been declared bankrupt?* Yes No Have you ever been convicted of any offence of any nature or is any prosecution pending?* Yes No Claims:Please provide details of any claims in the last 5 years.Farm Details:What type of Farming are you engaged in?*BeefSheepDairyMixtureOtherAre you involved in any other Farm linked activities?*Examples: Agri Contracting, Farm Walks, Auctions, etc. What are the total number of acres owned/leased by you?* Are you involved in Agri Contracting?* Yes No Private Dwelling House:Do you require cover for your property?* Yes No What is your Eircode?* Is the Property to be insured a listed building?* Yes No Is the property on the farmland?* Yes No Year of Build?* Construction Type* Detached Two-Storey Detached Bungalow Occupancy Type* Rented Owner Occupied Number of Bedrooms* Number of Bathrooms* Does the property contain any flat roof?* Yes No Please include percentage* What is the heating system? Air to water Oil Mixed Is the property Alarmed?* Yes No If yes, what type of Alarm? Does the property have minimum 2 smoke detectors?* Yes No Has the property had any claims in the last 5 years?* Yes No Is the property unoccupied for more than 30 consecutive days?* Yes No If yes, please provide details. What is the Building Sum Insured? What is the Contents Sum Insured?* Have you any specified items?* Yes No If yes, please specify. Farm Vehicles & Machinery:Do you require cover for any farm Vehicles or machinery? Please also include any trailers belowMake/ Model Reg Number/ Chassis Value Make/ Model Reg Number/ Chassis Value Make/ Model Reg Number/ Chassis Value Is the Vehicle owned by you?* Yes No Do you have any medical conditions that must be notified to the Driving Licence Authority?* Yes No Have you any Penalty Points?* Yes No If yes, please state when and why you got them.* Have you ever been disqualified from driving?* Yes No Have you had any motoring accidents in the last 5 years?* Yes No General Farm Property:Do you require any cover for farm outbuildings?* Yes No Do you currently have storm cover on the outbuildings?* Yes No With Current Provider Description Year of Build Value Description Year of Build Value Description Year of Build Value Description Year of Build Value Description Year of Build Value Description Year of Build Value Description Year of Build Value Farm Implements: Livestock Cover:Do you require Livestock cover?* Yes No No. of Cattle/Sheep/Horses/Donkeys Total Value No. of Cattle/Sheep/Horses/Donkeys Total Value Do you currently have or require Theft of Livestock?* Yes No Do you require Pedigree Cover?* Yes No Public Liability:Employers Liability:Do you require Employers Liability cover?* Yes No If Yes, please provide details? Additional InformationThe above information was provided by: Please upload supporting documentationMax. file size: 32 MB.* please note we accept .pdf - .jpg - .png files onlyDate* DD slash MM slash YYYY I confirm that neither Proposer(s) nor Occupant(s) of the premises have:* By ticking this box, I confirm that neither Proposer(s) nor Occupant(s) of the premises have:*• had insurance refused, declined or special terms imposed; • been cautioned, charged or convicted of any criminal offense, or any other offense involving dishonesty of any kind, within the past 7 years (excluding driving offenses under the Road Traffic Acts); • been declared bankrupt.By ticking this box, I confirm that I have answered all questions honestly and with reasonable care to ensure all responses are accurate to the best of my knowledge. If I have any reason to doubt the accuracy of the information provided, I shall contact Mannion Insurances immediately. I am aware that any negligent or fraudulent misrepresentation could invalidate or affect my policy and/or lead to a policy cancellation.* By ticking this box, I confirm that I have answered all questions honestly and with reasonable care to ensure all responses are accurate to the best of my knowledge. If I have any reason to doubt the accuracy of the information provided, I shall contact Mannion Insurances immediately. I am aware that any negligent or fraudulent misrepresentation could invalidate or affect my policy and/or lead to a policy cancellation.*Consent* By clicking Submit, I/We consent to Mannion Insurances Terms of Business & Privacy Statement which can be found here .* IMPORTANT: Cover does not commence until formally confirmed by a member of our staff.CAPTCHA