Mannion Insurance Farm Quotation Sheet"*" indicates required fieldsName*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 NoHave you ever been declared bankrupt?* Yes NoHave you ever been convicted of any offence of any nature or is any prosecution pending?* Yes NoClaims: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 NoPrivate Dwelling House:Do you require cover for your property?* Yes NoWhat is your Eircode?*Is the Property to be insured a listed building?* Yes NoIs the property on the farmland?* Yes NoYear of Build?*Construction Type* Detached Two-Storey Detached BungalowOccupancy Type* Rented Owner OccupiedNumber of Bedrooms*Number of Bathrooms*Does the property contain any flat roof?* Yes NoPlease include percentage*What is the heating system? Air to water Oil MixedIs the property Alarmed?* Yes NoIf yes, what type of Alarm?Does the property have minimum 2 smoke detectors?* Yes NoHas the property had any claims in the last 5 years?* Yes NoIs the property unoccupied for more than 30 consecutive days?* Yes NoIf yes, please provide details.What is the Building Sum Insured?What is the Contents Sum Insured?*Have you any specified items?* Yes NoIf yes, please specify.Farm Vehicles & Machinery:Do you require cover for any farm Vehicles or machinery? Please also include any trailers belowMake/ ModelReg Number/ ChassisValueMake/ ModelReg Number/ ChassisValueMake/ ModelReg Number/ ChassisValueIs the Vehicle owned by you?* Yes NoDo you have any medical conditions that must be notified to the Driving Licence Authority?* Yes NoHave you any Penalty Points?* Yes NoIf yes, please state when and why you got them.*Have you ever been disqualified from driving?* Yes NoHave you had any motoring accidents in the last 5 years?* Yes NoGeneral Farm Property:Do you require any cover for farm outbuildings?* Yes NoDo you currently have storm cover on the outbuildings?* Yes No With Current ProviderDescriptionYear of BuildValueDescriptionYear of BuildValueDescriptionYear of BuildValueDescriptionYear of BuildValueDescriptionYear of BuildValueDescriptionYear of BuildValueDescriptionYear of BuildValueFarm Implements:Livestock Cover:Do you require Livestock cover?* Yes NoNo. of Cattle/Sheep/Horses/DonkeysTotal ValueNo. of Cattle/Sheep/Horses/DonkeysTotal ValueDo you currently have or require Theft of Livestock?* Yes NoDo you require Pedigree Cover?* Yes NoPublic Liability:Employers Liability:Do you require Employers Liability cover?* Yes NoIf 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 offences, or any other offences 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