Land Insurance
Quote Form

Address: 339 Union Road, Oswaldtwistle, Accrington, Lancashire, BB5 3HS, GB
Telephone: 01254 231 332

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to receive your quote

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Date cover required from?

Current insurance held with?

Current insurance premium

How did you hear about us?

CONTACT DETAILS

Contact name*

First Last

Contact number*

Email*

Correspondence address*

Street Address City / town County Postcode Country

What is the insured’s trading type?

Please provide details

Address of plot of land

Street Address City / town County Postcode Country

If the plot of land address is the same as the correspondence address, is the plot of land on the same title as your home residence?

INTERESTED PARTIES

Do you need to note the interest of an interested party?

Please provide details

LANDOWNERS’ LIABILITY

Public liability limit of indemnity

Is cover required for employers' liability?

Enter the number of employees for the following types

Clerical or non-manual

Farming

Maintenance – heat work

Any other manual work

Are you or your company exempt from having an ERN?

What is your Employer Reference Number (ERN) / Employer PAYE reference?

INFORMATION ABOUT THE LAND TO BE INSURED

Number of years you have owned the land?

Type of land

Please provide details

Is the private road in a good state of repair and regularly maintained?

Size of land (please select the size of the land in acres)

Is the land rented out?

Please provide details

If the land is let out to a Third Party to use as farmland, do they have their own farming insurance policy in place?

Is the land being used for growing crops for a commercial benefit?

Do you allow neighbours to use the land to let their animals graze?

Are there any public footpaths and / or rights of way situated on the land?

Are there any watercourses or significant water features within the land to be insured or adjacent?

Is the land used for any boating, fishing or the mooring of boats?

Is or was the land to be insured used or ever used, by any petrol station, chemical works, gas works, oil refineries, power stations, landfill, waste tip, underground mines, quarrying or any other industries of this nature?

Please provide details

Do you allow any of the following as commercial activities?

Extreme sports (such as off-road BMX)

Shooting

Water sports

Do you allow camping on the land?

Does the land contain any playgrounds or play areas?

Does the land have any perimeter protection such as walls, gates or fences?

Do you allow events on the land such as shows, car boot sales, festivals or similar?

Please provide details

BUILDINGS ON THE LAND

Are there any unoccupied buildings / structures on the land?

Are the unoccupied buildings structurally sound and in a secure area, not accessible to the public?

CLAIMS

During the last five years under any other insurance policy made a claim(s), incurred a loss, damage or liability whether insured or not at any premises, land or any other location

Provide further details including dates, incidents and amounts paid or reserves held below

ADDITIONAL INFORMATION

Please provide any further information or material facts you wish to disclose below

DECLARATION

You or any director or partner in any business, any partner in any partnership, any director of any company, or the company;
either in any personal capacity, in the name of the business proposed or in respect of any other business in which any of you have ever had an interest have:

- Never had a proposal for insurance declined, cancelled or refused;

- Never had insurance cancelled mid-term, a renewal refused, increased or special terms or conditions imposed by an insurer;

- Never been given an official police caution, convicted of, charged (but not yet tried) or have any prosecution pending for any offence (excluding any motoring convictions and any offences which are spent under the Rehabilitation of Offenders Act 1974);

- Never been the subject of or issued with a County Court Judgement (CCJ), money judgement or court decree and/or ever been cited in any unsatisfied court judgements (or the Scottish equivalent) or any other judgements or decrees in relation to debt;

- Never been declared bankrupt or insolvent, the subject of an individual voluntary arrangement (IVA) or company voluntary arrangement (CVA) with creditors, voluntary liquidation, a winding up or administration order, or administrative receivership proceedings, bankruptcy or insolvency proceedings;

- Never been disqualified from being a company director;

- Never been censured by any regulatory or trade body or any action been taken against the company by the office of fair trading, consumer groups or the alike;

- Never been served under any Health & Safety, Welfare, Environmental, Consumer Protection or Food Safety legislation or any other legislation, with any warnings, enforcement measures, prohibition notice, improvement orders, proceedings or criminal proceedings by any Health and Safety Executive, Environmental Health Office, Environment Agency, local or government authority or any other enforcement agency or authority;

- Never been convicted of, charged (but not yet tried) with, officially cautioned or have any prosecution pending for a breach of any Health & Safety, Welfare, Environmental, Consumer Protection, Food Safety legislation or any other legislation;

- Never been the subject of a recovery action by Customs and Excise or the Inland Revenue.

Please confirm if you agree with the declaration*

Please provide details

Land Insurance Quote Form

Land Insurance
Quote Form