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LAND INSURANCE QUOTE
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Policyholder Details

Title
First Name
Surname
Company Name (if applicable)
Contact Tel Number
E-Mail
Type of Land to be Insured
(select all that apply)

Arable Land - an area of land being used to grow crops
Development Site - an area of land that is designated as a site for future development
Development Site (Active) - an area of land that is undergoing development or on which development will proceed during the period of cover
Grazing Land - field or pasture land covered with grass or herbage and suitable for grazing by livestock and horses
Moorland - open land usually with peaty soil covered with heather and bracken and moss
Private Road - well surfaced and less than 0.5 miles long including land immediately adjacent to the road
Private Road (Other) - poorly surfaced and/or longer than 0.5 miles long including land immediately adjacent to the road
Residents Land - land which has had a dwelling erected upon it
Rough Country - large fields of hilly terrain or with scattered rocks
Undeveloped Pasture - undeveloped land with vegetation cover such as a field used for grazing
Woodland - land that is covered with trees and shrubs
Other - please select this and provide a description if you cannot find your type of land listed
Details of land if 'Other' selected above
Risk Details

Address of Land
Street (or nearest street)
Town
County
Post Code (or nearest post code)

Acreage of the site (round up to nearest whole acre)
Are there any watercourses or water features at or adjacent to the land
Are there any automatic gates or barriers on the site
Do the public have rights of access
Is there any childrens' play equipment on the land
Are there any non-residential buildings on the land
Cover

Date Cover Required From
Public Liability
Additional Information

Any Claims, Incidents or Losses in the last 5 years
Additional details that have not previously been
asked and may have a bearing on this risk
including details of any claims
Terms and Conditions

Do you agree with the above terms and conditions: Yes No

All Major Cards And Direct Debit Accepted
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