Farm Insurance Questionnaire


A farm insurance questionnaire is to be filled by farm insurance policy holders. The questionnaire is intended to analyse the requirements of the policy holders regarding the farm details and the related insurance needs. The below sample farm insurance questionnaire can help to know the type of questions to be asked.

Sample Farm Insurance Questionnaire:

Full Name of the farm owner: _______________________

Name of the farm: ________________________________

Full Address

Street: ______________City: _________________State: ____________________________

Phone Number: ________________________

Email address: _________________________

Policy State date: _______________________

Policy End date: ________________________

Q1. Please provide total area of the farm in acres ?

_________________

Q2. Please provide details regarding the locations of your farm

Location: _______________ No. of acres: ____________

Location: _______________ No. of acres: ____________

Location: _______________ No. of acres: ____________

Q3. Please list down the claims that have occurred in the past five years

___________________________________________________

___________________________________________________

___________________________________________________

Q4: What is the average number of horses / buffalos at any point of time during the year in your farm?

________________

Q5: What type of farm do you own?

___________________________________

Q6. How long have you been staying in the farm?

___________________________________

Q7. Please provide the following details regarding the farm insurance

Location: ___________ Equipment insurance value: ___________ Feed insurance: _________

Location: ___________ Equipment insurance value: ___________ Feed insurance: _________

Location: ___________ Equipment insurance value: ___________ Feed insurance: _________

Q8. Have you also included tractor insurance in your farm insurance policy?

a)   Yes

b)   No

Q9. If the answer to the above question is ‘yes’, please provide the details

____________________________________

Category: Insurance Questionnaire

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