LIVESTOCKINSURANCE

APPLICATIONAPPLICATION

What you need to tell us

You must tell us everything that you know, or shouldknow, could affect our decision to insure you and/orthe terms on which we insure you. You must do thiswhen you apply for a policy, renew your policy andwhen you change or reinstate your policy. When weask you specific questions, you must answer thesequestions truthfully and in a way that a reasonableperson in the circumstances would answer them. It isimportant that every person who will be insured bythe policy answers all questions in this way. Theserequirements are part of the Insurance Contracts Act

1984.

What you need NOT tell us

You do not need to tell us anything that:

■ Reduces our risk.

■ Is of common knowledge.

■ We know, or as an insurer should know.

■ We say that we do not want to know.

You do not need to tell us about when anotherinsurer has declined cover or refused to renew apolicy because of factors that do not relate to theassessment of your risk. For example, a previousinsurer may have decided to discontinue insuranceagainst injury and illness, for all its customers.

What will happen if youdo not tell us

If you withhold relevant information or you do notanswer our questions in the way we have described,we can reduce the amount we pay you for your claim,or we can cancel your policy. If your failure to tell usis fraudulent, or your answers are untruthful, we cantreat your policy as if it never existed.

When complete, please forward this application to:• CGU Insurance, GPO Box 9902 in the capital city of your state or

• your Insurance adviser• your local CGU Insurance office.

Please read this page and the policy booklet before you complete the application.

Keep this page and the policy booklet so you can refer to them again.

Important Notices

1. Acceptance of the Application

This insurance will not be in force until thecompleted Application has been received and therisk accepted by the Company. The Companyreserves the right to decline any Application.

2. Operations and Anaesthetics

Your attention is drawn to Exclusion Number 6 onpage 5 of the Policy booklet. It is recommendedthat You notify the Company of any intendedoperation or procedure which requires theadministration of any general or local anaestheticto ensure that Your cover is not invalidated.

3. Claims

This policy does not provide cover in relation toevents that occurred before the contract wasentered into.

The way we handle yourpersonal information

We collect personal information from you for thepurpose of providing you with insurance products,services, processing and assessing claims.

You can choose not to provide this information,however, we may not be able to process your requests.

We may disclose information we hold about you toother insurers, an insurance reference service or asrequired by law. In the event of a claim, we maydisclose information to and/or collect additionalinformation about you from investigators or legaladvisors.

If you wish to update or access the information wehold about you, contact us.

CGU Insurance Limited ABN 27 004 478 371 An IAG Company

RMA Insurance Brokers Pty Ltd

P: 1300 650 254

E: info@rmainsurance.com.au W: www.rmainsurance.com.au RMA Insurance Brokers ABN 62 495 340 856 Authorised Representative Number: 464657

RMA Insurance Brokers is the preferred insurance

advisor to the rma network. Below are the

guidelines for private sale applications on stud

insurance. For more information visit

www.rmainsurance.com.au

Why is this document important?

This document outlines the guidelines and

frequently asked questions about private sales. It

will provide you with the knowledge to assist your

clients complete the attached application.

When is a veterinarian report required?

Veterinarians report/sign off is required when the

sum insured exceeds $10,000 (per animal)

Or the extension “loss of use accident & illness” is

requested (regardless of sum insured).

What details are required for agent sign off?

If the sum insured is under $10,000 and the

extension “loss of use accident & illness” is not

requested, an agent must provide their name and

current qualifications/years of experience upon

signing the application.

What stamp duty applies?

The property address where the bull is to be

located will determine the stamp duty. Please find

stamp duty rates at the bottom of your RMA stud

insurance card.

Does minimum premium apply to private sales?

Yes, a minimum base premium of $150 (GST and

Stamp Duty to be added).

What is the sum insured?

The sum insured of any catalogue or private sale is

the purchased price of the animal by the insured.

This is to be verified in the inspector/agent report

(question 1) or by an invoice.

Is there age restrictions on stud stock insurance?

The following age restrictions apply:

Cattle, Min: 6 months, Max: 7 years

Sheep, Min: 6 months, Max 4 years

I want to insure 2 animals at different levels of

cover, what is required?

If 2 different levels of cover (either period of

insurance or cover extensions) is requested, then

2 separate applications will need to be

completed.

Can I insure an animal I intend to lease?

Yes. If you intend to lease or rent an animal, cover

can be provided. You will have to note the third

party involved under the animal details section of

the application.

When and where to send this application?

It is important to complete and forward this

private sale application to rma network

immediately after sale, to ensure cover can be

assessed.

Email : office@rma.com.au

Who can sell this policy?

Any rma network member signing off on this

policy needs to have completed the RMA

Insurance Brokers Stud Stock Training module and

accreditation. Link to training module below if

you don’t have this accreditation.

http://rmainsurance.com.au/livestock-stud-

insurance-training/

When is cover effective?

The date that you request cover is subject to

Insurer review and acceptance based on the

information you provide. Hence the importance

to provide up to date and correct information

and submit to rma network immediately. You will

be notified within 48 hours of submission of any

issues regarding the application.

To find out more simply call 1300 650 254

www.rmainsurance.com.auwww.rmainsurance.com.au

RMA Insurance Brokers Pty Ltd

P: 1300 650 254

E: info@rmainsurance.com.au W: www.rmainsurance.com.au RMA Insurance Brokers ABN 62 495 340 856 Authorised Representative Number: 464657

Stud Insurance Information Cover Provided

You can cover your stud stock with one simple

down to earth policy which can provide

immediate protection against:

Death due to Accident

Death due to Illness or Disease

Loss of use due to Accident

Loss of use due to Illness

Benefits:

Death due to destruction on humane

grounds

Death caused by accident during

transportation

What is not covered?

Genetic infertility

Surgical operations unless we agree and

note on your policy, or the operation is

preformed to preserve the life of the

animal

Wilful neglect or intentional injury by you

Death caused by: Anthrax, Anaplasmosis,

Babesiosis, Footrot, Johne’s Disease, Pleuro

Pneumonia, Swine Fever, Tuberculosis, Blue

Tounge, Rindepest, Infectious Adenovirus,

Hepatitis, Parvo Virus, Distemper, Caprine

Arthritis Encephalitis, Foot and Mouth

Disease, Bovine Spongiform

Encephalopathy (BSE or Mad Cow

Disease), Brucellosis.

Claims Settlement

Settlement of claims is subject to post mortem, by

a veterinarian to establish the cause of death.

Destruction on humane grounds has to be

authorised and performed by a veterinarian.

Policy Wording

http://rmainsurance.com.au/wp-

content/uploads/2016/05/Livestock-insurance-

Wording.pdf

To ensure cover send to rma network or RMA

Insurance Brokers immediately.

Refer to Guidelines on Veterinarian Reports.

Additional Client Information Required

Phone number _______________________________

Email Address: ________________________________

This is required to receive information regarding renewal of

your insurance policy.

To find out more simply call 1300 650 254

LIVESTOCK INSURANCE APPLICATION

Please answer all questions. This will help us to process your application quickly.

If you need more space to answer any of the questions, please use a separate sheet of paper.

Any attachments will form part of this application and the declaration will include them.

Policy is: New

Replacement

: : : : : :21A

LOB: SLD TB: AL

: : : : :

Accept

CGU Insurance use only

N

INSD SORT

: : : :

Period of Insurance

From

/ /

To 4.00 p.m. on

/ /

Agent or broker

Name Policy no.

: : : : : :

Previous Policy or Cover Note no.

Applicant

Postcode

Address

Surname Given name(s)

Name(s) of Applicant(s) - state Surname, Given name(s) and Company name as applicable

Surname Given name(s)

Postcode

Location of animals (if different to postal address)

Business or occupation

Description of animals to be insured

$ SumInsured Rate

1. Type of animal

Name Date of birth

/ /

Sire Dam Catalogue sales no.

Colour, ID Marks, Brand and Tag Numbers

$

Is any other party financially interested in the animal to be insured?

No Yes State

a) Type of interest

b) Name of interested party

c) Address

Postcode

Male

Female

Sex:

CGU Insurance Limited ABN 27 004 478 371 An IAG Company

Description of animals to be insured.. cont

Variations and Extensions

Do you require cover for Loss of Use - Bulls and Stallions only?

No Yes Indicate whether:

a) Accident only

b) Accident, illness ordisease

No Yes Animal No.(s) as shown overleaf

No Yes Animal No.(s) as shown overleaf

$ SumInsured Rate

2. Type of animal

Name Date of birth

/ /

Sire Dam Catalogue sales no.

Colour, ID Marks, Brand and Tag Numbers

$

Is any other party financially interested in the animal to be insured?

No Yes State

a) Type of interest

b) Name of interested party

c) Address

Postcode

Male

Female

Sex:

$ SumInsured Rate

3. Type of animal

Name Date of birth

/ /

Sire Dam Catalogue sales no.

Colour, ID Marks, Brand and Tag Numbers

$

Is any other party financially interested in the animal to be insured?

No Yes State

a) Type of interest

b) Name of interested party

c) Address

Postcode

Male

Female

Sex:

Please tick (✓) Yes or No and give details as requested.

Questionnaire: All questions must be answered by each of the applicants and not by the agent or broker.If insufficient space, please provide additional details on a separate page.

Yes No

1. Is any animal proposed for insurance suffering from any sickness, disease or injury?

If Yes, state which animal(s) and give details of the sickness, disease or injury

2. Has any animal proposed for insurance undergone surgery or been treated for any sickness,disease or injury in the past 12 months?

If Yes, state which animal(s) and give details of the surgery, sickness, disease or injury

3. State the current market value of Animal No.1

$

Animal No.2

$

Animal No.3

$

4. Did you purchase any animal proposed for insurance by private sale?

If Yes, state the following Animal No.1 Animal No.2 Animal No.3

Date Purchased / / / / / /

$ $ $ Purchase Price

5. State the purpose for keeping:

Animal No.1 Animal No.2 Animal No.3

6. Is any animal proposed for insurance a bull or stallion used for breeding purposes?

If Yes,

a) When did he commence stud duties?

b) How many females did heservice last season?

c) Has he proved a successful Sire?

d) Of those females serviced lastseason, what was his successratio?

Animal No.1 Animal No.2 Animal No.3

/ / / / / /

No Yes No Yes No Yes

7. If any animal is a stallion at stud.

a) What is his present servicefee?

b) What was his service feelast season?

c) Will he be turned loose withmares at any time?

$ $ $

$ $ $

No Yes No Yes No Yes

8. Is any animal a brood mare?

a) When is she due to foal?

b) Is she foaling for the first time?

If No, 1. How many foals hasshe had?

2. How many wereborn dead?

3. Has she had anytrouble in foaling?

/ / / / / /

No Yes No Yes No Yes

Please tick (✓) Yes or No and give details as requested.

Questionnaire: All questions must be answered by each of the applicants and not by the agent or broker.If insufficient space, please provide additional details on a separate page.

I/We declare that:

a) the information in this application is true and correct and I/we have not withheld any relevant information.

b) to the best of my/our knowledge the animals are sound and the sums proposed for insurance represent their fullvalue.

c) I/we undertake to exercise all reasonable precautions for the safety of the animals to be insured.

d) I/we agree to accept the insurance subject to the terms, exclusions, conditions and limitations of the company’spolicy.

e) I/we have received the Notices required under the Insurance Contracts Act 1984.

f) I/we authorise the company to obtain or supply details of claims and other relevant information.

DateSignature of the Applicant

/ /

DateSignature of the Applicant

/ /

Declaration - this panel must be completed by the Applicant(s)

If Yes, state the animal No.(s) and details of the trouble(s).

Yes No

9. Have the animals proposed for insurance been previously insured?

If Yes, state name of previous insurer.

NOTE: If more than one person is applying for insurance, the following questions must beanswered in respect of each individual person.

10.Do you hold any other types of insurance with this company?

If Yes, give full name of person, the types and details of the policies.

11. Has any company declined an application from you or cancelled or refused to renew your policyor required terms to insure you?

If Yes, give full name of person, date, name of insurer and details of action taken by the company.

12. Have you ever sustained a loss by any of the events against which you propose to insure?

If Yes, give the full name of the person, date, details of the loss, name of the insurance company.

13. Are there any other relevant facts which should be disclosed?

If Yes, give the full name of the person and the relevant information.

Agent’s or Inspector’s Confidential Report

1. a) In your opinion what is the actual present market value of each animal?

Animal No.1 Animal No.2 Animal No.3

$ $ $

4. State name of the occupant(s) of the premises where the animals are kept

Animal No.1

Animal No. 2

Animal No.3

5. From your knowledge of the occupants, applicant and the animal(s) have you any doubt about recommendingthe company to accept this application?

No Yes State your reasons

6. Further remarks

DateSignature of Agent or Inspector

/ /

......................... ....:....:....:....:.... .............................. ....:....:........:....:.... .... $.............. $..............$..............

......................... ....:....:....:....:.... .............................. ....:....:........:....:.... .... $.............. $..............$..............

......................... ....:....:....:....:.... .............................. ....:....:........:....:.... .... $.............. $..............$..............

............................

............................

UNT M/PTL

HT

TC

LA

LI

LC

TF

IC

UF

SHRSYN

SHRINS

SD PREMIUM

STAMPDUTY

AMOUNTPAYABLE

RATECHARGE

100 575

YRBI

b) Is any animal valued over cost price?

State animal No.(s) and the reasonNo Yes

3. Has the applicant any other stock including mares in foal that are not insured?

No Yes State the reason for not insuring them

2. Are the animals now healthy and in good condition?

Yes No State the animal No.(s) and the ailment or injury

/ Name / Qualifications / Years experience

Upon signing this document, please answer question 6 with your name / qualifications / years experience.

*

C0669 REV2 3/03

CGU Insurance LimitedABN 27 004 478 371

An IAG Company