Livestock in Transit - Member Insurance Application

Please complete this form to apply for Livestock in Transit Insurance. Have your business details, livestock information and recent loss history available before you begin.

Submitting this form does not confirm that cover has been accepted or that insurance is in place. RMA Insurance Brokers will review the information and contact you if anything further is required.

Member Business & Contact Details

rma network Member Office *

Member First Name *

Member Last Name *

Member Email Address *

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A one-time verification code will be sent to this address from no-reply@snapforms.com.au

Member Contact Number *

Member Business Details

Legal Entity Name *

ABN *

Number of Years in Business *

Business Address *

Street Address *Address Line 2

Suburb or Town *

State *

Postcode *

Description of Business *

Livestock Details

Select each type of livestock transported by the business. Additional questions will appear for each type selected.

Cattle Details

Cattle Description

Cattle estimate value carried per annum *

Sheep Details

Sheep Description

Sheep estimate value carried per annum *

Goats Details

Goats Description

Goats estimate value carried per annum *

Pigs Details

Pigs Description

Pigs estimate value carried per annum *

Stud Stock Details

Stud Stock Description

Stud Stock estimate value carried per annum *

Poultry Details

Poultry Description

Poultry Estimate Value Carried per Annum (AUD) *

Horses (excluding bloodstock)

Horses (excluding bloodstock) Description

Horses (excluding bloodstock) estimate value carried per annum *

Total Estimated Value Carried per Annum (AUD)

Previous History

Answer the following questions about the business’s recent loss and insurance history.

Has the business suffered any insured losses during the last three years? *

YesNo

Insured Loss Details (include dates, causes and amounts) *

Has the business suffered any uninsured losses during the last three years? *

YesNo

Uninsured Loss Details (include dates, causes and amounts) *

In the last five years, has any insurer declined, cancelled or refused to renew the business’s insurance, or imposed special terms or conditions? *

YesNo

Previous Insurance Decision Details *

Supporting Documents (Optional)

Upload up to three supporting documents relevant to this application. Maximum file size is 5 MB per document.

Document 1

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Document 2

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Document 3

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Declaration and Submission

Please review the information entered before submitting this application. RMA Insurance Brokers will use the information provided to assess the application and may contact you if further information is required.

Personal information will be handled in accordance with the RMA Insurance Brokers - Privacy Policy

This form is provided through Snapforms. Information submitted through the form is encrypted and stored in Australia.

Submitting this form does not confirm that cover has been accepted or that insurance is in place.

I confirm that I am authorised to submit this application and that, to the best of my knowledge, the information provided is true, complete and correct. *

RMA Insurance Brokers
1300 650 254
info@rmainsurance.com.au
rmainsurance.com.au

Insura Broking Group (Aust) Pty Ltd, trading as RMA Insurance Brokers, ABN 41 825 622 933, is a Corporate Authorised Representative (AR No. 1267581) of McCormick Harris & Associates Pty Ltd, ABN 29 912 806 252 (Australian Financial Services Licence No. 238979).

Security Verification *

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