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TRAVELERS INSURANCE COMPANY TRAVELERS AGRIBUSINESS CUSTOM FARMING QUESTIONNAIRE (Risk Placement Services, Inc.)

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TRAVELERS INSURANCE COMPANY
TRAVELERS AGRIBUSINESS
625 Eden Park Driv
e, Suite 500
Cincinnati, OH. 45202
CUSTOM FARMING QUESTIONNAIRE
DATE:
TO:
RE:
Policy #:
Please provide us with the following information regarding the insured’s custom farming activities.
• TYPE OF OWNED
CROPS:__________________________________________________________
• CROPS CUSTOM
FARMED:_________________________________________________________
• FARMING RECEIPTS:____________________________________
• CUSTOM FARMING RECEIPTS:___________________________
• OPERATIONS PERFORMED:______________________________________________________
• DOES THE CUSTOM FARMING INCLUDE ANY CHEMICAL APPLICATION? (If yes,
explain in “Remarks.”):______________
• RADIUS OF OPERATION:_________________________________
• IS THE EQUIPMENT TRAILERED FROM ONE LOCATION TO THE NEXT OR DRIVEN
OVER ROADS?______________________________________________________________
REMARKS/DESCRIPTION OF CUSTOM FARMING LOSSES PAST 3 YEARS:
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Completed 30 July 2020

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