Beekeeping Insurance Application

Proposed effective date of policy:*

First Name:*

Last Name:*

Address:*

Street Address City State Zip Code

Email:*

Phone:*

Company Name:

DBA if applicable:

Type:*

Other

Years in business?*

Do you have insurance now?*

Yes

Who is your current insurance provider?

Hidden

What is your premium?

Hidden

Current liability limits:

Number of hives:*

Annual income from honey sales:*

Would you like your quote to include coverage for performing swarm removals?

Yes

Would you like your quote to include coverage for selling products in which the first ingredient is Beeswax, such as candles or lip balms?

Please note that if your products contain CBD, they are excluded from the coverage under this policy.

Yes

Have you had any insurance claims in the last (3) years?*

Yes

Please Explain:*

The applicant represents that the above statement and facts are true and that no material facts have been suppressed or misstated and further acknowledges that the answers provided herein are based on reasonable inquiry and/or investigation.

Completion of this form does not bind coverage. Applicant’s acceptance of the company’s quotation is required prior to binding coverage and policy issuance.

All written statements and materials furnished to the company in conjunction with this application are hereby incorporated by reference into this application and made a part thereof.

Applicant’s Name:*

Date:*

Hidden

Applicant’s Signature:

Applicant’s Signature:*

This field is for validation purposes and should be left unchanged.