Aquaculture Proposal Form s1

Aquaculture Proposal Form

Fish Farm Proposal Form (Marine & Freshwater Cage Sites)

Checklist: Please make sure to include the following with your submission Completed  Annotated Mooring Diagram including any barges and feeding systems  Production plan  Indemnity scale to reflect cost of production  Site location / map  Site diagram Please note there are extra pages at the back of this proposal form for additional information that may be relevant for this proposal. Fish Farms (Marine & Freshwater)

CONSENT

I have received a collection statement from Sunderland Marine Insurance Company Limited (“Sunderland Marine”).

I give the information contained in this form, and any further information I provide, to Sunderland Marine for the purposes outlined in the collection statement. I understand that this information may be disclosed to, and held by, any of the people or organizations set out in the collection statement for the purposes outlined in the statement. I consent to Sunderland Marine using the information contained in this form for those purposes and disclosing it to the people or organizations identified in the collection statement.

DISCLOSURE OF PERSONAL INFORMATION TO SUNDERLAND MARINE

You agree and warrant to Sunderland Marine that any personal information that you disclose to Sunderland Marine in connection with this claim or with any application for insurance and any policy of insurance subsequently issued has been or will be collected in accordance with the Privacy Act 1988 (as amended). You also agree and warrant to Sunderland Marine that the individual to whom the personal information relates has been or will be made aware of Sunderland Marine’s identity, of how to contact Sunderland Marine, and of the other matters that Sunderland Marine is required to inform a person about whom it collects personal information under the Act and that Sunderland Marine is authorised or permitted to collect any personal information disclosed to it by you or on your behalf.

GENERAL INSURANCE CODE OF PRACTICE

The Insurance Council of Australia promulgates the General Insurance Code of Practice. We are members of and support the code, which is self-regulatory, and aims to raise the standards of practice and service in the general insurance industry. If you would like further information about the code, please contact us. Alternatively, a full copy of the General Insurance Code of Practice can be viewed at: http://www.codeofpractice.com.au.

Fish Farms (Marie & Freshwater Cage Sites) 2 Fish Farms (Marine & Freshwater)

1 EXPLANATORY INFORMATION The checklist and completed proposal form are necessary to correctly evaluate each operation. Failure to submit the information requested may result in delays, the indication of more restrictive terms or a disinclination to cover. Please note that this checklist is not definitive; our risk managers and underwriters may request additional information to help analyse the risk. Likewise you should include any additional information that you feel may be relevant to this submission.

2 PROPOSER / SITE INFORMATION

Proposer’s Name

Contact Name Position

Mailing Address

Postcode

Tel No Email

Site Name

Site Address

Postcode

Location (Lat. & Long) Site Licence No.

Tel No Email

Site Management Personnel First Name Surname Position Qualifications Number of Years’ Experience Number of Years’ at this Site Mobile No Total Number of Production Personnel

Date Site First Established and by Whom

Date Site Commenced Operation Under Current Ownership

Give name & proximity of other aquaculture consents within 5 miles (8 kilometres) of this site

Is this site subject to an area management agreement?

Surrounding Area

Please provide details of any know or potential sources of risk (pollution, navigation, bloom, disease etc.) at the site where cover is applied for and any other locations within 5 miles.

3 WATER PARAMETERS AND SITE LOCATION

Water Parameters Water Temperatures MIN: MAX: Dissolved Oxygen (D.O) Levels MIN: MAX:

Fish Farms (Marie & Freshwater Cage Sites) 4 Fish Farms (Marine & Freshwater) pH Levels MIN: MAX: Salinity Levels MIN: MAX:

Water Current at MAXIMUM SPEED: DIRECTION: Site

Maximum Fetch / IN MILES: Exposure

Maximum Wave Height (m)

Normal Minimum Water Depth at Site (m) Tidal Variance of MIN: MAX: Water Depth at Site (m) Maximum Wind Speed

Worst Wind Direction

Water Quality Monitoring FREQUENCY: i.e. Oxygen etc. METHOD:

State any water quality problems past & present

Exposure to Ice or Superchill?

Fish Farms (Marie & Freshwater Cage Sites) 5 Fish Farms (Marine & Freshwater) 4 STOCK

Stock - Current Average of Projected Projected Projected Date of Number at Species Weight at Supplier Mortality to Harvest Harvest Transfer Transfer Transfer Harvest Weight Date

Stock – Future (Within the Next 12 Months)

Overall Maximum Stock Value: Currency Amount Average Stock Value Over Policy Period

Maximum Stocking Density kg/m2 or kg/m3 When this Occurs

5 EQUIPMENT

Equipment Type; (Cages, Manufacture Year of Feed Barge / Size Material Number Value r Manufacture System etc.)

Cover Required

Fish Farms (Marie & Freshwater Cage Sites) 6 Fish Farms (Marine & Freshwater) Nets Twine Material – Mesh Year of Spec. Tagged Manufacture Nylon, Size Type Depth Manufactur e.g. Number Yes/ Value r Dyneema e.g. e Denier No etc. 18mm / Ply

Cover Required

6 PREDATOR EXCLUSION

Predator Exclusion Predator Nets (Seal, Age Year of Type Manner of Installation Value Bird etc.) Manufacture

Cover Required

7 MOORINGS & ANCHORING

Moorings & Anchoring System Designed / Specified by Cage Manufacturer? If Not Who Designed / Specified Name: Qualifications / Experience Fish Farms (Marie & Freshwater Cage Sites) 7 Fish Farms (Marine & Freshwater)

Cages Installed by Whom? Name: Qualifications / Experience

Spare Moorings Available on Site?

Cover Required

8 BOATS

Boats Value Year Excluding Outboard Year of Value of Type Length Tonnage Construction Built Engine if Make Manufacture Outboard Outboard

Cover Required

9 EQUIPMENT CARE & STOCK CONTROL

Frequency & Extent of Maintenance Cages By Whom Qualifications Nets By Whom Qualifications Moorings By Whom Qualifications

Schedule of Net Changes

Method for Mortality Removal (Other than Diving)

Fish Farms (Marie & Freshwater Cage Sites) 8 Fish Farms (Marine & Freshwater) Dive Reports Recorded?

Frequency of Site Summer Winter Dives Purpose of Dives Mort Removals Moorings Inspection Other

HEALTH

Stock Health Record (Detail Any Problems During the Last 5 Years) Causative Agent Date Treatment Frequency Outcome

Detail Disease Monitoring & Laboratory Facilities On Site Off Site Veterinarian Used

Frequency of Health Checks: Name Qualifications Experience / Job Title Fallowing Period

10 SECURITY

Security Site General Alarms Guard or Patrol

11 RISK

Is the site exposed to any of the following?

If yes, Please state preventative/remedial Particular Risks Yes No measures

Fish Farms (Marie & Freshwater Cage Sites) 9 Fish Farms (Marine & Freshwater) Tsunami

Disease / Parasites

Blooms

Pollution

Predation

Salinity Fluctuations

Water Quality

Debris Exposure

Freezing / Superchill

Other (Details)

1 LOSS HISTORY Please indicate any losses, irrespective of whether or not it resulted in a claim, noting the site, causation, number and size of fish lost and the settlement, in the last 5 years.

Cause of Average Nett Date Species Number Gross Loss Loss Weight Settlement

Equipment / Boats

Type: Cage / Nett Date Cause of Loss Value Gross Loss Boat Etc. Settlement

12 INSURANCE HISTORY

Name of Present Renewal Date Insurer

In respect of the property, the subject of this proposal has any insurer:

(A) DECLINED: YES

(B) CANCELLED COVER: YES

(C) IMPOSED RESTRICTED TERMS OR ADDITIONAL PREMIUMS: YES

If so, please provide details

Please provide any other information which you feel may be relevant to the application for insurance on the additional information pages provided.

Additional Information

SIGNING THIS FORM DOES NOT BIND THE PROVIDER OR INSURER TO COMPLETE THE INSURANCE, BUT IT IS AGREED THAT THIS PROPOSAL SHALL BE THE BASIS OF THE INSURANCE CONTRACT ENTERED INTO WITH THE COMPANY.

I HEREBY DECLARE THAT THE PARTICULARS AND ANSWERS GIVEN IN THIS PROPOSAL ARE IN EVERY RESPECT TRUE AND CORRECT AND THAT I HAVE NOT WITHHELD OR MISREPRESENTED ANY INFORMATION CALCULATED TO INFLUENCE THE DECISION OF THE COMPANY IN REGARD TO THE UNDERWRITING OF THE RISKS TO WHICH THIS PROPOSAL RELATES.

YOUR DUTY OF DISCLOSURE BEFORE YOU ENTER INTO AN INSURANCE CONTRACT, YOU HAVE A DUTY TO TELL US ANYTHING THAT YOU KNOW, OR COULD REASONABLY BE EXPECTED TO KNOW, MAY AFFECT OUR DECISION TO INSURE YOU AND ON WHAT TERMS.  YOU HAVE THIS DUTY UNTIL WE AGREE TO INSURE YOU.  YOU HAVE THE SAME DUTY BEFORE YOU RENEW, EXTEND, VARY OR REINSTATE AN INSURANCE CONTRACT.  YOU DO NOT NEED TO TELL US ANYTHING THAT: o REDUCES THE RISK WE INSURE YOU FOR; OR o IS COMMON KNOWLEDGE; OR o WE KNOW OR SHOULD KNOW AS AN INSURER; OR o WE WAIVE YOUR DUTY TO TELL US ABOUT.

IF YOU DO NOT TELL US SOMETHING

IF YOU DO NOT TELL US ANYTHING YOU ARE REQUIRED TO, WE MAY CANCEL YOUR CONTRACT OR REDUCE THE AMOUNT WE WILL PAY YOU IF YOU MAKE A CLAIM, OR BOTH.

IF YOUR FAILURE TO TELL US IS FRAUDULENT, WE MAY REFUSE TO PAY A CLAIM AND TREAT THE CONTRACT AS IF IT NEVER EXISTED.

SIGNATURE: DATE:

PRINT NAME: POSITION:

COMPANY:

COMPANY ADDRESS:

Please return the completed and signed proposal forms to the following address:

Sunderland Marine Insurance Company Limited The Quayside Newcastle upon Tyne NE1 3DU Tel: +44(0)191 232 5221 Fish Farms (Marie & Freshwater Cage Sites) 15 Fish Farms (Marine & Freshwater) Fax: +44(0)191 261 0540 COLLECTION STATEMENT

When we collect personal information about you we must, under the Australian Privacy Principles in the Privacy Act 1988, give you the following information.

ABOUT US

Sunderland Marine is Sunderland Marine Insurance Company Limited, a company incorporated in England under number 16432 and authorised to conduct business in Australia under ARBN 007 508 401 and ABN 89 007 508 401. The principal address of Sunderland Marine’s Australian business is 19 Agnes Street, Jolimont, East Melbourne, Victoria 3002, Australia. Contact details: Telephone +61 03 9650 6288 Fax +61 03 9650 6396 Email: [email protected]

YOUR ACCESS TO YOUR PERSONAL INFORMATION

You can ask for access to personal information which we collect about you. Your rights to access and our rights to refuse access to the information are set out in the Australian Privacy Principle 12 in the Privacy Act 1988.

OUR USE OF YOUR PERSONAL INFORMATION

We use personal information we have collected, or may collect, from you for the following purposes: • gathering information in order to provide a quotation for (re)insurance (including a renewal, amendment or midterm adjustment); • providing (re)insurance (including a renewal, amendment or midterm adjustment); • altering the terms of a(n) (re)insurance policy; • processing a(n) (re)insurance claim; • providing information about its products and services; • complying with our legal and regulatory obligations; or • processing a job application.

OUR DISCLOSURE OF YOUR PERSONAL INFORMATION

We may disclose personal information we have collected, or may collect, from you to: • assess a proposal or provide a quotation for (re)insurance (including a renewal, amendment or midterm adjustment); • provide (re)insurance (including a renewal, amendment or midterm adjustment); • seek or obtain reinsurance (including retrocessions); • respond to an insurance claim; • provide information about its products or services; • process a job application; • meet the requirements of applicable regulatory bodies and/or law enforcement agencies; and • obtain advice from our professional advisers.

IF YOU DO NOT PROVIDE US WITH YOUR PERSONAL INFORMATION

We need your personal information to insure you, your property, or other insurable risks, and to respond to any claims made under our policies. If you do not give us this information we will not be able to insure you, your property, or other insurable risks.

OUR PRIVACY STATEMENT

Please contact us if you would like a copy of our privacy statement. A copy is also available from the Australia page of our website: www.sunderlandmarine.com Fish Farms (Marie & Freshwater Cage Sites) 16 Fish Farms (Marine & Freshwater)

Fish Farms (Marie & Freshwater Cage Sites) 17