sjc poultry proposal form plus heat stress 2010 · 2018-07-02 · cuestionario para seguro de aves...

17
Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form BLAT – Corredoria d’Assegurances i Reassegurances, S.L. TAMARIT, 155-159 E-08015 BARCELONA SPAIN TEL +34 93 414 30 05 FAX +34 93 414 61 51 [email protected] www.blatseguros.com BLAT, CORREDORIA D’ASSEGURANCES I REASSEGURANCES, S.L., es una Correduría de Seguros y Reaseguros, con domicilio social en la calle Tamarit 155-159 de Barcelona, inscrita en el Registro Mercantil de Barcelona, Tomo 6734 Libro 6014 Sección 2 Folio 90 hoja 80167. NIF B58064056. Inscrita en los Registros de la D.G.S. y F.P. Corredores de Seguros clave J-378. Corredores de Reaseguro clave RJ-0012, concertado Seguro de Responsabilidad Civil, constituida garantía, conforme a lo estipulado en la Ley de Mediación 26/2006. 1 Poultry Insurance Proposal Form Cuestionario para Seguro de Aves de Corral Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L. Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Upload: others

Post on 20-Apr-2020

0 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/

Poultry Insurance Proposal Form

BLAT – Corredoria d’Assegurances i Reassegurances, S.L. TAMARIT, 155-159 E-08015 BARCELONA SPAIN

TEL +34 93 414 30 05 FAX +34 93 414 61 51 [email protected] www.blatseguros.com

BLAT, CORREDORIA D’ASSEGURANCES I REASSEGURANCES, S.L., es una Correduría de Seguros y Reaseguros, con domicilio social en la calle Tamarit 155-159 de Barcelona, inscrita en el Registro Mercantil de Barcelona, Tomo 6734 Libro 6014 Sección 2 Folio 90 hoja 80167. NIF B58064056. Inscrita en los Registros de la D.G.S. y F.P. Corredores de

Seguros clave J-378. Corredores de Reaseguro clave RJ-0012, concertado Seguro de Responsabilidad Civil, constituida garantía, conforme a lo estipulado en la Ley de Mediación 26/2006.

1

Poultry Insurance Proposal Form

Cuestionario para Seguro de Aves de Corral

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 2: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/

Poultry Insurance Proposal Form

BLAT – Corredoria d’Assegurances i Reassegurances, S.L. TAMARIT, 155-159 E-08015 BARCELONA SPAIN

TEL +34 93 414 30 05 FAX +34 93 414 61 51 [email protected] www.blatseguros.com

BLAT, CORREDORIA D’ASSEGURANCES I REASSEGURANCES, S.L., es una Correduría de Seguros y Reaseguros, con domicilio social en la calle Tamarit 155-159 de Barcelona, inscrita en el Registro Mercantil de Barcelona, Tomo 6734 Libro 6014 Sección 2 Folio 90 hoja 80167. NIF B58064056. Inscrita en los Registros de la D.G.S. y F.P. Corredores de

Seguros clave J-378. Corredores de Reaseguro clave RJ-0012, concertado Seguro de Responsabilidad Civil, constituida garantía, conforme a lo estipulado en la Ley de Mediación 26/2006.

2

CONFIDENCIAL CONFIDENTIAL

Cualquier Póliza de Seguro que sea emitida estará basada en la información facilitada por el Solicitante a partir de las respuestas de las siguientes preguntas. Por favor responda a todas las preguntas dentro de los espacios correspondientes utilizando cualquier documento adicional si fuera necesario. En el caso de que la pregunta no tenga una respuesta aplicable, por favor escriba en el campo correspondiente la expresión “No Aplicable”. Any Insurance Policy to be issued is drawn up on the basis of information supplied by the Proposer in answer to the question below . Please answ er all questions in the space provided, using additi onal paper or document if necessary. In case that the question does not have an applicable answer, please write in the corresponding field the expression “Not Applicable”. Por favor conteste al siguiente y seleccione la casilla correcta en los casos en que se aplique. Please answer the following questions and tick the correct tick-box, when applicable.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 3: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

Parte 1-Detalles de la Explotación (Part 1-Site Details)

Name of Insured and Site Address Poultry Type - Broilers or Layers?

Production TypeCaged, barn, free-range, organic? Please state

Poultry Species Breed Age of flock

Number of cycles/crops per year Number of houses and Total Floor Area Site Capacity

Construction of Buildings

AcreageAre all buildings in good condition and well maintained? YES NOAre all buildings owned by you ? If no please provide full details YES NOFeeding System Drinking System

Ventilation System

Nest Boxes / Egg Collection Alarm System

Heating System Emergency Equipment

Product Buyer Value of Stock(Name of company you supply) Maximum value per bird:

Annual revenue:

Total annual egg sales per house and overall

(e.g. - 3 houses, Hse1 - 200m2, Hse 2 - 300m2, Hse -

Chickens, Turkeys, Ducks?

(Include type, make and age of system and Sum insured). Please attach any detailed ventilation information.

(Include type, make and age of system / equipment and stocking densities and sum insured).

(Include type, make and age of system and what the alarm covers and sum insured)

(Include type, make and age of system and sum insured). (Include type, make and age of system and sum insured).

( Type of house and approximate age, manufacturer and a detailed description of floors, walls, frame, insulation and roof including type of materials used). State Sum insured. Please attach any plans, details or information relative. Also provide location if different to above

Include Postcode, Telephone / Fax Numbers and e-mail address

Current age and general age range (i.e. - 0-42 days, 20 - 72 weeks)

(Include type, make and age of system / equipment and numbers of feeders/ sum insured)

(Include type, make and age of system / equipment and numbers/ sum insured)

Growers, breeder layers, breeder replacements? Please state

(Maximum Number of birds placed per house and total on site)

3

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 4: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

Parte 2-Cuestionario (Part 2-Questionnaire)

Sección 1-Bioseguridad (Section 1-Biosecurity)1 Do only essential visitors have access to the site? YES NO

2 YES NO

3 YES NO

4 Is the poultry site fully enclosed and surrounded by fencing? YES NO

5 Are all individual buildings locked when there are no personnel on site? YES NO

6 YES NO

7 YES NO

8 Are hand washing and toilet facilities available on site? YES NO

9 Is hand washing enforced by management at entry / exit to poultry and after bird handling? YES NO

10 YES NO

11 Do all individual houses operate on an "all in, all out" basis? YES NO

12 Is there provision for the wheel wash / disinfection of vehicles entering the site? YES NO

13 YES NO

14 Is there adequate pest control carried out to control rodents, flies and parasites? YES NO

15 Is pest control carried out by a licensed contractor / properly trained staff? YES NO

16 Is pest control planned, documented and recorded? YES NO

17 Is smoking restricted to designated areas, away from birds, and enforced? YES NO

Sección 2-Edificios y Cercanías (Section 2-Buildings and Surroundings)18 Are the buildings specifically designed for the type of poultry housed? YES NO

19 Is the poultry site and buildings separate from other enterprises on farm? YES NO

20 Has the poultry house / houses integral anterooms, washrooms and storage areas? YES NO

21 Does any other building physically join the poultry housing? YES NO

22 What is the distance from the poultry housing to the incinerator area? m

23 Have all houses fire fighting equipment fitted? YES NO

24 Do buildings house computer / office equipment? YES NO

25 Is there a service contract with your electrician? YES NO

26 Are electrical switchgear/controls housed in a service area? YES NO

27 Are service areas entirely lined with non-combustible materials? YES NO

28 Are heaters suspended on metal safety chains? YES NO

Does the management refuse visitor entry if the health and welfare of the birds would be effected?

Are footdips / barrier systems provided at the entrance to all buildings and the use of applied?

Are all visitors monitored from points of arrival to departure with full records of the visit kept?

Are all disinfectants DEFRA Approved, used to the correct dilutions, replaced and recorded?

Is site dedicated clothing supplied for all personnel and washed / discarded between flocks?

Is poultry the only livestock species that ever enters the poultry houses or service buildings?

4

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 5: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

29 Are fail safe devices fitted to each heater? YES NO

30 Are fuel storage tanks bunded? YES NO

31 Are fuel storage tanks more than 25m from the houses? YES NO

32 Are all final exit doors fitted with minimum standard dead lock or YES NOminimum standard of 3 lever mortise?

33 Is vegetation kept short around the poultry houses and cut at least quarterly? YES NO

34 Are areas around buildings kept clear of non - essential equipment? YES NO

35 YES NO

36 Do all buildings provide a safe, hygienic and comfortable environment for birds? YES NO

37 Are all surfaces within the houses in good condition, waterproof and cleanable? YES NO

38 Are all floors made of concrete / asphalt and above the outside ground level? YES NO

39 Are all surfaces within the house waterproof, draught-proof and vermin-proof? YES NO

40 Are all houses insulated? YES NO

41 YES NO

Sección 3-Equipos de Emergencia (Section 3-Emergency Equipment)42 YES NO

43 Can the audible / visual alarm be heard / seen outside the building? YES NO

44 Has it a secondary form of communication directly to a stockperson via pager / telephone? YES NO

45 Is there a service contract on the alarm system? YES NO

46 YES NO

47 YES NO

48 YES NO

49 YES NO

50 Is all automatic equipment inspected daily and defects rectified immediately? YES NO

51 Is there a stand-by generator on site? YES NO

52 Is the stand-by generator ‘automatic’ cut-in and cut-out? YES NO

53 Is the stand-by generator tested at least weekly under full load and records kept? YES NO

54 Is the stand-by generator subject to a service contract? YES NO

55 Are the electrics checked by a qualified electrician, at least quarterly? YES NO

Are all automatic environment control systems monitored by an audible / visual alarm covering mains failure (all phases), minimum and maximum temperatures and humidity?

Is all feeder, drinker, ventilation, heating and lighting systems installed by competent persons?Are all feeder, drinker, ventilation, heating and lighting systems maintained by competent persons?Are all fire extinguishers, alarm systems, and other automated / mechanical equipment installed by competent persons?

Are all fire extinguishers, alarm systems, and other automated / mechanical equipment maintained by competent persons?

Are all houses plated with floor space, drinker, feeder, feed bin capacity and nest box information?

Are all houses constructed and maintained to prevent any likely cause of injury or distress to birds?

5

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 6: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

Sección 4-Iluminación (Section 4-Lighting)56 YES NO

57 YES NO

58 Are all lighting patterns recorded? YES NO

59 Are patches of high and low light intensity avoided within each house? YES NO

Sección 5-Temperatura, Ventilación y Calidad del Aire (Section 5 - Temperature, Ventilation and Air Quality)60 Do all houses have a controlled environment? YES NO

61 YES NO

62 YES NO

63 Are ventilation rates variable to allow for environmental changes? YES NO

64 YES NO

65 Is equipment available to measure air quality (e.g.- ammonia / carbon dioxide) YES NO

66 YES NO

67 Is the heating system capable of producing heat sufficient to stop chicks huddling? YES NO

68 YES NO

Sección 6-Existencias/Densidad de Stocks (Section 6-Stocking / Stocking Density)69 Do all birds, on arrival, get placed into a pre-heated house and their behaviour monitored? YES NO

70 YES NO

71 Do stocking densities ever exceed 38kg/m2 (Int. Broiler Growers) of available floor space? YES NO

72 What is the maximum stocking density over the last 3 crops in kg/m2 of available floor space? kg/m2

Sección 7-Camada/Calidad del Suelo (Section 7-Litter / Floor Quality)73 Are all flocks provided with clean, fresh litter in excess of 2cm? (caged birds N/A) YES NO

74 Is litter managed and recorded and action taken if it becomes capped? YES NO

75 Is litter storage dry , vermin-proof and hygienic? YES NO

76 YES NO

77 Are records kept of litter quality and disposal? YES NO

Sección 8-Alimentación y Agua (Section 8-Feed and Water)78 Do all birds have access to adequate feed and water up to 1 hr prior to depopulation? YES NO

79a Is there sufficient storage of water to supply birds for at least 24 hours in an emergency? YES NO

79b Is there sufficient storage of water to supply birds for at least 12 hours in an emergency? YES NO

Does the ventilation system retain air quality to COSHH and CLUL parameters (Ammonia 20ppm, Carbon dioxide 300ppm and humidity at 50 - 70% at 29 degrees centigrade?

Are heaters and additional circulation fans available in times of low or high temperatures to ensure that ventilation is not compromised?

Is there a lighting programme that is suitable for the poultry type kept, produced and implemented?

Is a documented ventilation plan covering air quality, flow speed and temperature implemented?

Are the maximum and minimum temperatures of each house measured and recorded daily?

Is there procedures in place that will keep bird environmental temperatures constant as possible?

Are lighting levels sufficient at all times during the lighting period to allow birds to see feed and water, to see each other, and to be able to show normal behaviour?

Do all birds have sufficient space to walk, turn, sit, preen, flap wings and practice normal behaviour?

Is old litter removed from site promptly after depopulation, transported and disposed of properly?

6

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 7: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

80 Can all birds reach water without travelling more than 3 meters and feed within 4 meters? YES NO

81 Are drinker and feeder heights checked daily? YES NO

82 Do all houses have water meters connected and consumptions recorded daily? YES NO

83 Are all header tanks covered and hygienically managed? YES NO

84 Is borehole water tested for TVC and coliforms every 6 months and recorded? YES NO

85 YES NO

86 YES NO

87 Are all feed bins numbered and identifiable? YES NO

88 Is all feed transported and stored to avoid contamination or spoilage? YES NO

89 Is all feed which is medicated or has a withdrawal period stored separately and identifiable? YES NO

90 YES NO

91 Are compound feeds sourced from a UKASTA compliant mill? YES NO

92 Are samples of feed kept for 3 months and delivery tickets kept for a year? YES NO

Sección 9-Salud y Higiene (Section 9-Health and Hygiene)93 Has the site the services of a poultry specific veterinary surgeon? YES NO

94 Does the site have a written veterinary health plan tailored to the needs of the unit? YES NO

95 Are sick , injured or dead birds removed daily and if required humanely destroyed? YES NO

96 Are birds culled by a trained stockperson by neck dislocation? YES NO

97 Are mortality and culls recorded on a daily basis? YES NO

98 Are dead birds stored in sealed, vermin-proof containers? YES NO

99 YES NO

100 YES NO

101 Does only staff trained to administer medicinal products have access to them? YES NO

102 YES NO

103 YES NO

Sección 10-Limpieza (Section 10-Cleaning)104 YES NO

105 YES NO

106 Are cleaning procedures recorded and dated and a copy kept on site? YES NO

Are all medicines and vaccines stored in a secure (locked) store and in accordance with any recommendations on the label?

Are all buildings and equipment thoroughly cleaned and disinfected (and fumigated if necessary) after use e.g. between flocks?

Are vaccination programmes tailored to the needs of the farm and developed in consultation with the responsible veterinary surgeon?

Is the an even distribution of drinkers and feeders, free from contamination within each house?

Are feed delivery systems checked daily for areas capable of injuring birds and performance?

Are records kept to cover type, levels and withdrawal dates of medicated feeds or coccidiostats?

Are the use of medicines (prophylactic, therapeutic, in-feed, in-water ) and vaccines recorded?

Are medicines and vaccines used in strict accordance with written instruction that must be provided by the responsible veterinary surgeon?

Is there an implemented detailed written programme for the cleaning and disinfecting of buildings and equipment specific to the site in operation?

7

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 8: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

107 YES NO

108 YES NO

Sección 11-Químicos (Section 11-Chemicals)109 YES NO

110 YES NO

111 Is a record of all chemicals stored and/or used on site kept? YES NO

112 Are COSHH regulations followed? YES NO

Sección 12-Teste de Salmonella (Section 12-Salmonella Testing)113 YES NO

114 Are tests carried out in a Government-authorised accredited laboratory? YES NO

115 Are all results of salmonella / pathogen tests retained and available? YES NO

116 YES NO

117 Is feed tested for salmonella at the mill? YES NO

Sección 13-Despoblación (Section 13-Depopulation)118 YES NO

119 Is there a level, well drained loading area for the loading / unloading of birds? YES NO

120 Are catchers provided with protective clothing? YES NO

121 YES NO

122 Is feed supplied up to 12 hours prior to depopulation? YES NO

Sección 14-Residuos/Eliminación de Desechos (Section 14-Waste/Disposal)123 Is all packaging and waste stored in sealed containers and removed from the site regularly? YES NO

124 Are carcasses disposed of by incineration? YES NO

125 YES NO

Sección 15-Administración y Especialistas de Aves (Section 15-Managers and Stockmen)126

Emergency procedures and water sources available for fire fighting YES NONormal and abnormal behaviour of birds, and fear reactions YES NOSigns of good health and signs of poor health and disease YES NOCorrect handling of birds in a positive and compassionate manner YES NOHumane slaughter methods YES NOLitter management, signs of poor litter and remedial action YES NOEquipment operation, maintenance, recognition of failures and action to rectify YES NOBristol Gait Scoring YES NOGeneral hygiene, basic Health and Safety requirements including COSHH YES NORecognition of the signs of thermal stress in birds and the procedures to followed to rectify YES NOWhere necessary, training In the administration of medicinal products. YES NOA working knowledge of the production manual procedures relating to their area. YES NO

Is potable quality water used for all wet cleaning procedures and pressure washers used to clean and sanitise buildings and equipment?

Are storage tanks and drinker lines physically cleaned and sanitised with food grade sanitizer where water is for consumption by animals?

Are all chemicals used on sites clearly labelled and stored in a lockable building with data sheets?

Are all chicken flocks sampled, tested and monitored for salmonella at the appropriate stages?

Is there a written cleaning and disinfection procedure to eliminate a pathogen implemented?

Are all cleaning chemicals and sanitizers licensed and approved by DEFRA for the intended use?

Are vehicles and crates cleaned and disinfected and in good condition prior to bird transport?

After depopulation is each house thoroughly cleaned and disinfected before another flock is placed?

Do carcasses, not disposed of on site, get stored as 98 and removed weekly in winter, twice weekly in summer unless frozen?

Are managers and stockmen competent / trained in the following before being given responsibility for the care of birds?

8

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 9: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

127 Are untrained staff used without the direct supervision of trained personnel? YES NO

128 Do all staff have National Insurance cards before being employed? YES NO

Sección 16-Manejo de las Aves y Inspección (Section 16-Bird handling and Inspection)129 Are all birds checked at least twice / day and three times / day in periods under stress? YES NO

130 Are records of inspection kept, retained and inclusive of observations? YES NO

131 Do stockmen walk within 3m of each bird and encourage them to move? YES NO

132 Where problems are identified are they rectified, recorded with remedial action detailed? YES NO

133 Where stockmen cannot rectify problems is expert advice sought and acted upon? YES NO

Sección 17-Responsabilidad de la Administración (Section 17-Managers' Responsibilities)134 Is there a maximum number of birds per trained stockmen within the following criteria?

YES NO

A maximum 40,000 breeder rearers per trained stockman. YES NOA maximum 30,000 breeder layers per trained stockman. YES NO

135 YES NO

136 YES NO

Sección 18-Formación (Section 18-Training)

137 YES NO

138 YES NO

139 Is all training regularly reviewed and updated? YES NO

140 Is staff competency assessed regularly and these assessments kept on record? YES NO

Sección 19-Planos y Procedimientos de Seguridad (Section 19-Plans and Safety Procedures)141 Are the following plans and policies available and implemented on site?

YES NO

YES NO

YES NO

A COSHH policy, updated annually and including all relevant chemical data sheets YES NOYES NO

A Pest Control Plan with evidence to show its effect. YES NOYES NO

YES NO

YES NO

YES NO

142 YES NO

Is training given by a recognised trainer to NVQ/SVQ level or formal in-house programme?

Is a record of training for all staff, detailing courses attended and training received retained?

A Chemical Spillage Plan based on parameters stated in the COP for Air, Soil And Water including all relevant chemical data sheets.

A current Quality / Production Manual, specific to the business and containing all the procedures carried out within the business.

A Farm Waste Management plan, updated annually based on parameters stated in the COP for Air, Soil And Water.

Do managers / staff have access to Codes of Practice relevant to the production and regulations?Do managers ensure staff responsible for birds have adequate training in specific area's of duty?

A maximum 100,000 commercial growers per trained stockman (where fully automated systems are in use and there is full back up if problems occur).

A Veterinary flock health plan, updated annually and agreed with the attending veterinary surgeon.

Are managers aware of HACCP and have commitment to the utilisation of these principles within future procedural protocols?

A Health and Safety at Work policy, updated annually and drawn up in conjunction with the H & S Executive.

A heat / cold stress policy with a ventilation plan

A Unit Site plan detailing house size, access points, location of fire extinguishers and first aid kits, water sources (fire fighting) and pest control bait points.An emergency action plan ,sited in a prominent position near a telephone point, covering procedures to be followed in the case of emergencies such as fire, flood, power failure, equipment failure or the interruption of supplies.

9

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 10: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

143 YES NO

144 Do all sites have telephone access and all staff aware of there positions? YES NO

145 Are all staff aware of the water sources available for the purposes of fire fighting? YES NO

146 YES NO

147 Does the nearest fire brigade (within 20km) have knowledge of OS information for the unit? YES NO

148 Is the farm manned 24 hours daily? YES NO

Sección 20-Manejo de los Huevos (Section 20-Egg Handling)149 Are all setting eggs clean and free from cracks and damage? YES NO

150 Are hatching eggs sanitised, not washed? YES NO

151 YES NO

152 Is each trolley marked with the breeder farm and date laid? YES NO

153 YES NO

154 YES NO

155 Is the storage room temperature always below 18oC? YES NO

156 Are eggs collected at the following minimum frequencies? YES NO

Rollaway systems - once per day YES NOOther systems - 3 times per day YES NOFloor eggs - 3 times day YES NO

157 Does egg collection records include the following details? YES NO1. Quantities recovered YES NO2. Quantity of floor eggs YES NO3. Reject egg count YES NO

Sección 21-Datos Generales (Section 21-General Data)158 Has this farm been in operation for more than 12 months under the current management? YES NO

159 Has this farm been flood free for the past 5 years? YES NO

160 Has this farm been free from vandalism? YES NO

161 Is there a flood risk? YES NO

162 Does the farm make a profit? YES NO

163 Is your Veterinary within 20km of farm? YES NO

164 Has the farm been free from defects, ailments, injuries or diseases over the past 3 years? YES NO

165a YES NO

165b YES NO

166 YES NO

Is the temperature (and humidity) of the egg store recorded with a max/min thermometer or twice daily with a standard thermometer?

Is an emergency water supply capable of providing water for 24 hours at full demand available?

Are all eggs marked with a black mark and labelled so that the site and age of flock can be verified?

Are floor eggs to be set clearly identified, placed at the bottom of the trolley or on a separate trolley?

Are procedures for dealing with contingencies plans known by staff and relevant telephone numbers displayed at a suitable point.

BROILERS: Has the average mortality rate over the past 3 years been below 5% for each crop?

LAYERS: Has the average mortality rate over the past 3 years been below 8% for each crop?

Has any company declined a proposal from you, cancelled or refused to renew your policy or required special terms to insure you?

10

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 11: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

167 YES NO

Sección 22-Historial de Seguros (Section 22-Past Insurance History)

Sección 23-Comentarios (Section 23-Comments)

Declaration

FirmaSigned

FechaDate

Posición en la empresaPosition in the company

Este cuestionario fue emitido y deberá ser devuelto a:This application form has been issued by and should be returned to:

BLAT-Corredoria d’Assegurances i Reassegurances, S.L.Tamarit, 155-15908015 - Barcelona (España)Tel. +34 93 414 30 05 Fax +34 93 414 61 51 [email protected]

DeclaraciónLA FIRMA DE LA PRESENTE SOLICITUD NO OBLIGA AL SOLICITANTE O A LOS SUSCRIPTORES A Yo, el abajo firmante, garantizo la veracidad y precisión de lo manifestado en la presente solicitud. He Declaro que según mi leal saber y entender, mis aves están en buenas condiciones y estado sanitario.

SIGNING THIS FORM DOES NOT BIND THE PROPOSER OR THE UNDERWRITERS TO COMPLETE THE INSURANCE BUT IT IS I, the undersigned, warrant the truth and accuracy of the statements contained in this proposal. I understand that any false statement or

Question No. Comments

Have you or any director, partner or principal of the business been convicted of arson or any offence involving dishonesty? If yes provide full details

Please attach, veterinary certificate, any recent survey reports, vaccination certificates, a sketch map and photographs of the location of poultry houses.

Please enter details of current insurers and details of any claims made together with reasons for the claim within the last 3 years

Por favor, adjunte certificado veterinario, cualesquiera informes de riesgo recientes, certificados de vacunación, un esquema dibujado de la Explotación y fotografias con la ubicación de los pabellones con aves.

Where any questions have been answered with a 'negative' response please provide full details, or provide full details where a question has requested further information. Continue on additional paper where necessary

I further warrant that, to the best of my knowledge and belief, my Poultry is in sound health and good condition.

11

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 12: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral (sección de Stress por Calor)/Poultry Insurance Proposal Form (Heat Stress section)

Sección 1-Edificios (Section 1-Buildings)

2

3

4

1

2

3

4

5

6

1

2

3

1 Los pabellones deberán tener las paredes y tejados aislados, con un standard de aislamiento moderno que esté en línea con los standards recomendados de valores U de 0.4 W/m/oC. (Houses must be insulated, roof and walls, with a standard of insulation that will meet the modern recommendedstandard U values of 0.4 W/m/oC.)

La estructura de aislamiento deberá estar adecuada a la estructura del pabellón y deberá existir una capa de vapor entre el material aislante y el aire interno. (House insulation must be of a suitable type for the house structure and a vapour layer must be in place between insulant and the internal air.)

Los pabellones deberán tener sistemas de controle automáticos (un ordenador de pantalla que controle la apertura y cierre de ventanas, la utilización de ventiladores/calefactores de acuerdo a estadísticas internas de temperatura, humedad, presión del aire, rácios de ventilación min/máx). (Houses must be controlled by automatic control systems (a computer control panel controlling the opening and closing of vents, the usage of fans / heaters governed by in-house stats for temperatures, humidity's, air pressures, min / max ventilation rates).

Deberá existir un Plan de Ventilación detallado y por escrito, incluyendo detalles parametros de calidad del aire, flujo de aire, velocidad y temperaturas y rácioss de ventilación minimos y máximos. (A documented ventilation plan must be in place detailing target air quality parameters, airflow, speed and temperature and minimum and maximum ventilation rates.)

Los niveles de ventilación deberán ser variables (0.6 - 4.5m3/hr/kg) de manera a permitir alteraciones ambientales pero hasta un minimo de 0.6m3/hr/kg en todos los momentos. (Ventilation rates must be variable from 0.6 - 4.5m 3 /hr/kg to allow for environmental changes with a minimum of 0.6m 3 /hr/kg at all times.)Los ventiladores de circulación de aire o ventiladores Jumbo deberán estar disponibles para colocar en el interior del pabellón de manera a incrementar la circulación de aire al nivel de las aves en épocas de mucho calor y, así, disminuir las pérdidas por convexión de las aves. (Circulation fans or Jumbo fans must be available to place within the house to circulate and provide extra air movement at bird level in hot weather thus increasing the convection loss from the birds.)

Los pabellones deberán tener ambiente y ventilación controlados electricamente, preferiblemente con un sistema de ventilación hecho a la medida pero, como mínimo de capacidad, deberá poder mantener la ventilación dentro de los parámetros establecidos en el plan de ventilación. (Houses must be controlled environment and power ventilated, preferably with a custom built ventilation package, but as a minimum have the capability to maintain the environment within the parameters of the ventilation plan.)

El pabellón habrá sido diseñado teniendo en consideración el color del tejado, reflectividad, inclinación y orientación y si el edificio está en la sombra por forma a controlar la ganancia de calor. (The house must have been designed so roof colour, reflectivity, pitch and orientation, and whether the building is in the shade where factors that where used to control solar heat gain.)

Los niveles de los gases en el aire (máx.) a altura de aves nunca deberán ultrapasar los siguientes: Dioxido de Carbono 3000ppm, Monoxido de Carbono 50ppm, Amoniaco 20ppm, Humedad 50-70% (a 29ºC) de Humedad Relativa. (Levels of gases in the air (max.) at bird height should never exceed the following: Carbon dioxide 3000ppm, Carbon monoxide 50ppm, Ammonia 20ppm. Humidity 50-70% (at 29°C) relative humidity.)

Los pabellones deberán terner alarma controlada a partir de la pantalla de control con relación a fallo de la red eléctrica (todas las fases), temperaturas min/máx y humedad, como mínimo. (Houses must be alarmed via the control panel for mains failure (all phases), min / max temperatures and humidity as a minimum.)La alarma deberá ser audible y visual y de preferencia estar conectada a un pager /comando centralizado. (The alarm must be audible and visual and preferable linked to a pager / central control.)

Los pabellones deberán ser impermeables y a prueba de corrientes de aire. (Houses must be waterproof and draught proof.)

Sección 3-Equipos (Section 3 - Equipment)

Sección 2-Ventilación (Section 2-Ventilation)Los pabellones deberán ser ventilados electricamente. (Houses must be power ventilated.)

12

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 13: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral (sección de Stress por Calor)/Poultry Insurance Proposal Form (Heat Stress section)

4

5

6

1

2

3

4

5

6

1

2

1

2

3

4

5

Las aves deberán tener acceso a por lo menos un bebedero de campana (1m) por cada 100 aves o 1 bebedero de mamilo por cada 10-20 aves. Birds must have a minimum of 1 bell drinker (1m) per 100 birds or 1 nipple for every 10 - 20 birds.

La camada deberá tener una altura de, por lo menos, 2cm. (Litter must be provided to a minimum depth of 2cm.)La camada se deberá gestionar de manera a asegurar que no ocurra operculación de la misma o que esté mojada en permanencia. (Litter must be managed to ensure capping and wet litter does not occur.)

Los equipos automáticos deberán ser capaces de prevenir la subida de la temperatura en exceso de 5ºC con relación a las temperaturas externas. (Automatic equipment must be capable to prevent the house temperatures from rising above 5 o C above outside temperatures.)

Agua deberá estar disponible en caso de fallo de suministro (hasta 24 horas sin suministro en caso de emergencia). (Water must be available to depletion and there must be a minimum of 24hours water capacity available in an emergency.)

Se deberán usar aparatos de evaporación para cuando el aire en el interior del pabellón esté caliente y seco pero NO en tiempo húmedo, cuando la humedad relativa ultrapase los 70%. (Evaporation devises may be installed (mister systems) to be used when the house air is hot and dry but NOT in humid weather when relative humidity exceeds 70 %.)

Deberá existir un generador, debidamente apto, capaz de suministrar de energia a toda la explotación y con función automática start/stop. (There must be a generator, fully serviced, capable of powering the whole site and auto start / stop.)

Sección 4-Agua y Alimentación (Section 4 - Water and Feed)

Las aves no deberán desplazarse más que 3m para llegar al agua. (Birds must not have to travel more than 3m to reach water.)El uso del agua deberá ser monitorizado a través de un manómetro y registrado al diario. (Water usage must be monitored via a meter and be recorded daily.)

Las aves no deberán desplazarse más do que 4 m para llegar a su punto de comida. (Birds must not have to travel more than 4m to reach feed.)

Sección 5-Camada (Section 5 - Litter)

Las aves deberán tener como mínimo 1 alimentador de chapa (1m) por cada 100 aves o un alimentador de 0,75m en cadena por cada 100 aves. (Birds must have a minimum of 1 Pan feeder (1m) per 100 birds or 0.75m of chain feeder per 100 birds).

Sección 6-Existencias (Section 6 - Stocking)Las densidades de las existencias de aves se deberán planificar y calcular de manera a no ultrapasar los 38Kg/m2. (Stocking densities must be planned and calculated to not exceed 38kg/m 2 ).Se deberá implementar una politica de reducción del número de aves durante el Verano. (There must be summer stocking policy that reduces the number of birds placed in that period.)

El aclareo de la producción se deberá practicar teniendo en consideración la necesidad de aclareo extra en los meses de Verano. (Thinning of the crop must be practiced with extra thinning planned for summer periods.)

Cualesquiera cálculos con respecto a la máxima densidade de stocks que un solo pabellón de aves podrá soportar en situaciones de calor deberán realizarse en base a hechos conocidos con respecto al pabellón y a la eficácia de su sistema de ventilación. (Calculations of the maximum stocking density that any particular poultry house can support in hot weather must be done using known facts about the house and its ventilation efficiency.)

Los cálculos deberán basarse en todos los aspectos que puedan afectar el tamaño del bando, tal como la espécie y raza, nivel de aporte alimentar y su calidad, edad de abate, peso en vivo previsto y si los bandos de aves se han agrupado ya separados por sexos o "como eclosionado". (Calculations must be based on all of the aspects that will affect flock size such as species and breed, level of feed intake and quality, slaughter age, anticipated live-weight and whether flocks are stocked sexed or "as hatched".)

13

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 14: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral (sección de Stress por Calor)/Poultry Insurance Proposal Form (Heat Stress section)

1

2

1

2

3

4

5

6

7

8

9

10 Todos los Produtores deberán disponer de un Manual de Calidad/Producción específico para el negocio y accessible a la Administración y la plantilla, donde se incluyan todos los procedimientos a considerar en este tipo de actvidad. (All producers must have a Quality / Production Manual specific to the business and containing all procedures implemented within the business available to all managers and staff on site.)

Toda la Administración y plantilla deberán tener acceso y estar familiarizados con los Códigos de Buenas Prácticas del Ministerio de Agricultura. (All management and staff must have access to and be familiar relevant Ministry of Agriculture's Welfare Codes of Practice.)

Los equipos automáticos se deberán inspeccionar por lo menos una vez al día. En caso de encontrar un defecto, o se lo rectifica de inmediato o se deberán tomar medidas para evitar que las aves sufran desnecesariamente. Los registros de las verificaciones, averías y acciones para rectificar deberán registrarse. (Automatic equipment must be inspected at least once each day. Where a defect is found, either the defect must be rectified immediately or measures must be taken to safeguard the birds from unnecessary suffering or distress. Records of checks, malfunctions and actions taken to rectify must be recorded.)

Los números de contacto de los Veterinarios y Ingenieros de los equipos deberán enseñarse cerca de los puntos telefónicos. (Contact numbers of veterinary surgeons and equipment engineers must be displayed next to telephone points.)

El sistema de la alarma deberá verificarse todos los días, registrando las averías y solucionandolas de inmediato. (The alarm system must be checked daily, recorded and malfunctions fixed immediately.)

Toda la Administración y plantilla deberán ser capaces de reconocer los primeros sintomas de stress por calor. (All management and staff must be able to recognise the early signs of heat stress.)

La Humedad (interna y externa) se deberá controlar y los Administradores de la Explotación deberán ser conscientes de cómo esta afecta el stress por calor. (Humidity (internal and external) must be measurable and managers have knowledge of how it effects heat stress.)

Se deberán verificar todos los equipos al final de cada ciclo productivo por un Ingeniero cualificado, siendo las averías rectificadas y registradas. Esto incluye los sistemas eléctricos. (All equipment must be checked every crop by a qualified engineer, malfunctions rectified and records kept. This includes electrical systems.)

Deben existir Planos de Contingencia y una Politica/Plano para Stress por Calor de manera que toda la plantilla sepa lo qué hacer en una emergencia. Las instrucciones de emergencia deberán estar a vista de todos y deberá existir personal con potestad para decidir qué hacer en todos los momentos. (There must be Contingency Plans and a Heat Stress Policy / Plan so that all staff know what to do in an emergency. Emergency instructions must be displayed and personnel on site to authorise decisions at all times.)

Los planos deberán incluir acuerdos con proveedores y transformadores para hacer la despoblación de las aves en el momento exacto. (Plans must include agreements with suppliers and processors for depopulation of the crop at correct times.)

Las predicciones metereologicas relativas a tiempo caluroso se deberán realizar en base a un período de 7 días a través del Instituto de Metereologia o equipos de medición de la Explotación. (Weather forecasting and predictions for hot weather must be done over a 7 day period via Met. Office or Met. Equipment.)

Toda la Administración y plantilla deberán tener acceso y estar familiarizados con los detalles de la politica del Ministerio de Agricultura relativa al stress por calor en Aves de Corral. (All management and staff must have access to and be familiar with the contents of the Ministry of Agriculture's Heat Stress in Poultry Document.)

Sección 8 - Responsabilidades de la Administración (Section 8 - Management Responsibilities)

Sección 7-Previsión Metereologica (Section 7 - Weather Forecasting)

14

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 15: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/

Poultry Insurance Proposal Form

BLAT – Corredoria d’Assegurances i Reassegurances, S.L. TAMARIT, 155-159 E-08015 BARCELONA SPAIN

TEL +34 93 414 30 05 FAX +34 93 414 61 51 [email protected] www.blatseguros.com

BLAT, CORREDORIA D’ASSEGURANCES I REASSEGURANCES, S.L., es una Correduría de Seguros y Reaseguros, con domicilio social en la calle Tamarit 155-159 de Barcelona, inscrita en el Registro Mercantil de Barcelona, Tomo 6734 Libro 6014 Sección 2 Folio 90 hoja 80167. NIF B58064056. Inscrita en los Registros de la D.G.S. y F.P. Corredores de

Seguros clave J-378. Corredores de Reaseguro clave RJ-0012, concertado Seguro de Responsabilidad Civil, constituida garantía, conforme a lo estipulado en la Ley de Mediación 26/2006.

15

Declaración LA FIRMA DE LA PRESENTE SOLICITUD NO OBLIGA AL SOLICITANTE O A LOS SUSCRIPTORES A CONTRATAR EL SEGURO PERO SE ACUERDA QUE ESTA SOLICITUD SERÁ LA BASE DEL CONTRATO PARA LA EMISIÓN DE LA PÓLIZA. Yo, el abajo firmante, garantizo la veracidad y precisión de lo manifestado en la presente solicitud. He sido informado que cualquier declaración falsa o información oculta puede ir en contra de mi derecho a recibir indemnización del seguro que estoy solicitando. Declaro que según mi leal saber y entender, mis aves están en buenas condiciones y estado sanitario. Declaration SIGNING THIS FORM DOES NOT BIND THE PROPOSER OR THE UNDERWRITERS TO COMPLETE THE INSURANCE BUT IT IS AGREED THAT THIS FORM SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED. I, the undersigned, warrant the truth and accuracy of the statements contained in this proposal. I understand that any false statement or material fact withheld may prejudice my right to indennity under the insurance for which I am now proposing. I further warrant that, to the best of my knowledge and belief, my Poultry is in sound health and good condition. Firma Signed Fecha Date Posición en la empresa Position in the company Este cuestionario fue emitido y deberá ser devuelto a: This application form has been issued by and should be returned to: BLAT-Corredoria d’Assegurances i Reassegurances, S.L. Tamarit, 155-159 08015 - Barcelona (España) Tel. +34 93 414 30 05 Fax +34 93 414 61 51 [email protected]

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 16: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/Poultry Insurance Proposal Form

Asegurado/Dirección de la Explotación

Assured/ Farm Location

Codigo Postal

Zip/Postal Code

Nr. de Pabellón

House Number

Tipo de Producción

Type of Production

Estructura del Edificio

Structure of building

Edad del Edificio

Age of building

Nº. Máx. de Aves

en el Local

Max number of

birds placed

Valor Máx. por

Ave Max value

per bird

Valor Máx. Total

Total Max Value

Pérdida de Lucros

Business Interruption

16

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Page 17: SJC Poultry Proposal Form plus heat stress 2010 · 2018-07-02 · Cuestionario para Seguro de Aves de Corral/ Poultry Insurance Proposal Form Parte 2-Cuestionario(Part 2-Questionnaire)

Cuestionario para Seguro de Aves de Corral/

Poultry Insurance Proposal Form

BLAT – Corredoria d’Assegurances i Reassegurances, S.L. TAMARIT, 155-159 E-08015 BARCELONA SPAIN

TEL +34 93 414 30 05 FAX +34 93 414 61 51 [email protected] www.blatseguros.com

BLAT, CORREDORIA D’ASSEGURANCES I REASSEGURANCES, S.L., es una Correduría de Seguros y Reaseguros, con domicilio social en la calle Tamarit 155-159 de Barcelona, inscrita en el Registro Mercantil de Barcelona, Tomo 6734 Libro 6014 Sección 2 Folio 90 hoja 80167. NIF B58064056. Inscrita en los Registros de la D.G.S. y F.P. Corredores de

Seguros clave J-378. Corredores de Reaseguro clave RJ-0012, concertado Seguro de Responsabilidad Civil, constituida garantía, conforme a lo estipulado en la Ley de Mediación 26/2006.

17

Declaración LA FIRMA DE LA PRESENTE SOLICITUD NO OBLIGA AL SOLICITANTE O A LOS SUSCRIPTORES A CONTRATAR EL SEGURO PERO SE ACUERDA QUE ESTA SOLICITUD SERÁ LA BASE DEL CONTRATO PARA LA EMISIÓN DE LA PÓLIZA. Yo, el abajo firmante, garantizo la veracidad y precisión de lo manifestado en la presente solicitud. He sido informado que cualquier declaración falsa o información oculta puede ir en contra de mi derecho a recibir indemnización del seguro que estoy solicitando. Declaro que según mi leal saber y entender, mis aves están en buenas condiciones y estado sanitario. Declaration SIGNING THIS FORM DOES NOT BIND THE PROPOSER OR THE UNDERWRITERS TO COMPLETE THE INSURANCE BUT IT IS AGREED THAT THIS FORM SHALL BE THE BASIS OF THE CONTRACT SHOULD A POLICY BE ISSUED. I, the undersigned, warrant the truth and accuracy of the statements contained in this proposal. I understand that any false statement or material fact withheld may prejudice my right to indennity under the insurance for which I am now proposing. I further warrant that, to the best of my knowledge and belief, my Poultry is in sound health and good condition. Firma Signed Fecha Date Posición en la empresa Position in the company Este cuestionario fue emitido y deberá ser devuelto a: This application form has been issued by and should be returned to: BLAT-Corredoria d’Assegurances i Reassegurances, S.L. Tamarit, 155-159 08015 - Barcelona (España) Tel. +34 93 414 30 05 Fax +34 93 414 61 51 [email protected]

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.

Copyright ©: BLAT-Corredoria d'Assegurances i Reassegurances, S.L.