Application for Equine Insurance
Protect your equine friend and investment with equine insurance
If you are unsure of an answer, please enter "Don't Know"
Owner Information First Name Last Name Residence Address Mailing Address City CA Zip - Phone E-mail Company Information Type of Business Description of Operations Legal Entity Individual Partnership Corporation Association DBA Contact Name Location Address Mailing Address City CA ZIP - Telephone Fax E-mail Name of Horse Breed Use Gender Age Height Color Markings/Tattoos Value $ Present Insurance Company Annual Premium $ Expiration Date Have you had any claims or canceled coverage in the past three years? Yes No Explain all incidents; give dates, cause of loss and amount paid, give reason for cancellation Insurance Needs Full Mortality. Includes automatic colic surgery up to $3,000 at no additional charge. Major Medical/Surgical Surgical Only Full Loss of Use - Requires Medical or Surgical coverage. External Injury Loss of Use - Requires Medical or Surgical coverage. Stallion Infertility - AS&D International Transit (one way) - Excludes travel into Mexico. International Transit (round trip) - Excludes travel into Mexico. Third Party Liability Insurance Personal Horse Owners Liability Commercial Equine Liability Equine Professional Liability Care, Custody and Control Independent Horse Shows and Events Riding Clubs and Associations A variety of liability limits are available
Owner Information
First Name
Last Name
Residence Address
Mailing Address
City CA Zip -
Phone E-mail
Company Information
Type of Business
Description of Operations
Legal Entity Individual Partnership Corporation Association
DBA
Contact Name
Location Address
City CA ZIP -
Telephone Fax E-mail
Name of Horse Breed
Use Gender Age
Height Color Markings/Tattoos
Value $
Present Insurance Company
Annual Premium $ Expiration Date
Have you had any claims or canceled coverage in the past three years? Yes No
Explain all incidents; give dates, cause of loss and amount paid, give reason for cancellation
Insurance Needs Full Mortality. Includes automatic colic surgery up to $3,000 at no additional charge. Major Medical/Surgical Surgical Only Full Loss of Use - Requires Medical or Surgical coverage. External Injury Loss of Use - Requires Medical or Surgical coverage. Stallion Infertility - AS&D International Transit (one way) - Excludes travel into Mexico. International Transit (round trip) - Excludes travel into Mexico. Third Party Liability Insurance Personal Horse Owners Liability Commercial Equine Liability Equine Professional Liability Care, Custody and Control Independent Horse Shows and Events Riding Clubs and Associations A variety of liability limits are available
Insurance Needs
Full Mortality. Includes automatic colic surgery up to $3,000 at no additional charge. Major Medical/Surgical Surgical Only Full Loss of Use - Requires Medical or Surgical coverage. External Injury Loss of Use - Requires Medical or Surgical coverage. Stallion Infertility - AS&D International Transit (one way) - Excludes travel into Mexico. International Transit (round trip) - Excludes travel into Mexico. Third Party Liability
Insurance
Personal Horse Owners Liability Commercial Equine Liability Equine Professional Liability Care, Custody and Control Independent Horse Shows and Events Riding Clubs and Associations A variety of liability limits are available
$300,000 / $300,000 - Occurrence / Aggregate $300,000 / $600,000 - Occurrence / Aggregate $500,000 / $500,000 - Occurrence / Aggregate $500,000 / $1,000,000 - Occurrence / Aggregate $1,000,000 / $1,000,000 - Occurrence / Aggregate $1,000,000 / $2,000,000 - Occurrence / Aggregate $50,000 Fire Legal and $5,000 Medical Payments are included. Higher limits are available upon request.
$300,000 / $300,000 - Occurrence / Aggregate
$300,000 / $600,000 - Occurrence / Aggregate
$500,000 / $500,000 - Occurrence / Aggregate
$500,000 / $1,000,000 - Occurrence / Aggregate
$1,000,000 / $1,000,000 - Occurrence / Aggregate
$1,000,000 / $2,000,000 - Occurrence / Aggregate
$50,000 Fire Legal and $5,000 Medical Payments are included.
Higher limits are available upon request.
Liability limit requirement
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Revised: Saturday, August 23, 2008 04:28:55 PM. Webmaster Christina Nichols of Gal Tec Incircumscriptible
