INFORMATION, APPLICATION & QUOTATION REQUEST FORM Horse Quotation & Application Form Name   Mr Mrs Miss Ms Dr. Rev      Surname                            First                        Address:                              Post Code         Telephone        E-MAIL                    Fax                       Address where horse is kept                               Post Code          CLASS OF USE     A B Please see below for class of use Class A:  Hacking, Gymkhanas, Showing, Driving, Pony & Riding Club Events, Breeding, Showjumping, Dressage, Heavy Horses, Foals over 30 days Class B: AS ABOVE PLUS Hunting, Hunter Trails, Novice One & Three Day Events, Polo, Endurance & Long Distance Riding, Cross Country, Horse ball. Horses Name     Sex     Height    Colour of Horse           Age of Horse          Date of Purchase     Price Paid  Present Market Value Horse trailers/carriage make & serial No. Trailer value:     £ Has any animal to be covered by this insurance suffered any accident, sickness, disease, colic, sprained tendons, been fired or denerved, operated on for wind or respiratory defects or suffered spells of coughing or been involved in any incident involving a complaint or claim by any person? No Yes Has any insurer in any relation to any sections of insurance ever declined a proposal, refused renewal, terminated cover, required increased premiums or imposed special terms and/or in the last 6 years suffered any loss or had any claim made upon you, or them, insured or otherwise, in connection with any sections of insurance? No Yes Have you or any other person to whom this insurance will apply: Any physical defect, infirmity or serious medical condition? No Yes If you have answered yes to any of the above three questions please give details: Preferred payment method: Annual Monthly Thank you. A personalised quotation will be placed in your e-mail Inbox