Donkey Insurance Renewal

1 Your current policy

2 Your policy details

3 Additional questions

4 Declaration

Your current policy
Your policy number*
Annual price of policy*
Please fill in the amount listed on your policy document.

Your policy details
Insured Name*
First Last
Telephone number*
Address*
Street Address Address Line 2 City County Postcode Country
Email address of policy holder*

Additional questions
Please complete the following questions and confirm the declarations at the end
Are the insured horse(s) at present normal in eye, wind and action and in good health to the best of your knowledge and does it/do they in your opinion represent a normal risk for the proposed insurance?*
If NO please provide more details, including when, below
Have any of the insured horse(s) suffered from or exhibited symptoms of colic or any other digestive illness at any time?*
If yes please provide more details, including when, below
Have the insured horse(s) ever exhibited any symptoms of lameness, undergone diagnostic ultrasound, MRI, bone scan or x-rays?*
If yes please provide more details, including when, below
Have insured horse(s) suffered at any time from melanoma, Sarcoids, warts or any other type of skin growth or disorder?*
If yes please provide more details, including when, below
During the last 12 months have any of the insured horse(s) between treated by a veterinary surgeon for any reason (including injuries, illness and respiratory problems), or undergone any surgery, other than for routine vaccinations or preventative care, or received any other form of treatment for remedial purposes including farriery?*
If yes please provide more details, including when, below
Has there been any evidence of contagious or infectious diseases during the past 12 months at the stables/barn where the horses are kept?*
If yes please provide more details, including when, below
Has the insured horse(s) been diagnosed with any degenerative condition (including but not limited to degenerative joint disease, laminitis, navicular, OCD or arthritis) or have received treatment for lameness either by a veterinary surgeon or an equine specialist any time to the best of your knowledge?*
If yes please provide more details, including when, below
Has the insured horse(s) received any complimentary treatment by any Equine Specialist during the last 12 months ?*
If yes please provide more details, including when, below
Is the insured Donkey(s) at present normal in eye, wind and action and in good health to the best of your knowledge and does it/do they in your opinion represent a normal risk for the proposed insurance ?*
If no please provide more details, including when, below
Has the insured Donkey(s) suffered from or exhibited symptoms of colic or any other digestive illness at any time?*
If yes please provide more details, including when, below
Has the insured Donkey(s) ever exhibited any symptoms of lameness, undergone diagnostic ultrasound, MRI, bone scan or x-rays?*
If yes please provide more details, including when, below
Has the insured Donkey(s) suffered at any time from melanoma, Sarcoids, warts or any other type of skin growth or disorder?*
If yes please provide more details, including when, below
During the last 12 months has the insured Donkey(s) between treated by a veterinary surgeon for any reason (including injuries, illness and respiratory problems), or undergone any surgery, other than for routine vaccinations or preventative care, or received any other form of treatment for remedial purposes including farriery?*
If yes please provide more details, including when, below
Has there been any evidence of contagious or infectious diseases during the past 12 months at the stables/barn where the Donkeys are kept?*
If yes please provide more details, including when, below
Has the insured Donkey(s) been diagnosed with any degenerative condition (including but not limited to degenerative joint disease, laminitis, navicular, OCD or arthritis) or have received treatment for lameness either by a veterinary surgeon or an equine specialist any time to the best of your knowledge?*
If yes please provide more details, including when, below
Has the insured Donkey(s) received any complimentary treatment by any Equine Specialist during the last 12 months ?*
If yes please provide more details, including when, below

Declaration
Declaration 2*
- I/We declare that there has been no material changes in the risk since the inception of the policy or the last renewal date whichever was later.
Declaration 3*
- I/We declare that all the statements made above are true to the best of my/our knowledge and belief and that this form shall form the bases of the contract between me/us and the Insurer and that I/we will accept and abide by the terms and conditions of the policy issued.
Comments
This field is for validation purposes and should be left unchanged.