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Bloodstock Insurance Application Form

Please fill in all the mandatory fields marked with *

Cover Details

Mortality

Sum Insured (HKD)*

Effective Date*

Restricted Loss of Use

Sum Insured (HKD)*

Effective Date*

Justification of Value

Purchase Price (HKD)*

Date of Purchase*

Winnings (HKD)

Country of Origin*

Name of Trainer

Details of Horse

Name of Horse*

Sex*

Sire*

Dam*

Breed

Colour

Current Location*

Date of Birth*

Rating in Hong Kong

Class of Horse (in Hong Kong)

Brand Number

Proposed Sum Insured (HKD)*

Additional Information

Has any insurer ever declined your insurance proposal, or cancelled or refused to renew your policy or required special terms to be imposed to insure you?*

Have you made any bloodstock insurance claims or sustained any bloodstock losses, whether insured or not, in the last five years?*

Any other information?

Details of Applicant

Full Name*

Corresponding Address

Phone Number*

Email*

Fax No.

Occupation*

Declaration

The above horses are owned by me and, to the best of my knowledge and belief the information provided in connection with this proposal, whether in my own hand or not, is true and I have not withheld any material facts. Any changes in material facts must be notified to the Underwriters. I understand that non-disclosure or misrepresentation of a material fact may entitle Underwriters to void the insurance. (N.B. A material fact is one that is likely to influence acceptance or assessment of this proposal by Underwriters: if you are in any doubt as to whether a fact is material or not you must disclose it in this space or on a separate sheet attached).

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This proposal and the information provided in connection therewith contain statements upon which Underwriters will rely in deciding whether to accept this insurance. Should a contract of insurance be concluded this proposal will form the basis of the insurance.

Successfully submitted!

Please fill in all the mandatory fields marked with *

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