Insurance

Insurance
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Dog Insurance


Email Address
Title
First Name
Surname
House Number/Name
Street
Town
County
Post Code
Country
Tel. Number - Day
Tel. Number - Evening
Particulars of First Animal to be Insured
Name
Breed
Sex
Date of Birth
Date of Purchase
Price Paid (inc. Currency)
Particulars of Second Animal to be Insured:  
Name
Breed
Sex
Date of Birth
Date of Purchase
Price Paid Paid (inc. Currency)
   
  • Have any of the above animals received veterinary treatment other than vaccinations?
YES NO
  • Has a complaint been made regarding any of the above animals?
YES NO
  • Do any of the above animals have any vicious tendencies?
YES NO
  • Are any of the above animals used in connection with any trade or business other than breeding?
YES NO
  • Have you been hospitalised for more than four days on any one occasion during the last 5 years?
YES NO

If the answer to any of the above 5 questions is "YES", please give further details in the space below (pressing 'enter' at the end of each line), or call us direct to discuss it.

Dog Insurance


Declaration: I warrant to the best of my knowledge and belief that the animal(s) described above are in good health and condition and have not suffered from any illness, disease or injury which makes the animal(s) an abnormal risk. I declare that the information I have given above is true and complete. I have not withheld any material facts (see IMPORTANT NOTES.)

OFML act as an introducer to Shearwater Insurance, I agree that this proposal shall form the basis of the Contract between me and Shearwater Insurance. I am 18 years of age or over.

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WB 7333 - 70- 29-06-2009