<< Back Personal Title Letters and spaces only Full Name Letters, spaces and hyphens only Email Only valid email addresses. E.g. name@something.com Phone Only numbers, spaces and +. E.g. +64 9 1234 1234 Mobile Only numbers, spaces and +. E.g. +64 9 1234 1234 Postal Address I am an existing client of New Zealand Bloodstock Ltd Horse Name Letters, spaces and hyphens only (if unnamed please type 'unnamed') Sire Letters and spaces only Dam Letters and spaces only Year of birth Whole numbers only Day & Month of birth Letters and spaces only If born within the last year Colour Letters and spaces only Sex Filly Mare Colt Gelding Stallion Breed Thoroughbred Standardbred Other Please select the breed Please select the breed Andalusian Apaloosa Arab Clydesdale Cross-breed Donkey English riding pony Friesian Hack hanoverian Holstiener Hunter Irish hunter Lipizzaner Miniature Paint horse Pasofino Pony Shetland pony Sport horse Station bred Warmblood (WA) Welsh pony You have selected "Other", which means that we require a completed Marking Sheet. Please download here, complete and attach below: Use Use Flat Racing Broodmare Yearling Weanling Foal Dressage Endurance Eventing Equestrian Harness Racing Hunting Polo Pony Club Polo Crosse Recreation Racehorse Show Jumping Showing Sport Horse Steeplechase Stud Duties Transit Unborn Unknown Western Current Location Letters and spaces only Insurance $ Insured value of horse ($NZD) i.e. Fair Market Value Only valid prices, in whole dollars. E.g. 1000 Policy Type Annual Mortality Transit Prospective Foal Note: we will provide a quote on standard mortality insurance unless otherwise requested This is our standard insurance policy, insuring you against your loss in the event of the death of your horse, if it needs to be euthanased on humane grounds, and for limited theft. Our standard policy insures the horse anywhere in New Zealand and Australia. The policy does not cover pre-existing conditions. We recommend an annual policy. Period Insurance Required Letters and spaces only From Letters and spaces only To Further Information To continue your application and apply for insurance cover online Continue Or, to receive an insurance quote only Submit Now Has an insurer ever: Declined your proposal of claim? Yes No Reasons Why? Letters, numbers and spaces only Cancelled your insurance? Yes No Reasons Why? Letters, numbers and spaces only Imposed special conditions of cover? Yes No Reasons Why? Letters, numbers and spaces only Is your insurable interest as Owner(s) Lessee(s) Do you own 100% of the horse? Yes No Percentage owned Numbers and decimals only Other parties to whom this proposal applies Have you had any bloodstock insurance claims in the last two years? Yes No How many and what were the total value of such claims? Additional Please provide any additional information that might influence an underwriter to accept this proposal or be relevant to this cover. Note: please read the Duty of Disclosure Your Duty of Disclosure The duty of disclosure is an important legal requirement which applies to insurance. To help you understand what this means to you, we have explained the main points below. When you apply for insurance you have a legal duty of disclosure. This means you must tell us all information you know (or could be expected to know) which would influence the judgement of a prudent underwriter whether or not to accept your application and if it is to be accepted, on what terms and at what cost. You also have this duty whenever you make a change to your insurance and when any new contract replaces that which may now be issued. Examples of information you may need to disclose include: any circumstances which could increase the risk of an insurance claim; any criminal offence; any cancellation, refusal to renew insurance, or imposing of special terms by another insurance company; any insurance claim you have made in the past. Examples of information you do not need to disclose include: anything you have already told us, or that we should be expected to know in the ordinary course of our business; anything we say you do not need to tell us; anything that is common knowledge; anything that reduces the risk of an insurance claim. These examples are intended as a guide to help you understand your duty of disclosure. If you are not sure whether you need to disclose a particular piece of information, please ask. If you fail to meet your duty of disclosure, the consequences can be serious. You may find that you never had any insurance at all. When in doubt - disclose. Please remember that all information will be treated confidentially. Additional Information Declaration All information provided in connection with this application for insurance cover, whether oral or written, is true and correct and I have disclosed all material facts required by law. I acknowledge that this application does not constitute acceptance by New Zealand Bloodstock or its Underwriters of the proposal. If accepted, this proposal shall form the basis of the contract and incorporated into the Insurance Certificate. New Zealand Bloodstock and its Underwriters reserve the right to place exclusions/warranties on any insurance issued pursuant to this application. I accept that any insurance certificate issued on this application will not cover any pre-existing condition(s) of the animal(s) to be insured. The Horse(s) proposed for insurance is (are) in good health and is (are) free from any injury, disability, abnormality or sickness and has (have) been so far for the past 12 months. I have read and accept the above declaration If I am/we are an Australian resident(s) or currently in Australia (if neither are applicable ignore this declaration). I/we confirm that the horse(s) proposed for insurance is (are) NOT: (a) wholly or predominantly used for personal, domestic or household purposes by me/us, me/our relatives, or any person with whom I/we reside; and (b) ordinarily used for that purpose. I have read and accept the terms and conditions Please read the terms and conditions and contact New Zealand Bloodstock before proceeding if you have any questions. Please provide me with a policy certificate and tax invoice based on the information supplied above Please note that by submitting this form New Zealand Bloodstock does not guarantee acceptance of insurance cover. In addition to the above declaration a Veterinary Surgeons Certificate of Health is required for all: Horses over 13 years old. Stallions (with specific reference to genitalia) All foals to 30 days including IgG levels from 24 hours, Other horses valued over $100,000, and Any horse domiciled outside New Zealand or Australia. Please note that if you are in doubt, you may submit a Veterinary Certificate for horses below the levels of value indicated above. It is emphasised that, on acceptance, the Insurance provided shall WARRANT that the horse is in good health and free from injury, disease, disability or abnormality AND that in the event of any claim the onus of proof thereof shall be upon the Insured. Thank you for your application. If accepted, your insurance certificate and tax invoice will be sent to you shortly. We will be in touch if further information is required. Apply now