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equine mortality & major medical application

*Submitting a quote request or contact form on this website does not bind, guarantee, or imply coverage of any kind. Saddle, Stock & Legacy operates as a wholesaler of equine and farm insurance policies and is not an insurance carrier. We do not fully underwrite, issue, or directly pay claims on any insurance policy.
 

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Person Applying for Coverage
Date and time
Month
Day
Year
Time
HoursMinutes
Equine Mortality Insurance Application

*If applying for multiple horses, please use one form per horse.

Sex of Horse
Purchase Date
Month
Day
Year
*If the horse was purchased over 30 days ago, what date was it?
Month
Day
Year
Horse Use:
Major Medical Requested
1. Was a pre-purchase exam completed on the above horse?
Yes
No
2. Are you the sole owner of the above horse?
Yes
No
3. Is the above horse currently sound and healthy and able to be used as intended?
Yes
No
4. Is the above horse currently insured?
Yes
No
5. Has any insurance company ever cancelled any insurance or denied coverage on the above horse?
Yes
No
6. Has the above horse tested positive for HYPP, HERDA, PSSM?
Yes
No
7. Has the above horse had any colic or intestinal disorder within the last 36 months?
Yes
No
8. Has the above horse had any past or present conformation problems, defects, ailments, illnesses, diseases, injuries, or physical disabilities requiring a licensed veterinarian's oversight in the last 12 months?
Yes
No
9. Has the above horse received, or is receiving, any type of medication, long- or short-term, prescribed by a licensed veterinarian over the last 12 months?
Yes
No
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