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Nameyour full name
Occupationyour full name
Telephoneyour full name
Fax No.your full name
Mobileyour full name
Addressmore details
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Particulars of Horse:

Name of Horseyour full name
Sireyour full name
Damyour full name
Breedyour full name
Colouryour full name
Rating (Hong Kong)your full name
Class of Horse (Hong Kong)your full name
Brand Numberyour full name
Date of Birthof appointment
Proposed Sum Insured (HKD)your full name

Justification of Value:

Purchase Price (HKD)your full name
Date of Purchaseof appointment
Winnings (HKD)your full name
Locationyour full name
Name of Traineryour full name

Cover:

Sum Insured (HKD)your full name
Effective Dateof appointment
Sum Insured (HKD)your full name
Effective Dateof appointment

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

If Yes please provide detailsyour full name

2. Have you made any bloodstock insurance claims or sustained any bloodstock losses, whether insuredor not, in the last five years?

If Yes please provide detailsyour full name

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).


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. Subject to acceptance by Underwriters, when would you like the insurance to commence:

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