Application for Broad Form Named Perils Horse Insurance

Complete and submit the online application and mail your cheque, payable to: Colley, Borland & Vale In Trust together with:

1. A dated, signed photo of your horse taken within the last 30 days
2. Bill of Sale
3. Vet Certificate dated within 30 days
4. Copy of registration papers.

(also available printable application or pdf application)

Broad Form Named Perils Horse Insurance rates and information

Important Notice. Coverage cannot be bound by e-mail, fax or voice mail. You MUST speak to a licenced broker. Owner Information to be completed by owner of authorized agent Full Name of Registered owner Address Email Work Phone Home Phone Work Phone Fax Horse Description Horse Name Breed Date of Birth Sex Registry # Location of Horse Value Premium Veterinarian Name Veterinarian Address Postal Code Last Vet Visit Reason Last Wormed Last Shots Insurance I request optional Vet Coverage (Applicable to insured perils only)   Yes No Amount Requested: $ Premium: Declaration of Owner I will supply CBV with: Bill of Sale               Registration Vet Certificate Dated Photo Cheque I am aware that coverage is NOT in effect until ALL documentation is received by CBV I hereby certify my horse has no pre-existing condition or illness that affects this policy coverage. Where did you find us? please choose from list another website word of mouth I'm an existing customer phone directory online directory or search engine OTHER - please indicate

Broad Form Named Perils Horse Insurance information

Underwritten by North Waterloo Farmers Mutual Insurance Co.