Colley Borland & Vale Insurance Brokers Limited - applications for broad form named perils horse insurance

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 months
2. Bill of Sale
3. Vet Certificate dated within 30 days
4. Copy of registration papers.

(also available printable application or pdf application or pdf flyer)

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 licensed 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?

Broad Form Named Perils Horse Insurance information

Underwritten by North Waterloo Farmers Mutual Insurance Co.

Call us for a quotation...we do barn calls!
Or fill out our Equine Online Quotation Request. or Corporate Quotation Request

200 - 4591 Highway 7 East, Markham ON L3R 1M6

Phone: 905.477.2720 Toll Free 1.888.473.8636 Fax 905.477.0424

email cbvins@broker.csio.com

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