Private Horse Owners (Liability)

Liability Insurance Quotation and Statement of Fact

Proposers Details

Name of Proposer

Correspondance Address: Line 1

Correspondance Address: Line 2

Correspondance Address: Line 3

Correspondance Address: Line 4

Contact Telephone Number

Step 2: Complete General Questions

General Questions
In connection with any liability insurance

a) Have you or any partner in business with you had any proposal for Insurance declined, renewal refused, cover terminated or special terms and conditions imposed by any Insurer?

Yes

b) Has any incident occurred over the past 5 years involving bodily injury or damage to property, whether a claim was made or not?

Yes

Limit of Indemnity

Excess €600.00 each and every third party property damage claim

Please select "Yes" for each additional horse required

Yes

Horse Name

Colour

Sex

Year of Birth

I have read Terms of Business /Product Suitability & Statement of Suitability