Application ABES horse insurance

1. applicant

Person

Sex

Title

First Name and Last Name

Address

E-mail

Priority phone no

BAN number for refunds

2. general information about the contract

Proposed Start date: (if not filled in, as per acceptance)

Is the horse currently insured?

Have you ever been declined insurance or had any such insurance canceled or renewal refused, or had special terms imposed?

Have you sustained a loss of a horse in the past 5 years?

Is there any other party with a financial interest in the horse?

3. general information about the horse to be insured

Name

Breed

Sex

Identity Marking

Color

DOB

Chip

Majority type of use

Address

Distance to usual vet

Distance to the nearest veterinary facility for major operations

4. health questions about the horse to be insured

To your knowledge, has the above horse ever suffered from any form of colic or other intestinal or digestive disorders?

To your knowledge, has the above horse ever suffered from any fractures, tendon or ligament injury?

Received attention from any veterinary surgeon of alternative therapist for any reason other than routine vaccination or obstetric work including farriery in the last 12 months?

Is the above horse at present normal in confirmation, eyes, heart, wind and action and in good health?

Is there any other factor affecting the health of the horse which should be disclosed?

A possible health examination (purchase examination) by the veterinarian must be carried out according to a separate form. The costs are be borne by the applicant.

5. sum insured and market value

Purchase Price in CHF (without tax)

Purchase Date

Proof of purchase available or follows later

Value of the horse in CHF

6. insurance cover applied for

The premium may change depending on the the answers to the application questions. If this is the case, or if the horse can only be the horse can only be insured with a reservation, you will be informed of this before the insurance contract is issued. If the horse can be insured on standard terms conditions, the insurance contract will be issued directly and sent to you electronically. sent to you electronically.

The premium may change due to your following declarations. If so, or if the horse may only be insured with exclusion or with a special condition, you will be informed before the insurance contract is issued. If the horse is accepted at standard conditions, the insurance contract will be issued directly.

Click or drag files to this area to upload. You can upload up to 12 files.

The applicant declares that he has answered the questions contained in this document to the best of his knowledge. knowledge. By signing this application, the applicant confirms that he/she has been informed of the identity of the insurer as well as the essential content of the insurance contract and that he/she has received the associated terms and conditions. In connection with the processing of the insurance contract, the insurer will create two data collections (customer data and data collections are created by the insurer (customer data and claims data). The customer data is used to prove whether insurance exists with the insurer. The claims data is used for claims settlement. Recipients of the data are the respective Lloyd's brokers and the insurers, in the event of a claim possibly also the claims settlement office commissioned by the the claims settlement office commissioned by the insurers and, if applicable, the Swiss Lloyd's UVG Claims Office. Office. Disclosure to other third parties will only take place with the consent of the person or persons concerned or based on a law. The data is stored partly electronically and partly in paper form and is destroyed after ten years. destroyed after ten years.

Place

Date

Clear Signature
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