Ark International Group

Livestock Insurance Applications

Forms for use to apply for Full Mortality Insurance, Surgical Insurance and Major Medical Insurance

Application For HORSE MORTALITY INSURANCE with Vet Exam Form NAHA M-73 (2/03) (2 Pages)(Use for all companies except Hartord Insurance Group.)
Animal Mortality Application LS 16 01 09 04 (3 Pages) (Use for Hartford Insurance Companies)
All-Around Horse Supplemental Application (1 Page)(A Form Used to Declare All Uses of a Horse to be Insured.)
(Owner’s) Statement of Health (1 Page) (Use for all companies except Hartford Insurance Group.)
(Owner’s) Statement of Health – Horses Only (1 Page) (Use for Hartford Insurance Companies)
Veterinarian’s Statement of Examination for Mortality Insurance LS 16 02 06 03 (1 Page) (Use for all companies except Hartford Insurance Group.)
Justification of Value Record FORMM _99.DOC (5/02) (1 Page) Complete to establish increased value of a horse due to additional training, performance and show record, and breeding record.
Substantiation of Value Form LS 16 22 06 03 (1 Page) (Use for Hartford Insurance Companies)

Forms for use to apply for Limited, Named or Specified Perils Insurance

Forms for use to apply for Transit Insurance

Forms for use to apply for Loss of Use Insurance

Loss of Use Examination Form [5/00] (1 Page) (G reat American Insurance Companies)
Loss of Use Endorsement Supplemental Questionnaire (1 Page) (Great American Insurance Companies)
Loss of Use Renewal Examination [5/00] (1 Page) (Great American Insurance Companies)

Forms for use to apply for Stallion Infertility Insurance

Stallion Breeding Soundness Exam (1 Page) (Great American Insurance Companies)
Stallion Statement of Breeding Condition (1 Page) (Great American Insurance Companies)
Accident, Sickness and Disease Stallion Infertility Supplemental Application (1 Page) (American Equine Ins. Group – United National Group)
Stallion Infertility (Accident, Sickness, and Disease) LS 16 28 03 04 (1 Page) (Use for Hartford Insurance Companies)
Breeding Soundness Evaluation LS 16 27 03 04 (1 Page) (Use for Hartford Insurance Companies)