Livestock Insurance Applications

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

• Livestock Named or Specified Perils Application  FORMM76.doc (1/92)  (1 Page)

Forms for use to apply for Transit Insurance

• International Air Transit Information Form  (1 Page)

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)