Application for horse cover

Application for horse cover

If you’re interested in an FMG horse policy complete the application form below and our Equine team will get back to you to arrange cover.

New policies

Please note that all horses need a Declaration of Health, and in some cases a veterinary certificate as well.

Veterinary Certificates

We require the following for any new policies:

  • A 5 stage veterinary certificate for all Horse Deluxe policies.
  • A 2 stage veterinary certificate for:
    • horses insured over $30,000;
  • An FMG Foal Veterinary Certificate and a satisfactory result of over 800 for foals under 10 days.
  • An FMG Foal Veterinary Certificate for foals aged 11-45 days.

Application Form

Note: Mandatory fields are marked with a '*'
Personal details 
Title
 
*
 
*
 
*
 
*
 
*
 
 
 
 
Are you a current FMG client?
 
 
 
Horse details 
*
 
 
 
 
*
 
*
 
Height Unit*
 
*
 
*
 
*
 
 
 
*
 
*
 
*
 
Declaration of Health 
Has the horse 
1. Suffered from any accident, sickness, disease or received any medical treatment within the last 3 years?*
 
*
 
2. Suffered from colic, heart abnormalities or respiratory conditions?*
 
*
 
3. Suffered from sprained tendons, been fired or denerved?*
 
*
 
4. Been examined for purchase by a vet?*
 
*
 
General UW Questions 
1. Are there any other parties involved in the ownership of the horse to be insured?*
 
*
 
2. Have you ever been insured with FMG before - or your family?*
 
3. Will this proposal replace another proposal?*
 
4. In the past 7 years have you or anyone who normally lives with you ever: 
a) Had any insurance cancelled, refused, not renewed or any imposed terms imposed on your policies by any Insurer?*
 
*
 
b) Have you made any claims or been legally liable for an event in the last 5 years?*
 
*
 
c) Had any claims declined by an Insurer?*
 
*
 
d) Been convicted or charged with a criminal offence?*
 
*
 
e) Have you, or any other person who wishes to be covered by this insurance, ever been declared bankrupt?*
 
*
 
5. Is there any other material information you need to disclose?*
 
*
 

Your duty of disclosure

You have a continuing legal duty to disclose to FMG everything that is material to the risk to be insured under this contract. If you do not do this, FMG may have the right to cancel your policy and/or decline to pay any benefits.

 
I have read and agree to the Duty of Disclosure 
*
 

I have read the FMG Disclosure Statement

 
*
 
  
All information given in support of this proposal, whether oral or written, is true and correct. 
I/We have disclosed to the underwriters all material facts required by law 
*
 
  
Insurance option 
What type of insurance cover(s) are you interested in?
 
*
 
*
 
 
Clear