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Pick & Mix
Horse Details
Saddlery & Tack Details

Select Plan

Horse Pick & Mix Plan
Liability Plan
Horse Saddlery & Tack
Horse Float

Horse Age

Horse Cover Detail

Sum Insured

A Petplan Equine Veterinary Certificate can be downloaded here

Purchase Price(NZD $)

Optional Extra Benefits :

Please select any additional benefits you would like to add to your quote:

Vet Fee Cover

Hi-Xcess
Normal
None

Permanent Loss of Use (Optional)

100%
60%
None

Loss of Use requirements can be downloaded here

Disposal

Yes No

Veteran Plan

Veteran Plan A

Death from Injury Up to $3,000
Loss by Theft or Straying Up to $3,000

Veteran Plan B

Death from Injury Up to $3,000
Loss by Theft or Straying Up to $3,000
Vet Fee Cover (Injury Only) Up to $2,000

Purchase Price(NZD $)

Optional Extra Benefits :

Please select any additional benefits you would like to add to your quote:

Saddlery and Tack

Horse float & Drawn Vehicles

Equine Activities

Leisure

Competitive (Low Risk)

Competitive (Medium Risk)

Competitive (High Risk)

Name

Sex

Breed

Height

Colour

Current Vet Details

Name of Vet

Address

Contact Number

I do not have a Vet

Monthly Amount($ NZD)

Yearly Amount($ NZD)

Particular Details

Do you understand your Duty of Disclosure requirements and the implications of non-disclosure?

List all the activites that the Horse is used for

Have you made a claim or any incident that may give rise to a claim under a similar insurance policy in the last five (5) Years?

Yes No

Has any insurer declined or refused renewal or required special premium or imposed any exclusions on a similar insurance policy?

Yes No

Has the Horse proposed for insurance suffered any injury, illness or disease which required veterinary attention?

Yes No

Has the Horse proposed for insurance suffered any injury, illness or disease which did not require any veterinary attention?

Yes No

You declare that the Horse proposed for Insurance is currently in a sound state of health?

Yes No

Do you authorize any treating veterinarian to supply Petplan with your Pet’s complete veterinary history, details of any claims, and any other relevant information?

Yes No

Do you own any other horses which are currently not insured with Petplan?

Yes No

Does the sum insured reflect the current full market value of the horse?

Yes No

Is purchase price less than sum insured or is the horse home bred?

Yes No

Has the Horse proposed for insurance shown any aggressive tendencies or have any vices?

Yes No

Will the horse proposed for insurance be transported by a commercial transport company within the next 14 days?

Yes No

Is the horse proposed for insurance currently subject to a lease agreement or trial period?

Yes No

You must answer all of the questions truthfully and accurately. Please be aware that if You have answered YES to any of the above questions, We may vary the cover, apply exclusions to Your Policy, or decline to cover your Pet entirely. This will be determined after an underwriting assessment.

Please confirm that you understand this declaration.

Yes – I would like my Policy Documents & Product Disclosure Statements (PDS) emailed to me.

I have read and accepted Terms & Conditions

Saddlery & Tack Details

List of Saddlery and Tack

Has Saddlery and Tack proposed for insurance have any damage ?

Yes No

Float Details

GVM (Kgs)

Year of Manufacture

Carrying Capacity (number of horses)

Make

Model

Registration

VIN (Vehicle Identification Number)

Does the Horse Float proposed for insurance have any damage?

Yes No

Road Worthy

Yes No

Non Standard Modifications Or Accessories

Yes No

Additional Information

Liability Cover Detail

Limit of Liability

Name

Sex

Breed

Height

Colour

Promotional code

Monthly Amount($ NZD)

Yearly Amount($ NZD)

Particular Details

Do you understand your Duty of Disclosure requirements and the implications of non-disclosure?

List all the activites that the Horse is used for

Have you made a claim or any incident that may give rise to a claim under a similar insurance policy in the last five (5) Years?

Yes No

Has any insurer declined or refused renewal or required special premium or imposed any exclusions on a similar insurance policy ?

Yes No

Do you own any other horese which are currently not insured with Petplan?

Yes No

Has the Horse proposed for insurance shown any aggressive tendencies or have any vices?

Yes No

Please confirm that you understand this declaration.

Yes – I would like my Policy Documents & Product Disclosure Statements (PDS) emailed to me.

I have read and accepted Terms & Conditions

Saddlery and Tack Cover Details

Saddlery and Tack amount

List of Saddlery and Tack

Monthly Amount($ NZD)

Yearly Amount($ NZD)

Particular Details

Do you understand your Duty of Disclosure requirements and the implications of non-disclosure?

Promotional code

Have you made a claim or any incident that may give rise to a claim under a similar insurance policy in the last five (5) Years?

Yes No

Has any insurer declined or refused renewal or required special premium or imposed any exclusions on a similar insurance policy ?

Yes No

Has Saddlery and Tack proposed for insurance have any damage ?

Yes No

Please confirm that you understand this declaration.

Yes – I would like my Policy Documents & Product Disclosure Statements (PDS) emailed to me.

I have read and accepted Terms & Conditions

Float Cover Details

Horse Floats & Horse drawn vehicles

GVM (Kgs)

Year of Manufacture

Carrying Capacity (number of horses)

Make

Model

Registration

VIN (Vehicle Identification Number)

Does the Horse Float proposed for insurance have any damage?

Yes No

Road Worthy

Yes No

Non Standard Modifications Or Accessories

Yes No

Additional Information

Monthly Amount($ NZD)

Yearly Amount($ NZD)

Particular Details

Do you understand your Duty of Disclosure requirements and the implications of non-disclosure?

Have you made a claim or any incident that may give rise to a claim under a similar insurance policy in the last five (5) Years?

Yes No

Has any insurer declined or refused renewal or required special premium or imposed any exclusions on a similar insurance policy ?

Yes No

Please confirm that you understand this declaration.

Yes – I would like my Policy Documents & Product Disclosure Statements (PDS) emailed to me.

I have read and accepted Terms & Conditions

Payment Details

Plan

How would you like to pay?

Yearly Monthly

Amount($ NZD)

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Payment Type

Card Type

Credit Card Holder Name

Credit Card Number

Expiry Date

CVV

I have read and agreed to Direct Debit Client Agreement

Download Direct Debit Form

Client Details

Horse Details

Name :

Sex :

Age :

Breed :

Height :

Colour :

Equine Insurance Quote Form

Horse Cover Detail

Optional Extra Benefits :

Optional Extra Benefits :

Equine Activities

Current Vet Details

Particular Details

Saddlery & Tack Details

Float Details

Liability Cover Detail

Particular Details

Saddlery and Tack Cover Details

Particular Details

Float Cover Details

Particular Details