PROPOSAL FOR
STALLION FIRST SEASON INFERTILITY INSURANCE
NOTE: Losses due to genital tract infections of the stallion are not covered by this Policy. This is because such losses are not Congenital Infertility within the meaning of this Policy and are more appropriately included in available "Permanent Infertility (Accident, Sickness and Disease)" Policies, when infection damage is both permanent and total, or by "Loss of income" Policies, when infection damage is temporary.
(1) Name and address of Proposed Assured: ......
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(2) Name of Proposed Insured Stallion: ......
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(3) Name and address of Farm where
Proposed Insured Stallion is
presently maintained: ......
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(a) Name and address of principal of such farm: ......
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(b) Name and address of manager of such farm: ......
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(4) Name and address of stud farm where ......
Proposed Insured Stallion is to stand:
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(a) Name and address of principal of ......
stud farm:
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(i) Number of years of ownership or management at stud farm: ......
(ii) Number of years in thoroughbred breeding business: ......
(b) Name and address of manager of stud farm ......
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(i) Number of years of ownership or management at stud farm: ......
(ii) Number of years in thoroughbred breeding business: ......
(c) Where and by whom will the Stallion's records be kept? ......
(5) Has Proposed Insured Stallion raced or been trained for racing: YES/NO ......
(a) If so, annex as an addendum a schedule of racing history; including races entered, race result and winnings, separately designating any claiming races.
(b) If so, state when the horse went out of training: ......
(6) State the date that the horse arrived or is due to arrive at the stud: ......
Date horse scheduled to begin stud duties: ......
(7) Has proposed Insured Stallion been semen tested or test bred? YES/NO ......
If so, when and what were results? ......
(8) Will proposed Insured Stallion be semen tested or tested or YES/NO ......
test bred prior to covering season?
If so, when? ......
(9) Have anabolic steroids been administered to the proposed
Insured Stallion during the past 12 months? YES/NO ......
(If not known please provide full veterinary information)
If so, please give details:
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(10) In current Code of Practice for Venereal Disease adhered to: YES/NO ......
(11) How many mares will proposed Insured Stallion cover
during first season at stud? ......
(a) State the maximum number of mares the proposed Insured
Stallion may normally be asked to cover in one week......
(b) State the maximum number of mares the proposed Insured
Stallion may normally be asked to cover in one day......
(12) Are walk-in mares accepted at stud? YES/NO ......
If so, how many in respect of Proposed Insured Stallion? ......
(13) Is there a resident Veterinary Surgeon at stud? YES/NO ......
Name: ......
(14) State whether Proposed Assured is sole and exclusive owner of
Proposed Insured Stallion to the extent of 100% ownership,
currently vested and not subject to any condition relating to or
based upon, in whole or in part, the fertility of the Proposed
Insured Stallion. YES/NO ......
(15) State whether Proposed Assured is sole and exclusive owner of
Proposed Insured Stallion to the extent of !00% ownership,
currently vested and not subject to any condition relating to or
based upon, in whole or in part, payments required pursuant to
any purchase or sale agreement. YES/NO ......
(16) If questions numbered (14) and (15) above are not answered "yes", and without qualification, then please provide the following:
(a) If ownership of Proposed Assured is less than 100%,
state the percentage of ownership......
(b) Is the Proposed Insured Stallion subject to any form of
syndicate agreement? YES/NO ......
1. If so, number of shares: ......
2. If so, detailed breeding rights: ......
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3. If so, specify sale price each share ......
(without inclusion of valuation for
breeding rights) ......
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4. Set forth details of deferred payment terms: ......
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5. Set forth details of warranties given: ......
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6. If so, does there exist any agreement under
which ownership interest of the Proposed
Assured will or may be modified or altered
in the event of injury or infertility? YES/NO ......
I declare that the above statements are true and complete. I make this Proposal with knowledge that any insurance Policy to be issued will be based on the statements contained herein, and that such statements shall, in the Policy, be deemed warranties and representations, as shall the statements contained in any veterinary certificate supplied in furtherance of this Proposal.
Signing this form does not bind the proposed Assured to complete the insurance, nor does receipt of the Proposal bind any Insurer to accept the same.
SIGNATURE OF PROPOSED ASSURED ......
DATED: ......
PLEASE SEE PAGE 5 FOR INDEMNITY EXTENSION
STALLION FIRST SEASON INFERTILITY INSURANCE EXTENSION No.1
(Attaching to a Mortality Policy)
Please note that at the discretion of the Underwriters the following Option is available as an extension to the Stallion First Season Infertility Wordings:-
It is hereby declared and agreed that subject to the terms, conditions and definitions of this Policy it is extended to indemnify the Assured for up to %of the value of the Stallion (but not exceeding the sum insured) in the event of the Stallion being unable to be bred to the minimum number of mares (see Conditions 2 of this Policy) from any cause, provided such cause, or causes, be solely attributable to the Stallion and have been certified as such by the panel of Veterinary Surgeons provided for in Conditions 8 of this Policy.
This extension does not cover losses arising out of or contributed to by or associated with:-
1. Death of the Stallion or
2. Any infection of Stallion's reproductive tract including surface infections of the penis or sheath, or
3. Infection of a venereal or other character in the mare, or
4. Mares not being presented to the Stallion for breeding for any reason whatsoever.
I * DO /DO NOT REQUIRE THIS EXTENSION
(*Please delete as necessary)
SIGNED ......
DATED ......