Please answer the following questions as fully as possible:

Have you had previous animal insurance? If yes, which insurer was it with?

No Yes

Did you have any claims? If yes, what was the claim for?

No Yes

Has any insurer declined a proposal, refused renewal, terminated cover or imposed special terms in respect of the risk to be insured?

No Yes

Have you ever been convicted of arson, fraud, deception, robbery, forgery, theft, handling stolen property or any crime under the Wildlife & Country Act 1981?

No Yes

For how long have you been keeping these types of animals?

DECLARATION - Please Read Carefully - In making this application, you warrant that the animal(s) identified are owned by you and to the best of your knowledge and belief, the information provided in connection with the application is true and you have not withheld any material facts. You fully understand the conditions and declaration of cover and also understand that non-disclosure or misrepresentation of a material fact will entitle the underwriters to void the insurance. NB a material fact is one likely to influence the acceptance or the assessment of this proposal by underwriters. If you are in any doubt as to what constitutes a material fact, please ask. You understand that the submitting of the application does not bind you to complete the insurance but agree that should a contract of insurance be concluded, this application and the statements made therein shall form the basis of the contract.