Pearl Series Nomination
Fill out the form carefully for registration
Please fill our the following information about your personal contact information.
Street Address Line 2
State / Province
Nominator's Bank Account for Direct Credit of Nominator's Bonus:
Name of Account:
2. NOMINATIONS YEARLING FILLIES
NOMINATIONS YEARLING FILLIES (BORN 2019)
Sire & Suffix (eg. AU & USA)
Dam & Suffix
I declare I am authorised to make this/ these nomination(s) and the nomination(s) is/are eligible to be nominated.
4. PAYMENT OPTIONS
Please select your preferred payment method;
By Direct Credit/ Internet Banking
By Electronic Payment Via Payment Express
By Credit Card
If you selected Direct Credit/ Internet Banking:
Credit NZTBA Pearl Series: BNZ A/c No: 02/ 0360/ 0105172/ 00
If you selected Electronic Payment Via Payment Express:
By Cheque made payable to: NZTBA Pearl Series
5. INSURANCE OPTIONS:
Please select one of the following options that best suits your needs.
Insurance Required for $ (Contact NZB Insurance 09 298 0055 or email email@example.com)
Insurance Not Required
Filly already Insured with NZB (An endorsement will be made to your existing policy to include the 'Colic Clause' extension.)
6. NOMINATOR'S GST
7. NZTBA GST Reg No: 10-387-272
GST: When the fee is paid, this form constitutes a GST Tax Invoice. If payment forms part of a taxable activity with the GST Act, a copy should be retained for your records.
Should be Empty: