From what date is cover required?
*
/
Day
/
Month
Year
Date
Please select the option which best describes your business:
*
Please Select
Limited Company
Trading As
Sole Trader
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Address
*
Address line 1
Address line 2
City
Postcode
Email
*
Confirmation Email
Confirm email
Telephone
*
Please enter a valid phone number.
Is a joint policy required?
*
Yes
No
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Is the risk address the same as the correspondence address?
*
Yes
No
Please provide the full risk address
What is your main business activity?
*
Are any other activities carried out?
*
Yes
No
Please provide full details
How many years' experience do you have in the equine industry?
*
What equine qualifications do you have?
*
How many horses do you require cover for?
*
Do you require Care, Custody and Control cover for any third party horse in your care?
*
Yes
No
If yes, please advise the maximum value of any third party horse in your care.
Do you have any employees (paid or voluntary)?
*
Yes
No
If yes, how many?
What is your annual turnover?
*
What level of cover do you require?
*
Please Select
£2,000,000
£5,000,000
£10,000,000
Have there been any claims made in the last 5 years?
*
Yes
No
How would you prefer to be contacted by Cliverton?
Phone
Email
SUBMIT
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