Please refer to the medical coverage PDF before deciding to choose a medical plan. 

If a Medical Plan is selected above, COLIC & SURGICAL coverages are included in your selected limits.

STATEMENT OF CONDITION

I declare to the best of my knowledge and belief that the animal listed on the above schedule to be in normal healthy sound condition. I further declare that during the past 12 months the above listed animals have been free from any ILLNESS, INJURY, DISEASE OR ACCIDENT. I understand and agree that this application shall be the basis of the Insurance contract and If anything be falsely stated or information withheld to influence the company's decision, the insurance contract will be null and void.

DECLARATION

I, the undersigned, hereby apply to insure the above mentioned animal owned by me, subject to the terms and conditions of the policy to be issued, including, but not limited to, the requirement under the policy to give IMMEDIATE notice by telephone of any ILLNESS, INJURY OR DISEASE or a claim may be denied. I declare that to the best of my knowledge and belief the above statements are true and complete and that I have not withheld any material information. Signing this form does not bind the applicant to complete the insurance but it is agreed that this form shall be the basis of the contract should a policy be issued and if anything be falsely stated or information withheld to influence the company's decision, the insurance contract will be null and void.