2025 Entain-NZB Insurance Pearl Series Entry Form
Please fill in the form below.
Full Name of Nominator
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Region
Postal Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
What is your involvement with the horse?
Breeder
Owner
Trainer
Agent
Lessee/ Lessor
Syndicate Manager
Other
Your Bank Account Details:
(Nominator's Bank Account for Direct Credit of Nominator's Bonus.)
Name of Account:
*
Account Number:
*
Yearling Information:
Early Bird Cost: $1,150 (Inc. GST) per yearling entered.
Nominations of Yearling Fillies (Born 2023)
*
GST Details:
(If applicable.)
Nominator's GST Number:
Owner's GST Number:
Insurance:
*An endorsement will be made to your existing policy to include the 'Lifesaving Surgery' extension.
Insurance Options:
*
Insurance Required
Insurance Not Required
Filly Already Insured with NZB*
INTERNET BANKING PAYMENT METHOD:
To pay via Internet Banking, please see below our bank account details: 02 0360 0105172 00 and use your invoice number as the reference.
DECLARATION: I declare I am authorised to make this/ these nominations and the nomination (s) is/ are eligible to be nominated.
*
I accept
I don't accept
ENTRY FEE
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Entain-NZB Insurance Pearl Series Entry - Per Yearling
$
1,000.00
NZD
NZB Pearl Series Entry - Per Yearling
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Subtotal
$
0.00
NZD
Tax
$
0.00
NZD
Total
$
0.00
NZD
Submit
Should be Empty: