Markel Horse Insurance Application

Markel Horse Insurance Application

Complete this application using the fields and instructions from the referenced PDF. All fields are optional unless marked required in the source.
Policy and Agent Information
Desired Effective Date

MonthDayYear
Date
Markel Agent Name/Number
Insured Type and Applicant Details
Insured Type
Individual Name

First NameMiddle NameLast Name
Name of Business/Organization/Trust
Spouse Name

First NameMiddle NameLast Name
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Applicant Details
Referral, Loss History, and Memberships
How did you hear about Markel?

Other
Referral details
Have you had any horse-related losses or claims?

Other
Loss history details
Horse association memberships

Other
Horse Identification, Ownership, Lease, and Health
Horse Name
Breed
Sex
Date of Birth

MonthDayYear
Date
Height (hands)
Do you own the horse?
If leased, from whom?
Lease term (months)
Is the horse used for breeding?
Date acquired

MonthDayYear
Date
Describe any current or past medical conditions
Number of prior owners
Location, Care, and Coverage
Stable / Primary Location

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Location Type

Other
Care Arrangements

Other
Coverage Options Requested

Other
Coverage Limit Selection
Requested Coverage Amount
International Transit
Transit Route / Countries
International Transit Start Date

MonthDayYear
Date
International Transit End Date

MonthDayYear
Date
Equine Essentials Coverage

Other
Equine Essentials Limit
Equine Essentials Deductible
Liability Coverage

Other
Liability Limit
Liability Premium Estimate
Additional Interests

Other
Additional Interest Details
Signatures
Applicant Signature
Date Signed

MonthDayYear
Date
Agent Signature
Agent Date Signed

MonthDayYear
Date
Should be Empty:

Markel Horse Insurance Application

Policy and Agent Information

Insured Type and Applicant Details

Referral, Loss History, and Memberships

Horse Identification, Ownership, Lease, and Health

Location, Care, and Coverage

Signatures