Fillable Substantiation of value show, breeding and in-training horses (Abram Interstate Insurance)

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Substantiation of value show, breeding and in-training horses (Abram Interstate Insurance)

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MAIL 040 05 16 Page 1 of 2
Markel Insurance Company
P.O. Box 2009, Glen Allen, VA 23058-2009
Telephone: (800) 262-7535 Fax: (804) 527-7999
Email applications to: agapplications@markelcorp.com
Website: horseinsurance.com
Substantiation of value – show, breeding and in-training horses
Markel agent number: ____________ Submission or policy number: _________________________________________
Insured’s name: _____________________________________________________________________________________
Phone #: ____________________ Fax #: _____________________ Email: _____________________________________
Mailing address: ________________________________ City: ________________ State: _____ Zip code: __________
Name of horse: ___________________________________________ Year of birth: ______________________________
Sire: ______________________________________________ Dam: ___________________________________________
Show record for prior 12 months
Name of show & rating Date Name of class or division Number in class Placing/Score
1.
2.
3.
Breeding record of mare
List sires Years foaled Stud fees Foal sex Price when sold
1. $ $
2. $ $
3. $ $
Breeding record of stallion
(List for prior three years beginning with third year prior to present.)
Year Number of outside
mares bred
Stud fees
earned
Number of homebred
mares bred
Income from sales
of foals
Number of foals
produced
$ $
$ $
$ $
Total number of foals produced:
How many Mares are booked in the coming year?
Stud fee charges: $ /
$
Training record
Total number or months training to date:
Trainer & location:
Cost of training per month (excluding boarding): $
Type of training:
MAIL 040 05 16 Page 2 of 2
Comments
If additional details are necessary, provide on a separate page.
NOTE: This form becomes part of your primary application and must be signed and dated. Coverage cannot be bound
until the Company approves your completed application. The Company’s receipt of premium does not bind coverage until
a written quote has been issued. Before electronically signing this document, verify your information is correct.
Electronically signing will disable further editing of your application.
I hereby certify that to the best of my knowledge and belief, the information provided is true and complete
and that no information, which would materially affect this insurance, has been withheld.
Applicant’s signature: ____________________________________________________________ Date: ___________
Agent’s signature: _______________________________________________________________ Date: ___________
(Florida only) Agent license number: _________________________
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Completed 10 July 2021

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