ACORD 192 (7/98) – Equine Insurance Application

Use this form to apply for insurance on horses such as thoroughbreds and racing horses.

ANIMAL INFORMATION

Complete all items to provide important information about each animal to be insured. Space is provided for four animals.

COVERAGE/LIMITS

Enter each coverage limit desired. Use the Remarks section to request coverage not shown.

ACCOMMODATIONS

For each animal, indicate whether the horse is kept in a stall, corral, open pasture or other accommodation.

GENERAL INFORMATION

Answer all questions. With the exception of questions 5, 14, 15 and 16, explain all “yes” responses.