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Medical Declaration
(Prestige Pets insurance)
1. Has your Pet had any Accident resulting in bodily injury which may or may not have required Veterinary Treatment? If Yes, please provide details:
Yes
No
2. Has your Pet had any physical disability which may or may not have required Veterinary Treatment? If Yes, please provide details:
Yes
No
Is it a Congenital Condition?
Yes
No
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3. Has your Pet undergone surgery during the last 6 months? If Yes, please provide details:
Yes
No
4. Is your Pet undergoing any Veterinary Treatment arising from Illness or Injury? If Yes, please provide details:
Yes
No
5. Has your Pet ever experienced or shown signs or symptoms of any of the following conditions: lameness, seizures, anal gland conditions, fracures, skin/eye conditions, vomiting or diarrhoea? If Yes, please provide details:
Yes
No
Other Information
1. Is your Pet used for breeding, commercial, sporting, guarding and security or working purpose(s), or in any trade/professional/occupation? If yes, please note that your Pet is not eligible for cover under this Policy.
Yes
No
2. Does your Pet have any vicious tendencies? If yes, please provide details:
Yes
No
3. Has a claim or complaint involving your Pet ever been lodged to the authorities? If yes, please provide details:
Yes
No
4. Has your Pet ever caused Injury to a Third Party, or loss or damage to Third Party property? If Yes, please provide details:
Yes
No
Next
Fill In Your Info
(Prestige Pets insurance)
Select a plan:
Standard
Enhanced
Superior
This policy is for a:
Dog
Cat
*Gender
Male
Female
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Have your pet been to the vet or hospital for other than routine checkups or preventive medicine?
Yes
No
I have read and accepted the
privacy policy and Terms and Conditions.
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Payment Info
(Prestige Pets insurance)
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