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

2. Has your Pet had any physical disability which may or may not have required Veterinary Treatment? If Yes, please provide details:

Yes

3. Has your Pet undergone surgery during the last 6 months? If Yes, please provide details:

Yes

4. Is your Pet undergoing any Veterinary Treatment arising from Illness or Injury? If Yes, please provide details:

Yes

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

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

2. Does your Pet have any vicious tendencies? If yes, please provide details:

Yes

3. Has a claim or complaint involving your Pet ever been lodged to the authorities? If yes, please provide details:

Yes

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