STALLION STATEMENT OF BREEDING CONDITION
INSURED NAME AND ADDRESS:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
PHONE NUMBER:_____________________________________________________
NAME OF STALLION BREED AGE STUD FEE
BREEDING METHOD:
Artificial Insemination____Live Cover____Both____   *Pasture Breeding? Y/N
*(Note: ASD Coverage not available on pasture breeding stallions without prior company approval.)
BREEDING HISTORY:
      Number of mares bred last year_____ Number of mares conceived_____

      Number of mares booked this season: Owned_____ Outside_____
I declare to the best of my knowledge and belief that the stallion listed above is in normal, healthy and breeding sound condition. I further declare that to the best of my knowledge and belief during the past 3 years, the above stallion has been free from any illness, injury, disease or accident and has not had less than 75% fertility to mares bred. I understand and agree that this Statement of Breeding Condition shall be the basis of the Insurance contract and if anything is falsely stated or if information is withheld to influence the Company's decision to issue coverage, the Insurance contract will be null and void. Any exceptions must be noted:
____________________ __________________________________
DATE SIGNED SIGNATURE OF INSURED
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