Quotation Request

Post Insurance

Client Details
Claim details
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Policy Details
Declaration
Notes
Calculation

Client Details

How is the policy paid for?
Name:
Date of Birth
(Security Question)
Address
Email and password:




Telephone Number:
Alternate telephone number:
Would you like to add a joint policy holder?
Name of joint policy holder:
Coinsurance?
*ADMIN ONLY* Original Policy Number

Claim details

Have you had any claims in the last 5 years?
Please enter details:
DateDescriptionClaim amount
Add row

Pet 1

Pet name:
Species:
Breed
Please select the breed of your Cat:
Please select the breed of your Dog:

Unfortunately we cannot cover this breed of dog under this policy.

Please select the size of your dog:
Sex

Please be aware we cannot cover your Dog as it is over 5 years old.

Sorry we cannot cover your pet as it is under the age of 8 weeks or over 8 years.

Purchase Price:
Do you have a Receipt for the purchase price?
Microchipped?
Neutered?
Fully Vaccinated?

If you do not get your pet vaccinated it could invalidate any claims you may make

Healthcheck within 12 months?

Your pet must continue to have a health check every year otherwise this could potentially invalidate any claim made

If your pet does not have an annual healthcheck it could invalidate any claims you may make

Does the pet live with you?
If no, where is your pets main residence?
Is the pet currently showing any signs of illness or injury?
Pre-existing conditions?
Decline Breed:

Please be aware pre existing conditions are not covered by this policy

Pet 2

Pet name:
Species:
Breed
Please select the breed of your Cat:
Please select the breed of your Dog:

Unfortunately we cannot cover this breed of dog under this policy.

Please select the size of your dog:
Sex

Please be aware we cannot cover your Dog as it is over 5 years old.

Sorry we cannot cover your pet as it is under the age of 8 weeks or over 8 years.

Purchase Price:
Do you have a Receipt for the purchase price?
Microchipped?
Neutered?
Fully Vaccinated?

If you do not get your pet vaccinated it could invalidate any claims you may make

Healthcheck within 12 months?

Your pet must continue to have a health check every year otherwise this could potentially invalidate any claim made

If your pet does not have an annual healthcheck it could invalidate any claims you may make

Does the pet live with you?
If no, where is your pets main residence?
Is the pet currently showing any signs of illness or injury?
Pre-existing conditions?
Decline Breed:

Please be aware pre existing conditions are not covered by this policy

Pet 3

Pet name:
Species:
Breed
Please select the breed of your Cat:
Please select the breed of your Dog:

Unfortunately we cannot cover this breed of dog under this policy.

Please select the size of your dog:
Sex

Please be aware we cannot cover your Dog as it is over 5 years old.

Sorry we cannot cover your pet as it is under the age of 8 weeks or over 8 years.

Purchase Price:
Do you have a Receipt for the purchase price?
Microchipped?
Neutered?
Fully Vaccinated?

If you do not get your pet vaccinated it could invalidate any claims you may make

Healthcheck within 12 months?

Your pet must continue to have a health check every year otherwise this could potentially invalidate any claim made

If your pet does not have an annual healthcheck it could invalidate any claims you may make

Does the pet live with you?
If no, where is your pets main residence?
Is the pet currently showing any signs of illness or injury?
Pre-existing conditions?
Decline Breed:

Please be aware pre existing conditions are not covered by this policy

Pet 4

Pet name:
Species:
Breed
Please select the breed of your Cat:
Please select the breed of your Dog:

Unfortunately we cannot cover this breed of dog under this policy.

Please select the size of your dog:
Sex

Please be aware we cannot cover your Dog as it is over 5 years old.

Sorry we cannot cover your pet as it is under the age of 8 weeks or over 8 years.

Purchase Price:
Do you have a Receipt for the purchase price?
Microchipped?
Neutered?
Fully Vaccinated?

If you do not get your pet vaccinated it could invalidate any claims you may make

Healthcheck within 12 months?

Your pet must continue to have a health check every year otherwise this could potentially invalidate any claim made

If your pet does not have an annual healthcheck it could invalidate any claims you may make

Does the pet live with you?
If no, where is your pets main residence?
Is the pet currently showing any signs of illness or injury?
Pre-existing conditions?
Decline Breed:

Please be aware pre existing conditions are not covered by this policy

Pet 5

Pet name:
Species:
Breed
Please select the breed of your Cat:
Please select the breed of your Dog:

Unfortunately we cannot cover this breed of dog under this policy.

Please select the size of your dog:
Sex

Please be aware we cannot cover your Dog as it is over 5 years old.

Sorry we cannot cover your pet as it is under the age of 8 weeks or over 8 years.

Purchase Price:
Do you have a Receipt for the purchase price?
Microchipped?
Neutered?
Fully Vaccinated?

If you do not get your pet vaccinated it could invalidate any claims you may make

Healthcheck within 12 months?

Your pet must continue to have a health check every year otherwise this could potentially invalidate any claim made

If your pet does not have an annual healthcheck it could invalidate any claims you may make

Does the pet live with you?
If no, where is your pets main residence?
Is the pet currently showing any signs of illness or injury?
Pre-existing conditions?
Decline Breed:

Please be aware pre existing conditions are not covered by this policy

Policy Details

Do you have a Promotional code?
Promotional code:
Accident Standard Premier
Cover type Continuous Continuous Continuous
Cover Scope Accident Accident & Illness Accident & Illness
Maximum Veterinary Fees in policy period 2,000 4,000 6,000
Complementary treatment 500 750 750
Death Benefit 750 1,000 1,000
Third party liability 250,000 250,000 250,000
Dental cover No Yes Yes
Hereditary and congenital defects cover No No No
Euthanasia cover No No No
Prescription food No 20% of the cost (up to 150) 40% of the cost (up to 200)
Boarding fees No 200 200
Advertising & reward No 250 250
Loss by theft or straying No 1,000 1,000
Cover abroad Up to 3 months Up to 3 months Up to 3 months
Excess per policy section 100 100 100
Multi-pet discount Yes Yes Yes

Declaration

I understand that pre-existing conditions will not be covered. Pre-existing conditions are illnesses and injuries which happened or your pet showed signs of before your policy starts.

Please read the Terms and Conditions carefully and if you have any questions relating to the Terms and Conditions please call 1890 22 11 11.

Additional Notes

Please add any additional comments that you may feel will be necessary to your policy:

Calculation

Cover Level Pet 1:
Breed Load age Pet 1
Claim amount:
Number of Claims:
Cover Level Pet 2:
Breed Load age Pet 2
Claim amount:
Number of claim:
Cover Level Pet 3:
Breed Load age Pet 3
Claim amount:
Number of claims:
Cover Level Pet 4:
Breed Load age Pet 4
Claim amount:
Number of claim:
Cover Level Pet 5:
Breed Load age Pet 5
Claim Amount:
Number of claim:
ADMIN:
Number of claims:
Total Claim amount
Number of Dogs
Number of Cats
Promotional codes