N.B. Signing this form does not commit the applicant or the Insurers to complete the insurance contract. However, in the event that an insurance contract is completed, this form shall be the basis of the contract.
I declare that, to the best of my knowledge and belief, the statements contained in this application form are true. I understand that any false statement or material fact not disclosed may prejudice my right to indemnity under the insurance for which I am now applying.
I further declare that, to the best of my knowledge and belief, my stock are free from physical disability and in sound health and that all equipment, machinery and protective systems necessary for the containment and continuing survival of the stock are also in good condition.
(619) 222-1944
