Livestock Insurance Proposal Form

Birdview Insurance

The animals are not covered until premium is paid and risk is accepted.

PARTICULARS OF PROPOSER

Name of Proposer (in full)

Postal Address

Mobile/Tel No

ID Number

KRA PIN NUMBER

Exact location of the farm

Type of animal housing

Years in livestock farming

Animal Type

PARTICULARS OF ANIMAL/S TO BE INSURED

Breed	Age	Colour/Marks	Value (Kshs)	Identification	Action

Frequency of Veterinary Check-up

e.g., Monthly, Quarterly, Annually

Upload Veterinarian's Certificate (Optional)

Last certificate or report (PDF, JPEG, PNG - Max 5MB)

Health Declaration

Are the animals sound and healthy and free from disability or disease? If not, give full particulars

Has any animal been disabled through injury during the past 12 months? If so, give particulars

Is there any contagious disease or sickness in the last 12 months on the farm or within 5km radius?

How many other types of animals do you own? If any not insured, give reasons

Mode of branding/marking for identification (e.g., eartags, tattoo)

Animal Loss History (Last Three Years)

Year	Number of animals lost	Cause of Loss	Action

I/we hereby propose to insure the animal/s described in the schedule owned by me/us with Birdview Microinsurance subject to the terms conditions and exclusions of the Company's policy. I/We warrant that the answers to the above questions are true and that all the animals are correctly described, sound, in good health and free from disability or disease and that they are and shall be used solely for the purpose stated above. I/we declare that no information material to the Insurance has been withheld and agree that this proposal shall be the basis of the contract between me/us and the Company.

Signature (Full Name)

Date