For manual submission, download this form here.
JUSTIFICATION OF VALUE FORM
NAME OF OWNER:
PHONE #:
EMAIL:
NAME OF HORSE:
POLICY #:
PURCHASE DATE:
PURCHASE PRICE:
$
STUD FEE
(if homebred):
$
CURRENT MARKET VALUE:
$
INSURED VALUE OR ADDITIONAL COVERAGE REQUESTED:
$
REASON FOR INCREASE (if increase requested):
characters remaining:
USE OF HORSE:
TRAINING LEVEL OF HORSE AT TIME OF PURCHASE:
TRAINING LEVEL OF HORSE AT PRESENT TIME:
COST OF TRAINING / SHOWING DURING PERIOD OF OWNERSHIP:
(excluding board, veterenarian, and farrier bills)
$
NAME OF TRAINERS / CLINICIANS:
SHOW RECORD
SHOW NAME AND LEVEL
MONTH / YEAR OF SHOW
DIVISION SHOWN
PLACING
1.
2.
3.
4.
5.
6.
ADDITIONAL INFORMATION (i.e. offers to purchase):
characters remaining:
CHECK IF A BREEDING STALLION
CHECK IF A BROODMARE
SIRE:
IS MARE IN FOAL?
Yes
No
DAM:
# OF LIVE FOALS ON GROUND:
CURRENT STUD FEE:
$
AGE OF FOALS:
# OF BREEDINGS (CURRENT YEAR):
SALE PRICE OF FOALS:
$
SALE PRICE OF FOALS:
$
SIGNATURE (ENTER YOUR NAME)
*
:
date signed
D
M
YEAR
