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Equine Insurance Specialists

Insuring horses and their people since 1992.

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Equine Insurance Specialists

American Equine Mortality

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Mortality Applications (All Other States)

Mortality Application 09.01.2016 Mortality Application 09.01.2016
Fraud Statement 9.1.16 Fraud Statement 9.1.16
Renewal Application (4-horse) 09.01.2016 Renewal Application (4-horse) 09.01.2016

Mortality Applications (FL)

Mortality Application Florida 07.01.2017 Mortality Application Florida 07.01.2017
Fraud Statement Florida 07.01.2017 Fraud Statement Florida 07.01.2017
Renewal Application Florida (4-horse) 07.01.2017 Renewal Application Florida (4-horse) 07.01.2017

Mortality Applications (GA, IL, LA, ME, OK, OR, TX, WA)

LS1-Mortality Application 09.01.2016 LS1-Mortality Application 09.01.2016
LS1-Mortality fraud statement LS1-Mortality fraud statement
LS1-Renewal Application (4-horse) 09.01.2016 LS1-Renewal Application (4-horse) 09.01.2016

Supporting Documentation (All States)

M103 – Statement of Health M103 – Statement of Health
Value Substantiation Support Form 12.01.13 Value Substantiation Support Form 12.01.13
M104 – Vet Exam M104 – Vet Exam
M104E- Vet Exam (Expanded) M104E- Vet Exam (Expanded)
M104F – Vet Exam (Foals) M104F – Vet Exam (Foals)
M105 – LOU Vet Exam M105 – LOU Vet Exam
M105R – LOU Vet Exam (Renewal) M105R – LOU Vet Exam (Renewal)
M109 – All Around Supplement M109 – All Around Supplement
M111 – Health Condition Form M111 – Health Condition Form
M114 – Infertility Supplement M114 – Infertility Supplement
M114G – Genitalia Exam Certificate M114G – Genitalia Exam Certificate
M115 – HYPP Disclosure M115 – HYPP Disclosure
M116 – Schedule of Horses M116 – Schedule of Horses
M107a – e-Check Authorization M107a – e-Check Authorization

Brochures

AEIG_Submission_Instructions AEIG_Submission_Instructions
Mortality Coverages 11.1.16 Mortality Coverages 11.1.16
AEIG Medical Surgical 0916 AEIG Medical Surgical 0916
Catastrophic Accident and Illness Highlights 2014 Catastrophic Accident and Illness Highlights 2014
AEIG Mortality Flyer 0816 AEIG Mortality Flyer 0816
AEIG Mortality Highlights w Surg 0816 AEIG Mortality Highlights w Surg 0816
AEIG Stall Card AEIG Stall Card
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Equine Insurance Specialists, LLC
PO Box 12440
Lexington, KY 40583-2440

(800) 723-9414 - tel

(866) 207-6953 - fax

Hours: 8:00 am to 5:00 pm EST M-F

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