March 2025 – PET KAAP

Pet Insurance Proposal Form

1. Proposer Information

Title

Full Name

Gender

Date of Birth

2. Address & Contact

Address

Phone

Email

3. Pet Details

Pet	Name	Sex	Age	Breed	Weight	Chip No.	Features
Pet 1
Pet 2
Pet 3

4. Coverage Info

Sum Insured (₹)

Pedigree Certificate?

YesNo

5. Pet Health

Is Pet Healthy?

YesNo

Spayed/Castrated?

YesNo

If Not Healthy:

If Not Spayed/Castrated (Reason):

6. History

Loss Details

Insurer Name

Policy Number

7. Digital Signature

Your Signature (Name)

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