GUERNSEY PET (CAT OR DOG) INSURANCE QUOTE FORM
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Name of pet
Type of pet	Cat    Dog
Breed Type	Cross Breed    Pedigree
Breed	Select a breed Cross breed Select a breed Abyssinian American Exotic American Shorthair Angora Asian Balinese Bengal Birman Blue Spotted Bombay British British Black British Blue British Long Hair British Short Hair Burmese Burmilla Calico Californian Spangled Chinchilla Colour Point Colour Point Long Hair Cornish Rex Devon Rex Domestic Domestic Long Hair Domestic Medium Hair Domestic Short Hair Egyptian Mau European Short Hair Exotic Exotic Short Haired Exotic Variant Feral Foreign Foreign Black Foreign Blue Foreign Longhair Foreign Short Hair Foreign White Havana Himalayan Japanese Bobtail Japanese Shorthair Korat Maine Coon Manx Norwegian Forest Cat Ocicat Oriental Oriental Short Haired Persian Persian Chinchilla Persian Long Haired Ragdoll Red Spotted Russian Blue Scottish Fold Selkirk Rex Serengeti Siamese Siamese Cross Siberian Forest Cat Silver Spotted Silver Tabby Singapura Snowshoe Somali Sphynx Staffordshire Climber Tabby Tiffanie Tonkinese Turkish Angora Turkish Van Select a breed Aberdeen Terrier Affenpinscher Afghan Hound African Crested Dog African Hairless Airedale Terrier Alaskan Klee Kai Alaskan Malamute Alsatian American Bulldog American Cocker Spaniel American Indian Dog Anatolian Karabash Anatolian Shepherd Dog Australian Cattle Dog Australian Dingo Australian Kelpie Australian Shepherd Dog Australian Silky Terrier Australian Terrier Basenji Basset Bleu De Gascogne Basset Fauve de Bretagne Basset Hound Bavarian Mountain Hound Beagle Bearded Collie Beauceron Bedlington Terrier Belgian Shepherd Dog Belgian Shepherd Dog (Groenendael) Belgian Shepherd Dog (Lakenois) Belgian Shepherd Dog (Malinois) Belgian Shepherd Dog (Tervuren) Bergamasco Berger De Picard Bernese Mountain Dog Bichon Frise Bloodhound Boar Hound Bolognese Border Collie Border Terrier Borzoi Boston Terrier Bouvier des Flandres Boxer Bracco Italiano Briard Briquet Griffon Vendeen Brittany Broken Haired Terriers Bull Terrier Bull Terrier (Miniature) Bulldog Bulldog (Toy) Bullmastiff C K C Spaniel Cairn Terrier Canaan Dog Canary Dog Cane Corso Cavalier King Charles Spaniel Cesky Terrier Chesapeake Bay Retriever Chihuahua Chihuahua (Long Coat) Chihuahua (Smooth Coat) Chinese Crested Dog Chinese Crested Powder Puff Chow Chow Clumber Spaniel Cocker Spaniel Collie Corgi Coton de Tulear Cross Breed Curly Coated Retriever Dachshund Dachshund (Long Haired) Dachshund (Miniature Long Haired) Dachshund (Miniature Short Haired) Dachshund (Miniature Smooth Haired) Dachshund (Miniature Wire Haired) Dachshund (Miniature) Dachshund (Short Haired) Dachshund (Smooth Haired) Dachshund (Standard) Dachshund (Wire Haired) Dalmatian Dandie Dinmont Terrier Deerhound Dobermann Dobermann Pinscher Dogue de Bordeaux Dutch Shepherd Dog Elkhound English Bull Terrier English Bulldog English Cocker Spaniel English Setter English Springer Spaniel English Toy Terrier Eskimo Dog Estrela Mountain Dog Eurasier Fell Terrier Field Spaniel Finnish Lapphund Finnish Spitz Flat Coated Retriever Fox Terrier Fox Terrier (Smooth Haired) Fox Terrier (Wire Haired) Foxhound French Bulldog French Poodle Gascoigne German Pinscher German Pointer German Pointer (Long Haired) German Shepherd Dog German Shepherd (Long Haired) German Short Haired Pointer German Spitz German Spitz (Klein) German Spitz (Mittel) German Wire Haired Pointer Giant Schnauzer Glen of Imaal Terrier Golden Retriever Gordon Setter Grand Basset Griffon Vendeen Grand Bleu de Gascogne Great Dane Greek Harehound Greyhound Griffon Griffon Bruxellois Hamilton Hound Hamiltonstovare Harrier Havanese Hovawart Hungarian Kuvasz Hungarian Puli Hungarian Vizsla Hungarian Wire Haired Vizsla Husky Ibizan Hound Irish Red & White Setter Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Spinone Italian Whippet Jack Russell Jack Russell Terrier Japanese Akita Japanese Chin Japanese Shiba Inu Japanese Spaniel Japanese Spitz Japanese Terrier Keeshond Kelpie Kerry Blue Terrier King Charles Spaniel Komondor Kooikerhondje Labradoodle Labrador Retriever Laekenois Lagotto Romagnolo Lakeland Terrier Lancashire Heeler Landseer Large Munsterlander Leonberger Lhasa Apso Libyan Desert Dog Lowchen Lucas Terrier Lurcher Malinois Maltese Maltese Terrier Manchester Terrier Maremma Sheepdog Mastiff Mexican Hairless Miniature Bull Terrier Miniature Chihuahua Miniature Chihuahua (Long Coat) Miniature Dachshund Miniature Dachshund (Long Haired) Miniature Dachshund (Short Haired) Miniature Dachshund (Smooth Haired) Miniature Dachshund (Wire Haired) Miniature English Bull Terrier Miniature German Schnauzer Miniature Pinscher Miniature Poodle Miniature Schnauzer Miniature Toy Poodle Miniature Yorkshire Terrier Munsterlander Neapolitan Mastiff New Zealand Huntaway Newfoundland Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norweian Lundehund Norwich Terrier Nova Scotia Duck Tolling Retriever Old English Mastiff Old English Sheepdog Otter Hound Owczarek Podhalanski Papillon Parson Jack Russell Terrier Parson Russell Terrier Patterdale Terrier Pedigree Crossbreed Pekingese Petit Basset Griffon Vendeen Pharaoh Hound Pinscher Pointer Polish Lowland Sheepdog Pomeranian Poodle Portuguese Water Dog Pug Pyrenean Mountain Dog Pyrenean Sheepdog Red Setter Rhodesian Ridgeback Rottweiler Rough Collie Russian Black Terrier Saluki Samoyed Schipperke Schnauzer Scottish Deerhound Scottish Terrier Sealyham Terrier Segugio Italiano Shar Pei Shetland Sheepdog Shiba Inu Shih Tzu Short Haired Collie Short Haired German Pointer Shropshire Terrier Siberian Husky Skye Terrier Sloughi Slovakian Rough Haired Pointer Smooth Collie Smooth Fox Terrier Soft Coated Wheaten Terrier Spanish Bulldog Spanish Water Dog Specified Crossbreed Spinone St Bernard St John's Water Dog Staffordshire Bull Terrier Standard Dachshund Standard Poodle Sussex Spaniel Swedish Elkhound Swedish Lapphund Swedish Vallhund Teckel (min. Wirehaired Dachshund) Thai Ridgeback Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Toy Poodle Utonagan Victorian Bulldog Weimaraner Weimaraner (Long Haired) Welsh Corgi (Cardigan) Welsh Corgi (Pembroke) Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Whippet Working Sheepdog Yorkshire Terrier Select a cross breed ----------------------------------- Cross Breed ----------------------------------- American Bulldog Cross Bernese Mountain Dog Cross Bull Terrier (Miniature) Cross Bull Mastiff Cross Clumber Spaniel Cross Dogue de Bordeaux Cross Estrela Mountain Dog Cross Giant Schnauzer Cross Grand Basset Griffon Vendeen Cross Great Dane Cross Irish Wolfhound Cross Mastiff Cross Neapolitan Mastiff Cross Newfoundland Cross Polish Lowland Sheepdog Cross Rottweiler Cross Shar Pei Cross St. Bernard Cross
Age of pet	0 1 2 3 4 5 6 7 8 9 10+ Years    0 1 2 3 4 5 6 7 8 9 10 11 Months
Sex of pet	Male    Female
Value of pet (£)
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GUERNSEY PET (CAT OR DOG) INSURANCE QUOTE FORM PART 2
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Date of last visit to vet	//
Date of last routine vaccination	//
Sum Insured (£)
Purchase Price (£)
Purchase Date	//
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GUERNSEY PET (CAT OR DOG) INSURANCE QUOTE FORM PART 3
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Details of previous claims
Details of previous claims involving a third party
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GUERNSEY PET (CAT OR DOG) INSURANCE QUOTE FORM PART 4
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Title	Mr Mrs Miss Ms Dr *
First Name	*
Surname	*
Date of Birth	dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 mm 01 02 03 04 05 06 07 08 09 10 11 12 yyyy 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 *
Home Telephone	*
Work Telephone
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GUERNSEY PET (CAT OR DOG) INSURANCE QUOTE FORM PART 5
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Mobile Telephone
Email Address	*
House Name/No	*
Street Address	*
Town/City	*
Postcode	*
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