We acquired a New Animal!
Provide us some details about the animal so we can review your liability coverages.
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Full Name: *
(As it appears on your policy)
Phone Number: *
Email Address: *
Choose Animal type: *
Provide breed, and approximate full grown weight: *
Provide the sex of the animal: *
Has the animal been spayed or neutered? *
Will this animal be used for breeding purposes? *
Will any income be derived from owning this animal? *
Submitting this information IS NOT a Policy or Binder of Insurance. No coverage will be bound until you receive confirmation from us.
BY CLICKING THE "SUBMIT" BUTTON BELOW, I CERTIFY THAT THERE IS NO PRE-EXISTING CLAIM, LOSS OR CIRCUMSTANCE LIKELY TO LEAD TO SUCH A CLAIM OR LOSS FOR WHICH I AM APPLYING FOR COVERAGE.
WARNING: ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND [NY: SUBSTANTIAL] CIVIL PENALTIES. IN TN, VA AND WA, INSURANCE BENEFITS MAY ALSO BE DENIED.
NOTICE TO OHIO APPLICANTS: ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING HE/SHE IS FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD.

Questions? Contact:
Cameron A. Shandersky, CPCU
Schiff Insurance
P.O. Box 145496
Cincinnati, OH 45250-5496
P: 513.870.2580
cameron_shandersky@schiffinsurance.com
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