Saga Pet Insurance Form PDF Details

Saga Pet Insurance is a great way to ensure your furry friends are well taken care of in the event of an accident or illness, and provides financial support for any necessary medical treatments. The form, however, can be a bit confusing. At Saga Pet Insurance we want to make sure you understand every step so that signing up with us goes as smoothly as possible - that's why we've put together this helpful guide on filling out their pet insurance forms today! In this blog post, we'll walk through how to accurately submit a claim and answer any questions you might have along the way. Keep reading to learn more about everything you need to know when it comes submitting Saga Pet Insurance forms.

QuestionAnswer
Form NameSaga Pet Insurance Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namescst hm1092 download, saga pet insurance claim form, Ltd, SignedDate

Form Preview Example

Saga Pet Insurance claim form

Please return completed form to: Saga Pet Insurance claims,

5th floor, The Connect Centre, Kingston Crescent, North End, Portsmouth PO2 8DE.

Fax: 0843 309 4513

Important

Saga Pet Insurance does not cover the following veterinary treatment:

a)Any pre-existing condition/illness/injury, or one shown on the Schedule as excluded

b)Any illness or condition, arising prior to, or within 14 days of, the policy start date

c)Preventative, elective treatments and routine examinations

d)Non-essential hospitalisation and/or house calls unless the vet declares that to move your pet would endanger its health

e)Dental treatment, other than required as a result of injury.

Please check Policy Terms and Conditions for full details of what is and isn’t covered.

Section 1 – This section and section 3 to be completed by the policyholder

Title

Surname

Address

Home tel number

Forename

Postcode

Policy number

Start date

Pet name

Age of pet

Purchase price of pet £

Cover level

Policy dates

Breed

Sex of pet

First date of relevant illness/injury/condition

Please provide a brief description of illness/injury/condition:

Is your pet currently covered by another insurance policy? Yes

No

If ‘Yes’, please give name of insurer

Policy number

Has your pet been microchipped?

Yes

 

No

 

If ‘Yes’, please provide microchip number

 

 

 

 

 

Expiry date

Please complete section 3 after section 2 has been completed by your veterinary surgeon.

Section 2 – to be completed by the veterinary surgeon

Age of pet

How long have you been treating the animal?

If this is a referral, please state name and address of practice that referred case:

Practice name

Address

 

 

Postcode

 

 

 

 

 

 

Tel number

 

Date

 

 

 

 

 

 

 

 

 

 

Diagnosis

Treatment

Cost (inc VAT) £

Has the animal received treatment for any of the above, or any related conditions before? Yes

 

No

If ‘Yes’, please give details:

Is this a continuation claim? Yes

 

No

 

 

 

Has the pet died as a result of the illness/injury/condition stated above? Yes

Declaration by veterinary surgeon:

No

Veterinary practice stamp and VAT number

I certify to the best of my knowledge that all relevant information in Section 2 of this form is correct and, in my opinion, the condition treated was not present on the policy start date. I also confirm that, in my opinion, the fees charged are the normal amount relating to this matter.

Signed

Date

Print name

A full clinical history and itemised receipt or account must be enclosed.

Section 3 – to be completed by the policyholder

Should we make payment direct to the veterinary surgeon? Yes

No

If ‘No’, payment will be made to the policyholder. Please complete your bank details below.

If you would like your claim payment to be settled straight into your bank account by BACS (Bankers Automated Clearing Services) please provide the details here.

Account holder name

Sort code

Account number

If bank details are not provided, payment will be made by cheque.

If we pay your claim by BACS a confirmation e-mail will be sent once processed. If we do not hold your e-mail address it will be sent by post.

Declaration

i.I declare that all details provided herein represent a true and accurate statement of details pertaining to my claim and I have not omitted any details pertinent to the circumstances of this claim.

ii.I understand and agree that information relevant to my claim(s) may be obtained from, and shared with, my vet in order for my claim(s) to be administered.

iii.I declare that where a claim involves a potential refund from other insurers or a third party, I hereby authorise them to remit any refund to my insurer.

iv.I understand that, in the event this claim is found to be fraudulent, in whole or in part, this will invalidate the policy and may render me liable to prosecution.

Signed

Date

Print name

Saga Pet Insurance claims are administered by Ultimate Pet Partners Ltd (Registered no. 6740793. FCA No 493636), 5th Floor, The Connect Centre, Kingston Crescent,

Portsmouth PO2 8DE. Tel: 0845 604 2308, fax: 0843 309 4513, who are an appointed representative of Ultimate Insurance Solutions Ltd (FCA No. 311368)

who are authorised and regulated by the Financial Conduct Authority.

CST-HM1092