Ellenco Pet Insurance

Cat and Dog Medical Insurance

call 0800 738 752

Pet Health Insurance for Cats and Dogs

Our Pet Health Insurance Plans provide cost-effective cat and dog health insurance, with coverage of veterinary care costs for a range of medical conditions, as well as surgical requirements for accident or illness. For more information,

Contact Ellenco Enterprizes Ltd...

PET OWNERS INFORMATION... applicants details (*required)

Owner's Name #1

First Name*:

Last Name*:

Owner's Name #2

First Name:

Last Name:

Contact Details

Address*:

Suburb*:

City*:

Post Code:

Telephone*:

Cellphone:

E-mail:

Are you already an existing client of Ellenco with another pet prior to this application? Yes No

PETS INFORMATION... please note each pet needs a seperate application form

Pets Name*:

Date Of Birth (approx)*:

Sex: male female

Breed*:

Vaccination Date:

Do you want inherited cover? Yes No

Do you want funeral cover? Yes No

Has the above pet been seen by a veterinarian for anything other than routine vaccinations or de-sexing?
(i.e allergies, skin, ear infections) Yes No

If your pet has had treatment please provide full details or diagnosis of treatment?

Date of treatment/accident?

Is further treatment expected? Yes No

Details of further treatment?

Has any of the above treatments led to your pet having a chronic/ongoing condition? Yes No

Please state the name of the condition?

Veterinary clinic name:

Veterinary clinic address:

Veterinary clinic telephone:

Please state name of family or friend with a daytime contact telephone number:

Other additional information:

click here to add information for another pet

DECLARATION: I/We declare that all the statements and particulars contained in this Pet Insurance Proposal are true to the best of my/our knowledge and belief and I/we understand that no material fact has been withheld and that non-disclosure or misrepresentation of a material fact will render this benefit cover null and void. (A material fact is one likely to influence the acceptance and/or assessment of the Application Form. If in doubt as to whether a fact is material, it should be disclosed.)

I/we understand cover will commence from the date the first premium payment is received.

I/We authorize Ellenco Pet Insurance Ltd to obtain further information from my/our Veterinarian relevant to my pets health including any previous or expected future treatment at the time of application or claim.

By typing ACCEPT in the following box you are declaring that you have read and fully understood the terms as laid out above understood the terms as laid out above...

How did you hear about us?
eg Leaflet, Vet, Consultant

Payment Method

Cheque Direct Debit (we will post out the appropriate forms)

Electronic Payment (we will advise policy number to be entered in payee particulars)

Frequency of payments:

Please Note: Cover available within New Zealand only.

Ellenco Pet Insurance Ltd