Pre-Purchase Seller Declaration

Pre-Purchase Sellers Declaration Form

Full Seller’s Declaration in respect of the Sale of a Horse.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Horse Information

Name of Horse:*

Breed / Type:*

Colour:*

Age:*

Sex:*

The Horse has been in the ownership of the seller since:*

Is the Horse in work?*

Please describe level of work:

To the best of your knowledge and belief, has the Horse been lame?*

Please give details of the lameness:

To the best of your knowledge and belief, has the Horse had any medical problems?*

Please give details of the medical problems:

To the best of your knowledge and belief, has the Horse had any surgical treatment?*

Please give details of the surgical treatment:

To the best of your knowledge and belief, has the Horse shown any vices (e.g. Cribbing, Windsucking, Weaving)?*

Please give details of the vices shown:

To the best of your knowledge and belief, has the Horse shown any behavioural abnormalities (e.g. Head shaking, Box Walking, Biting)?*

Please give details of the behavioural abnormalities shown:

The Horse is routinely kept/managed (please select):*

If stabled, the Horse is bedded on (please select):

If Other, then please describe the bedding:

Was last shod on (date):

Was last vaccinated on (date):

Please describe what conditions the Horse was vaccinated against:*

Has the Horse received any medication during the last 30 days?*

Please describe what medication the Horse has been given, at what dose and when:

Do you accept the risks associated with the pre-purchase examination, including those posed by the ridden stage, to both the horse and those persons involved?*

Yes

Do you give permission for the Horse to be sedated for the any necessary procedures (the precise nature of the procedure will be discussed with you or your representative at the time of the examination)?*

Yes

Do you give permission for the Horse to be have blood samples taken if the vendor has requested this?*

Yes

Seller / Authorised Agent of Seller Details

Full Name:*

Please confirm if you are the Seller or Authorised Agent of the Seller of the Horse?*

Phone Number

Address Line 1*

Address Line 2

City*

Postcode*

Declaration & Consent

I declare that the information provided in the above form is true and accurate. I consent to a blood sample being taken from The Horse for the benefit of the prospective purchased and their appointed veterinary surgeon and for my personal data to be passed to and processed by LGC Ltd, Newmarket Road, Fordham, Cambs CB7 5WW in connection with the blood sample or where there is any other lawful basis:

Consent

I give permission for appropriate samples to be taken from my horse as per time of the examination.

Signed (Name):*

Date Signed:*

To find out more about how we handle your data, please see our Privacy Policy for information on our fair processing notice.

Pre-Purchase Seller Declaration

Pre-Purchase Seller Declaration

Pre-Purchase Sellers Declaration Form

Horse Information

Seller / Authorised Agent of Seller Details

Declaration & Consent

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