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  Given Name:  
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  Pet Type:*
  Important Notes:
  1. Additional Premium (including mixed-breed of these dog breeds) – 10% premium loading is imposed on the following dog breeds:
    American Cocker Spaniel / American Staffordshire Terrier / Basenji / Basset Hound / Bernese Mountain Dog / Boxer / Bulldog / Bullmastiff / Chinese Shar-Pei / Chow Chow / Clumber Spaniel / Dalmatian / Deerhound / Doberman Pinscher / German Shepherd / Great Dane / Greyhound / Irish Wolfhound / Leonberger / Mastiff / Mountain Terrier / Newfoundland / Old English Sheepdog / Otterhound / Pharaoh Hound / Rottweiler / Saint Bernard / Staffordshire Bull Terrier / Wheaton Terrier
  2. Excluded Dangerous Dogs (including mixed-breed of these dog breeds) – The following dangerous dogs are excluded from the Plan: Antarctic Husky / Bull Terrier / Dogo Argentino / Fila Brazilier / Japanese Tosa / Pit Bull Terrier / Tibetan Mastiff
The dog breeds mentioned above are for reference only. Blue Cross reserves the right for the final decision of dog breeds eligible for insurance.
  I agree that the above personal data is voluntarily provided to Blue Cross (Asia-Pacific) Insurance Limited (the "Company"). Failure to supply the requested information may result in the Company being unable to process my request for quotation. I also agree that all personal data provided will be used for purposes directly related to my request for quotation. Besides, I understand that I have the right to make requests for access to and correction of my personal data held by the Company. Such requests can be made in writing to the Company’s Corporate Data Protection Officer at 29th Floor, BEA Tower, Millennium City 5, 418 Kwun Tong Road, Kwun Tong, Kowloon, Hong Kong.
(Please click here for the Company’s Personal Information Collection Statement.)