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LivestockMortality InsuranceMERRY RAMA INSURANCE4236 County Highway 18, Delhi, NY 13753Ph: (607) 746-2226 ~ Fax: (607) 746-2911E-mail: merryrama@cattlexchange.comwww.cattlexhange.comRemove and Hand to Company RepresentativeApplication For Insurance with American Livestock Insurance CompanyI/We ______________________________________________________________of ______________________________________________________________Address City State Zip Code Telephonehereby apply for insurance against loss by death resulting from disease or accidentalinjuries for the term of ________________________, on the following described animal(s).This is not a Binder until accepted by Insurance Company RepresentativeLotName of AnimalRegistration and/orTattoo NumberBreedPurchase Price Amount ofSex Birthdate Purchase Date InsuranceRate PremiumDairy Cattle RatesCalves Annual 1 Month 3 Months 6 Months2 weeks to 7 weeks of age............... 12.0% 4.8% 3.2% 8.0%7 weeks to 3 months of age............. 10.0% 4.0% 6.0% 6.7%BullsUp to 6 years of age......................... 6.0% 2.4% 3.6% 4.0%7 years............................................. 7.0% 2.8% 4.2% 4.7%8 years............................................. 8.0% 3.2% 4.8% 5.3%CowsUp to 5 years of age........................ 8.0% 3.2% 4.8% 5.3%6 years............................................. 9.0% 3.6% 5.4% 6.0%7 years............................................. 10.0% 4.0% 6.0% 6.7%~Minimum Policy Premium is $100.00This is not a Binder until accepted by Insurance Company Representative