Nomination Form and Keep Charges

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="dacfd5a3.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Overa Farm Stud</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="Overa Farm Stud"><U><B>home</B></U></A></div> <div>                                                   </div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="dadd2b03.jpg"> <bR> <bR> <div> <A HREF="id18.htm" TARGET="_top" TITLE="Stallions at Stud"><U><IMG SRC="0f189a50.gif" border=0 width="137" height="165" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></U></A></div> <bR> <div> Back to Stallion Page</div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Nomination Form and Keep Charges</I></div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B><U>NOMINATION AGREEMENT</U></B></div> <bR> <bR> <div> <B>For mares visiting the stud only.</B></div> <bR> <div> I have read the terms and conditions as set out by Overa Farm Stud and agree to purchase a nomination for the 2008 season to the Stallion..........................</div> <bR> <div> I enclose a deposit of £50 plus VAT (£58.75) and agree to pay the balance of the stud fee and grooms fee once the mare has been covered.</div> <bR> <div> NAME OF MARE.....................................................................AGE.....................</div> <bR> <div> SIRE OF MARE......................................................................................................</div> <bR> <div> DAM OF MARE.....................................................................................................</div> <bR> <div> STUD BOOK REGISTRATION/PASSPORT NO...............................................</div> <bR> <div> <B><U>PRE-COVERING RECORD</U></B></div> <div> <I>(Please delete Yes/No as appropriate</I> <I>and give any further information overleaf)</I></div> <bR> <div> Is the mare quiet at all times?                                                                          Yes/No</div> <bR> <div> Does she cycle regularly?                                                                                Yes/No</div> <bR> <div> Does she normally conceal her heat?                                                             Yes/No</div> <bR> <div> Has she during the last 12 months had any infections</div> <div> or contagious diseases?                                                                                  Yes/No</div> <bR> <div> Has she during the last two years been to a stud/yard where there</div> <div> has been a case of Equine Herpes Virus or Equine Viral Arteritis?           Yes/No</div> <bR> <div> Has she ever had a uterine infection?                                                             Yes/No</div> <bR> <div> Has she ever been treated for infertility?                                                        Yes/No</div> <bR> <div> Covering record for the last three years:</div> <div>      Stud/Stallion visited          Live foal / Barren / Aborted</div> <bR> <div> 20..........................................................     .................................................</div> <bR> <div> 19..........................................................     .................................................</div> <bR> <div> 19..........................................................     .................................................</div> <bR> <div> Date of last worming and drug used........................................................</div> <bR> <div> Is the mare insured?                                                                                            Yes/No</div> <bR> <div> <B><U>Additional information for mares to be foaled down at Stud:</U></B></div> <bR> <div> Date due to foal..........................................................................................</div> <bR> <div> Has the mare been stitched? (Caslick operation)                                           Yes/No</div> <bR> <div> Does she foal early or without warning?                                                           Yes/No</div> <bR> <div> Has she ever had a haemolytic foal?                                                                Yes/No</div> <bR> <div> Has she ever had a barker/dummy foal?                                                          Yes/No</div> <bR> <div> Is she short of milk after foaling?                                                                       Yes/No</div> <bR> <div> Do you wish the stud to complete the foal identification certificate?             Yes/No</div> <bR> <bR> <bR> <bR> <div> Approximate date of arrival at stud..........................................................................</div> <bR> <div> To be kept: </div> <bR> <div> At grass / Stabled / In or out according to weather (at stud's discretion)</div> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> <I><B>KEEP CHARGES</B></I></div> <div> <I><B>(per week)</B></I></div> <bR> <bR> <div> <I><B>     Barren/Maiden Mares at grass                   £30.00</B></I></div> <div> <I><B>    Barren/Maiden Mares in at night               £55.00</B></I></div> <div> <I><B>    Mares with foal at foot at grass                 £35.00</B></I></div> <div> <I><B>   Mares with foal at foot in                            £60.00</B></I></div> <div> <I><B>   Foaling fee                                                     £95.00</B></I></div> <div> <I><B>   Grooms fee                                                    £15.00</B></I></div> <bR> <div> <I><B>   Long stay mares/youngstock by arrangement.</B></I></div> <bR> <bR> <div> NAME OF OWNER:..............................................................................................</div> <bR> <div> ADDRESS:.............................................................................................................</div> <bR> <div> ...............................................................................................................................</div> <bR> <div> ...............................................................................................................................</div> <bR> <div> Tel No:............................................(Day).............................................(Evening)</div> <bR> <div> ADDRESS WHERE NORMALLY KEPT (If different from above)</div> <bR> <div> ...............................................................................................................................</div> <bR> <div> ...............................................................................................................................</div> <bR> <div> ...............................................................................................................................</div> <bR> <div> NAME OF VETERINARY SURGEON:................................................................</div> <bR> <div> TEL NO:.................................................................................................................</div> <bR> <bR> <div> <B>Signature of Owner.................................................Date......................................</B></div> <bR> <bR> <div> <I><B>  <script type="text/javascript" language="javascript"> var sc_project=2653268; var sc_invisible=0; var sc_partition=25; var sc_security="c763e65d"; </script> <script type="text/javascript" language="javascript" src="http://www.statcounter.com/counter/counter.js"></script><noscript><a href="http://www.statcounter.com/" target="_blank"><img src="http://c26.statcounter.com/counter.php?sc_project=2653268&java=0&security=c763e65d&invisible=0" alt="web metrics" border="0"></a> </noscript>   </B></I></div> </td> </tr></table></body>