Certified that I have examined the animal described below, belonging to Sri/Smt. of , on , for the purpose of insurance. Based on its age, breed, production and health, in my opinion its present market value is (Rupees only).
| Species | Cattle |
| Breed | |
| Sex | Female |
| Age | |
| Ear tag no. | |
| Colour and identification marks | |
| Lactation no. | |
| Milk yield (litres/day) | |
| Pregnancy status | |
| General health | Healthy |