Fitness Individual

General & Professional Liability Insurance Application

Your Coverage: $1,000,000 per occurence / $3,000,000 aggregate limit


Requested Policy Effective Date
 
Policy Effective date must be greater than the current date and within 60 days of the current date.
Policy Expiration date defaults to (1) year following effective date.

Background
Yes / No
I sell ingestible and/or topical products (ex: vitamins, supplements, lotions) manufactured under my company's label?  
There have been claims made against me in the last 3 years  
I require signed waivers from all clients  
My previous insurance provider canceled my policy or did not allow me to renew  
I have read and understood the list of ineligible operations and declare I do not participate in any of the mentioned operations.  
Have you ever had an incident or been convicted of any crime, including sex-related or child abuse related offenses?  

Personal information
 
 
 
 
 

Please ensure the email address you are entering is valid. All policy communication such as renewal notification and policy delivery will be handled via email. Your policy will not be delivered by mail.

 
- -  
- - (optional)  
 
 
 

 

Mailing address is the same as home address

Credit Card Information
 
Billing address is the same as home address
(Do not include spaces or dashes)  
 
 

Additional Insured What's this?



Purchase Information
Please review the purchase information below.



*All rates are subject to underwriter approval
**General Liability coverage is written through the Fitness & Wellness Risk
  Purchasing Group and a fully earned and non-refundable fee of $50.00 is required
  to join this Risk Purchasing Group



Clicking the button below will launch a popup window where you must verify your address.
After verifying your address you will be navigated back to this screen where you can submit your application
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Fraud Notice
Notice to applicants:
Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act which is a crime and may subject such person to criminal and civil penalties.

*Note: The above proposal may not account for local taxes mandated by the State in which you/your business operate(s). The final policy will include a description of how local taxes, if applicable, have been allocated as determined by the risk location. Please contact a PHLY representative if you have any questions.

The Insurer may not be subject to all of the insurance laws and regulations of your resident state.