Martial Arts Insurance | Martial Arts Insurance Application

Martial Arts Insurance Application
Martial Arts Insurance

Select a Payment Method

Credit/Debit Card (online) $10 Processing Fee Added
Check/Money Order

User Name & Password
Your user name and password will allow you to access and update your account information in the future. It is advised that you only use STRONG Passwords. Strong passwords consist of random combinations of letters, numbers and symbols. “R%458)=” is an example of a strong password. You may access your account, at any time, in the future, via our Client Services Section.

Please make a note of your User Name and Password for future reference.
You will need them to access and update your application.

Please enter your e-mail address as your user name
User Name (Email)
Password (must be 7-30 characters)
Verify Password
Security Question & Answer You will use this information if you need to recover your password in the future
Security Question
Answer
Verify Answer

Required Fields are marked with a star (*)

Website (Example: www.martialartsliabilityinsurance.com)
Accurate e-mail mandatory for proper delivery of your documents.
Your E-Mail Address * (you@yahoo.com)
Verify Your E-Mail Address *
Customer Name * (Frist & Last)

School Details
School Name *
Address *
City *
State *
Zip *

Enter your Mailing Address (If different from above)
Mailing Address
City
State
Zip Code

() - Phone Number *
() - Cell Number (optional)
() - Fax (optional)

Business Type *

Number of Years in business

Which of the following instructions do you provide? Please check all that apply. *

Excess Limits

Excess liability available with total limit of $1,000,000.00 per Occurrence/$3,000,000.00 aggregate. You will receive a quote via e-mail.

Would you like more than $1,000,000 in Excess Limits?

Yes No Add to your policy

Current Insurance Company

Have you recently had a liability claim within the last 5 years? *
Yes No

Number of Students *
Amount of coverage *Most requested by landlords (95%)

Accidental Medical Coverage Limit: $100,000 USD
Your Deductible: $500 USD

WARNING: READ CAREFULLY!

Each school or studio must install a Release and Waiver of Liability and indemnity Agreement for all students and staff members. Unintentional error on your part in securing Waiver and Release forms shall not void your coverage in the event of any occurrence to a student or staff member. However, your failure to maintain an adequate system to regularly secure Waiver and Release forms shall void your coverage in the event of an occurrence to a student or staff member. A Waiver/Release form will be emailed to your school or studio upon request. Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer submits application or files claim containing a false or deceptive statement may be guilty of insurance fraud. The minimum premium on this program is $490.00 which is also the minimum earned. What this means is if you cancel your insurance, the insurance company will keep the minimum premium and not return any portion to you. Any premium amount in excess of the $490.00 minimum may be returned on a prorated basis if you cancel coverage.

I Accept I do not Accept *

Yes No    Do you have a release waiver on file for each student? *
Yes No    If so, are both signatures required for minors? *
Yes No   Do you offer Contact Boxing? *
Yes No    Do you permit contact of any kind? *
Yes No    Are Sparring rules addressed and given to all students? *

Yes No    Does your school practice/teach Historic European Martial Arts (HEMA)? *

Medical Expense coverage under general liability (Med Pay)
Coverage for general public medical injury, generally referred to as “Slip & Fall”
coverage is optional and NOT CURRENTLY INCLUDED in the General Liability policy.
This coverage of $5000.00, can be included in your policy for an additional fee of $10.00

Yes No Would you like to add Slip & Fall coverage to your policy? *

Additional Locations

Do you have any additional locations?
Yes No

If you have any additional locations, please enter them below.

Additional Location 1
Address
City
State
Zip

Additional Location 2
Address
City
State
Zip

Additional Location 3
Address
City
State
Zip

Additional Location 4
Address
City
State
Zip

If you have more than 4 additional locations, please e-mail us

Additional Insureds
Do you have any additional insureds? Strongly consider adding your landlord as an additional insured on your policy at no cost prior to submitting. Afterward, the cost is $25.00 per additional insured added. Yes No

Complete this section if you need to provide proof of insurance to a landlord, gym, municipality, school or other. If you need to know the difference between a certificate holder and an additional insured, click here. If you have more than 4 additional insured's, please e-mail us.
	Additional Insured 1 AI Name Address City State Zip Type Additional Insured 2 AI Name Address City State Zip Type Additional Insured 3 AI Name Address City State Zip Type Additional Insured 4 AI Name Address City State Zip Type

Add Tournament coverage to your policy

Would you like to add tournament coverage to your policy? If yes, you MUST email answers to questions to info@martialartsliabilityinsurance.com to pay and add to policy.
Yes No

Adding tournament coverage may increase your premium

Camp, Seminar or Demonstration?

To add a tournament to your policy now, please complete the section below. Price reflects a three (3) day tournament. Tournaments that are longer than three (3) days must be quoted on an individual basis so you would need to email us for the quote. We will make every effort to send your certificate within 24 hours if your application was made during normal business hours. (Normal business hours are M-F 9:00 am – 5:00 pm EST). Tournament coverage premium is an additional $125.00 for 200 or less participants. If you have over 200 participants, please EMAIL US FOR A QUOTE. If you have more than 2 additional insured to your tournament, please e-mail us.

Tournament Information

Tournament Name

Location Address
City
State
Zip
Tournament E-Mail
Participants

Spectators

Any tournament dates selected must be after “April 16, 2024” Applications with tournaments lasting longer than 3 days must wait for underwriter approval.
Effective Date End Date You must select a date after: April/16/2024

Tournament Additional Insured Information

Additional Insured 1
AI Name
Address
City
State
Zip
Type

Additional Insured 2
AI Name
Address
City
State
Zip
Type

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Returning Applicants

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Please make a note of your User Name and Password for future reference.
You will need them to access and update your application.

Camp, Seminar or Demonstration?

Item Schedule

Returning Applicants

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Select a Payment Method

Please make a note of your User Name and Password for future reference. You will need them to access and update your application.

Camp, Seminar or Demonstration?

Item Schedule

Martial Arts Insurance Application
Martial Arts Insurance

Please make a note of your User Name and Password for future reference.
You will need them to access and update your application.