Martial Art Insurance Lowest Cost Martial Arts Insurance on the Web!

 

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. *
  • Cardio
  • Kickboxing
  • Aikido
  • Judo
  • Jiu Jitsu
  • Karate
  • Tae Kwon Do
  • Tai Chi
  • Kung-Fu
  • Shotokan
  • Kenpo
  • Brazilian Jui Jitsu
  • MMA
  • Hapkido
  • Kempo
  • Capoeira
  • Boxing
  • Ninjitsu
  • Nunjitsu
  • Gracie Jiu Jitsu
  • Tae Bo
  • Jujutsu
  • Other Instructions (separate with comma) (0/500)





    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


    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


    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




    Content Coverage
    Would you like to add Contents Coverage? If yes, you MUST email answers to questions to info@martialartsliabilityinsurance.com to pay and add to policy.
    Yes No
    MANDATORY FRAUD WARNING STATEMENTS BY STATE

    ARKANSAS, LOUISIANA
    "Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly
    presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison."

    VIRGINIA, TENNESSEE, MAINE
    "It is a crime to knowingly provide false, incomplete or misleading information to an insurance
    company for the purpose of defrauding the company. Penalties may include imprisonment, fines or denial of insurance benefits."

    COLORADO
    "It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an
    insurance company for the purpose of defrauding or attempting to defraud the company.
    Penalties may include imprisonment, fines, denial of insurance and civil damages.
    Any insurance company or agent of an insurance company who knowingly provides false, incomplete,
    or misleading facts or information to a policyholder or claimant for the purpose of defrauding or
    attempting to defraud the policyholder or claimant with regard to a settlement or award payable from
    insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies."

    DISTRICT-OF-COLUMBIA
    "WARNING: It is a crime to provide false or misleading information to an
    insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines.
    In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant."

    FLORIDA
    "Any person who knowingly and with intent to injure, defraud, or deceive any insurer
    files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree."

    KENTUCKY
    "Any person who knowingly and with intent to defraud any insurance company or other
    person files an application for insurance 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."

    NEW JERSEY
    Insurance applications must contain this statement: "Any person who includes
    any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties."

    NEW MEXICO
    "ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT
    CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS
    FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A
    CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES."

    NEW YORK
    "Any person who knowingly and with intent to defraud any insurance company
    or other person files an application for insurance or a statement of claim
    containing any materially false information concerning any fact material thereto, commits a
    fraudulent insurance act, which is a crime, and shall also be subject to a civil
    penalty not to exceed five thousand dollars and the stated value of the claim for each such violation."

    OHIO:
    "Any person who, with intent to defraud or knowing that he is facilitating a fraud
    against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud."

    OKLAHOMA
    "WARNING: Any person who knowingly, and with intent to injure, defraud or
    deceive any insurer, makes any claim for the proceeds of an insurance policy
    containing any false, incomplete or misleading information is guilty of a felony."

    PENNSYLVANIA
    Purpose of misleading "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 information concerning any fact material thereto commits a
    fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties."

    I accept the terms I do not accept the terms *
    Signature Signature * (Typed name indicates signature)
    Today’s Date * (December 5, 2024)


    Please review your answers / selections for correctness. Applications can only be changed after submit button is pressed by logging into Client Services. This includes unpaid applications.