Martial Arts Insurance


Lowest Cost Martial Arts Insurance on the Web!

Martial Arts Liability Insurance

Martial Arts Insurance Application
Mixed Martial Arts Training

Select a Payment Method


Credit/Debit Card (online)
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.

We suggest using your e-mail address as your user name
User Name (must be 7-30 characters)

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

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


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)


Date that you would like coverage to start*


Limit of Liability: $2,000,000 USD

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 *
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?
Yes No


Add Tournament coverage to your policy
Would you like to add tournament coverage to your policy?
Yes No






Content Coverage
Would you like to add Contents Coverage?
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 * (April 19, 2014)