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

 

Tournament-only Insurance

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Before completing this application you must EMAIL US FOR A 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).

  • Security Question & Answer
    You will use this information if you need to recover your password in the future
  • Please make a note of your User Name and Password for future reference.
    You will need them to access and update your application.
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  • 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

  •    (Pricing above is the correct amount provided to you in the response email from your initial quote request?)

Type of Tournament
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)


WARNING: READ CAREFULLY!
Each tournament must install a Release and Waiver of Liability and indemnity Agreement for all participants, staff members and spectators. Unintentional error on your part in securing Waiver and Release forms shall not void your coverage in the event of any occurrence to a participant, staff member or spectator. 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 participant, staff member and/or spectator. A Waiver/Release form will be emailed to your tournament 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 claims containing false or deceptive statements may be guilty of insurance fraud. The minimum premium on this program is $450.00, 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 $450.00 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 participant? *
Yes No    If so, are both signatures required for minors? *
Yes No   Will your tournament offer Contact Boxing? *
Yes No    Does your tournament permit contact of any kind? *
Yes No    Are Sparring rules addressed and given to all participants? *

Yes No    Will Historic European Martial Arts (HEMA) be allowed/practiced during your tournament? *
Any tournament dates selected must be 5 days after “August 17, 2017”
Applications with tournaments lasting longer than 3 days must wait for underwriter approval.
Tournament Start
Tournament Ends
Tournament Additional Insured Information Additional Insured 1
AI Name
Address
City
State
Zip
Type

Additional Insured 2
AI Name
Address
City
State
Zip
Type

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 * (August 17, 2017)