Day Spa & Medi Spa Insurance Quote

Request an Insurance Quote
*When filling the form, please DO NOT use the PREFILLING feature of your browser to make sure that your information is properly sent.*
    Indicate number in your facility:

    PLASMA LIFT APPLICATION

    Please answer the following questions about your Plasma Lift practice to obtain a proposal​.
    ​Name of the Technician
    ​School Attended
    ​Graduation Date
    Max file size: 20MB

    MEDISPA APPLICATION

    SECTION I: LIGHT/ENERGY​​
    Includes IPL, Laser, Medical and/or High Heat Radio Frequency, Ultrasound, High Frequency (not listed on page 1) 
    Name of Operator
    ​Medical Designation (if any) 
    Years of Experience 
    If Less than 1 year of experience, provide training detail for each technician 

    ​Please fill out the following section to be covered for Micro-Blading and/or permanent makeup

    SALON/PERMANENT MAKEUP APPLICATION 

    Permanent Makeup Section: Complete for EACH technician 
    Pick which service (s) von will be performing: 
    Training:
    Information About Your Profession:  

    ​SALON/PERMANENT MAKEUP APPLICATION 

    History: Note — ALL questions must be answered. Failure to disclose claims history could invalidate coverage

    If Claims Made, most Recent Retroactive Date:

    List any Professional, General Liability or Property Claims history below, whether or not insured 
    Do you have knowledge of an event, circumstance or occurrence (other than listed above) prior to the effective date of the proposed policy, or are you aware that a claim may be brought as an result of said event, circumstance or ​occurrence?
    ​Other Coverages: additional premium and application will apply
    Do you provide any of the following? If so, please indication number of people performing ​
    ​Decorative Tattooing/Body Piercing: 
    Yoga/Personal Trainer:
    Laser/Intense Pulse Light:
    Do you want coverage for Non-Owned Or Hired Auto?
    ​If Yes, Separate Supplement Required
    Do you want coverage for Sexual Abuse at $25K/$50K limits?
    Do you want coverage for Cyber Protection at $50K limits?

    Schedule of Services

    ​Permanent Makeup Section: Complete for EACH technician
    Training:
    Information About Your Profession:
    Optional Coverages
    Business Interruption:

    Other Coverages: 
    (Additional premium and application will apply)

    ​Do you provide any of the following? If so, please indication number of people performing

    History:
    ​(    Note – ALL questions must be answered. Failure to disclose claims history could invalidate coverage)

    Attestation

    I understand and agree this Application and any supplements attached hereto will be relied upon for issuance of any policy. I further understand and agree that failure to provide a true and accurate response to the foregoing questions may, at the option of the company, result in the voiding of the insurance issued in reliance on this application and/or denial of claims under any policy issued. I authorize and consent to investigations of information bearing upon moral character, professional reputation and fitness to engage in the activities of my business including authorization to every person or entity, public or private, to release all Lloyd’s of London participating syndicates, any documents, records or other information bearing upon the foregoing. I understand and agree these investigations shall not be confined to information submitted in this application, but shall include any other sources of information deemed relevant by the Company as may be authorized by law. I understand this insurance is being provided through a surplus lines company and the insurer may not be subject to all the insurance laws and rules in my state and the risk is not protected by the State Insurance Insolvency Fund.

    Furthermore, I understand that the policy applied for will apply only to CLAIMS FIRST MADE to the Company in writing within the period of coverage shown on the certificate of insurance issued with the policy or certificate on the date the policy is canceled or terminated, whichever comes first or as otherwise provided by the policy. I understand this insurance is being provided through a surplus lines company and the insurer is not subject to all the insurance laws and rules in my state and the risk is not protected by the State Insurance Insolvency Fund.
    THIS APPLICATION MUST BE SIGNED BY APPLICANT WITHIN 30 DAYS OF BINDING. SIGNING THIS FORM DOES NOT
    BIND THE COMPANY TO COMPLETE THE INSURANCE. COVERAGE BECOMES EFFECTIVE WHEN ACCEPTED BY THE
    INSURANCE COMPANY.
    By signing below, I confirm on behalf of all technicians covered under this policy:
    1. Technicians are licensed as necessary for all services being provided.
    2. Technicians do not use any product that contains more than 2% formaldehyde.
    3. I understand that no service or individual is covered unless listed and a premium paid.
    4. That all technicians have been trained for the service they are performing or on the device they are using.
    5. I understand that no coverage is provided under this policy for invasive or surgical procedures unless specifically listed.