Malpractice Complementary Medicine Beauty Proposal Form

Complementary medicine and beauty Proposal acceptance form

This proposal form In deciding whether to accept the insurance and in setting the terms and premium, we have relied on the information you have given us. You must:  give a fair presentation of the risk to be insured by clearly disclosing all material facts and circumstances (whether or not subject to a specific question) which you, your senior management and those responsible for arranging this insurance, know or ought to know following a reasonable search;  take care by ensuring that all information provided is correct, accurate and complete.

Section 1 – Your business Business name

Other trading names

Address

Postcode Telephone

Current financial year end date / /

Estimated income (excluding sale of goods) for the current financial year £

Estimated income (excluding sale of goods) for the next financial year £

Section 2 – Your activities 2.1 Complementary therapies Indicate which complementary therapies you undertake or plan to undertake in the next 12 months. If you undertake any therapies not on this list, please refer to your insurance broker. You will only be covered for those activities you notify us of here. Aromatherapy Iridology Acupressure Indian head massage Aerobics instructor Kinesiology Alexander technique La Stone therapy Allergy testing Life coaching Auricular detox Lymphatic drainage Ayurveda Massage Baby massage McTimoney method of chiropractice Bach flower remedies Naturopathy Bowen technique Nutritional therapy Bio-magnetic technique On-site massage Biofeedback Pilates Crystal therapy Psychology Colour therapy Rebirthing Craniosacral therapy Reflexology Counselling Relaxation therapy Cupping Reiki Dowsing for stress relief Rolfing Exercise instructors Shiatsu sports massage Electro crystal therapy Sports massage Energy balancing Sports therapist Equine massage Stress control/management Gym instructors/personal trainers Swedish massage Herbalism Thai chi

PF-MM-UK-CMB(4) 5771 05/17 Complementary medicine and beauty Proposal acceptance form

Homeopathy Touch for health Hopi ear candles Yoga Hypnotherapy

2.2 Beauty therapies Indicate which beauty therapies or activities you undertake or plan to undertake in the next 12 months. If you undertake any therapies or activities not on this list, please refer to your insurance broker. You will only be covered for those activities you notify us of here. Body wrapping Nail art Ear piercing Nail extensions Electrical epilation (electrolysis) Pedicure Eyebrow tinting/shaping Qui Gong (non-contact) Eyelash tinting Red vein treatments False eyelash application Sugaring Hairdressing excl. hair extensions St Tropez tan/spray on tans Manicure Waxing Facial inc use of galvanic faradic and Facial peels (glycolic under 40% high frequency equipment strength)

Section 3 – Your cover Hiscox offers cover options for both self-employed individuals and for clinics and gyms. Please refer to the policy wording available from your insurance broker for full details of cover. The limits of indemnity shown apply in the aggregate, including all costs. Please select an option from either section 3.1 (individuals) or 3.2 (clinics), but not both. All premiums are inclusive of insurance premium tax and only apply if you can comply with the statement of fact and claims or losses statements in sections 4 and 5. Period of insurance: the premiums stated below are for an annual 12 month policy.

3.1 Individual therapists If you are a self-employed individual working from home or on a mobile basis or a self- employed individual contracted by a third-party, please select one of the cover options below. Cover includes malpractice, professional indemnity and public and products liability and is suitable for those with income of £50,000 or less. Maximum income: £50,000 per annum. If your income is greater than £50,000 per annum, please refer to your insurance broker. Excess: the excess applicable to each and every claim is £250.

Limit of indemnity Limit of indemnity £500,000 £1,000,000 Annual Monthly Annual Monthly Complementary therapist £216 £18 £268 £22.30 Beauty therapist £268 £22.30 £321 £26.80

If you are practicing activities from both the complementary and beauty therapy lists in section 2, you must select an option from the ‘beauty therapist’ category in the grid above.

3.2 Clinics The options below are suitable for complementary or beauty clinics and gyms. Cover is for malpractice only. Maximum turnover: £100,000. If your income (excluding the sale of goods) is greater than £100,000, please refer to your insurance broker. Excess: the excess applicable to each and every claim is £1,000. Limit of indemnity Limit of indemnity Limit of indemnity £1,000,000 £2,000,000 £3,000,000 Turnover Annual Monthly Annual Monthly Annual Monthly Nil - £526 £43.90 £631 £52.60 £821 £68.40 £25,000 £25,001 - £658 £54.80 £782 £65.80 £857 £71.40 £50,000 £50,001 - £789 £65.80 £957 £78.90 £1,231 £102.60 £75,000 £75,001 - £947 £78.90 £1,157 £96.40 £1,236 £103 £100,000

Section 4 – Statement 1. You hold recognised professional qualifications for the therapies or treatment you offer. of fact 2. You are either: a. a self-employed individual working from home or on a mobile basis; or b. a self-employed individual employed by a third-party; or c. a clinic, salon or other entity that employs staff who undertake one or more of the therapies listed in section 2 above, and you undertake sufficient checks that anyone working for you holds an appropriate professional qualification for the therapies or treatments they undertake. 3. You hold all clients record for a minimum of ten years after the date of treatment.

Section 5 – Claims You confirm the following statements to be true. and losses 1. You are not aware of any shortcoming in your work that could lead to a claim against you. This could include a shortcoming which you cannot reasonably put right or a complaint about your work or anything you have supplied which cannot be immediately resolved. 2. You are not aware of any loss from the suspected dishonesty or malice of any employee or self-employed freelancer. 3. You or any of your partners or directors either personally or in any business capacity have never been declared bankrupt or insolvent or made arrangements with creditors. 4. For any malpractice or professional indemnity insurance, you have never had a policy: a. cancelled; or b. declined; or c. renewal refused; or d. only accepted by an insurer with special terms and conditions attached.

Section 6 – Insurance Important notice for your protection details Within 30 days of receipt of this proposal acceptance form by us, and following review by us, you will be sent your policy documents which contain full details of your cover and other important information. Please take time to read these documents carefully, particularly noting the policy exclusions and limitations. Please ensure that the details in the policy documents sent to you are correct. In the event that you change your mind you have 14 days to cancel the policy and, providing that no claims have been made, receive a full refund. After that period you can cancel your policy by giving 30 days’ notice.

Section 7 – Acceptance I would like to proceed with cover to start on* / / *Please note that you can choose for cover to commence on any date within 30 days from when you sign this form. The commencement date cannot be in the past. Your application will be rejected if you choose a commencement date in the past or more than 30 days in the future. Please note that cover will only commence once all necessary underwriting has taken place and you have received confirmation of cover from Hiscox. I confirm that I have read the statements of fact in sections 4 and 5 above and I accept and agree the offer of insurance based on the cover and limits detailed above. Yes No If No, please speak to your broker.

Section 8 – Declaration You must complete this section. Please read the declaration carefully and sign at the bottom. 8.1 Material information Please provide us with details of any information which may be relevant to our consideration of your proposal for insurance. If you have any doubt over whether something is relevant, please let us have details.

Is there anything else that you would like to tell us about you or your business? Yes No

8.2 Your information By signing this proposal form, you consent to the Hiscox group of companies (collectively referred to as Hiscox) using the information we may hold about you or others related to your policy for the purposes of providing insurance and handling claims, if any, and to process sensitive personal information about you or others related to your policy where this is necessary (for example health information or criminal convictions). This may mean Hiscox has to give some details to third parties involved in providing insurance cover. These may include insurance carriers, third-party claims adjusters, fraud detection and prevention services, third-party service providers, reinsurance companies, insurer tracing offices and insurance regulatory authorities. Where such sensitive personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates both to the disclosure of such information to us and its use by Hiscox as set out above. The information provided will be treated in confidence and in compliance with all relevant regulation and legislation. You or others related to your policy may have the right to apply for a copy of this information (for which Hiscox may charge a small fee) and to have any inaccuracies corrected. For training and quality control purposes, telephone calls may be monitored or recorded.

8.3 Declaration I/we confirm that the information given in this proposal form is correct, accurate and complete and I have made a fair presentation of the risk.

Name of director/officer/board member/senior manager

/ / Signature of director/officer/board member/senior manager Date

A copy of this proposal should be retained for your records.

8.4 Complaints Hiscox aims to ensure that all aspects of your insurance are dealt with promptly, efficiently and fairly. At all times Hiscox are committed to providing you with the highest standard of service. If you have any concerns about your policy or you are dissatisfied about the handling of a claim and wish to complain you should, in the first instance, contact Hiscox Customer Relations in writing at: Hiscox Customer Relations The Hiscox Building Peasholme Green York YO1 7PR by telephone on 0800 116 4627/01904 681 198 or by email at [email protected]. Where you are not satisfied with the final response from Hiscox, you also have the right to refer your complaint to the Financial Ombudsman Service. For more information regarding the scope of the Financial Ombudsman Service, please refer to www.financial-ombudsman.org.uk.

PF-MM-UK-CMB(4) Hiscox Underwriting Ltd is authorised and regulated by the Financial Conduct Authority. 5771 05/17