Martial Arts Group Insurance 541 South State Road 7 13 Margate Fl 33068

Instructions Provided

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

Other Instructions (separate with comma) (0/500)

Appointment that you would similar coverage to start*

Current Insurance Company

Have you recently had a liability claim inside the last 5 years?
Yes No

If aye, provide date, amount paid, and a cursory description

(0/1000)

Students

Amount of coverage *Most requested past landlords (95%)

Adventitious 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 mistake on your part in securing Waiver and Release forms shall not void your coverage in the upshot of whatever occurrence to a educatee or staff fellow member. Nevertheless, your failure to maintain an adequate system to regularly secure Waiver and Release forms shall void your coverage in the upshot of an occurrence to a student or staff member. A Waiver/Release form volition be emailed to your schoolhouse or studio upon asking. Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer submits awarding or files claim containing a false or deceptive argument may be guilty of insurance fraud. The minimum premium on this programme is $490.00 which is also the minimum earned. What this means is if you lot cancel your insurance, the insurance company volition go on 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 y'all abolish coverage.

I Accept I practice not Take *

Yes No Do y'all take a release waiver on file for each pupil? *

YOU MUST Take A RELEASE WAIVER ON FILE.
Click here for a Release Waiver.

Yep No If so, are both signatures required for minors? *

Policy may be delayed or may not be issued

Aye No Do you offer Contact Boxing? *
Yep No Do you let contact of whatsoever kind? *

Yep NoAre Sparring rules addressed and given to all students? *
Yeah NoDoes your school practice/teach Historic European Martial Arts (HEMA)? *

Additional Locations

Do y'all take any additional locations? Yes No

If yous accept whatever additional locations, please enter them below.

Additional Location one Address City State Naught Additional Location 2 Address City State Nada Additional Location 3 Address City State Zip Additional Location four Address Urban center Land Nothing If you lot take more than than iv additional locations, please electronic mail united states of america

Additional Insureds

Practice you lot accept whatsoever boosted insureds? Yep No

Consummate this department if you demand to provide proof of insurance to a landlord, gym, municipality, school or other. If yous need to know the difference between a certificate holder and an additional insured, click here. If you have more than four additional insured'due south, please electronic mail us.
	Additional Insured i AI Proper noun Address Metropolis Land Zip Blazon Additional Insured two AI Name Address City Land Zero Type Additional Insured three AI Name Address City Land Zip Blazon Additional Insured 4 AI Name Address City State Zip Type

Content Coverage

Would you like to add Contents Coverage? Yeah No

Coverage is bachelor for miscellaneous holding and equipment: A schedule of items, with a value of $5,000.00 or more must be listed on our separate application grade. Click Here to Admission Policy Deductible: $250.00 Schedule Limit Premium/Taxes/Fees: Contents/Equipment/Inland Marine Exclusions The post-obit incidents are not covered; Damage to automobiles or like conveyances Theft by employees Damage to fine arts or jewelry Damage to plate glass Damage via flood or surface h2o Unexplained Disappearances Damage past wear & tear Damage past insects or vermin Damage via rust or corrosion Notation: Coverage tin but be purchased at the time of liability coverage purchase. Coverage expires on the aforementioned date of liability coverage expiration. In one case purchased, premium is fully earned. There volition exist no pro-ration or refund of any kind if policyholder decides to cancel coverage. Policyholder Name Have you suffered whatsoever losses, over $five,000.00, within the last three years? Yes No Have you already obtained a quote from OneBeacon? Yes No Locked Vehicle Warranty to use? Yes (Will add 10% to your premium) No Please contact Martial Arts Group for further details: (800) 207-6603 Item Schedule Merely listing items with a value of at least $v,000.00 Detail & Serial # Description Value $ $ $ $ $ $ $ $ $ $ NOTE: Fifty-fifty if you have no items, valued at $5,000.00 or more, this schedule must be signed and dated. If you lot have no items, valued at $5,000.00, indicate same by writing "NONE" on the first line. The above prices include a $forty.00 processing fee Do you have more than ten items? Yes No Please contact Martial Arts Grouping to include additional items in your schedule

MANDATORY FRAUD WARNING STATEMENTS By STATE ARKANSAS, LOUISIANA "Any person who knowingly presents a false or fraudulent merits for payment of a loss or benefit or knowingly presents false data in an awarding for insurance is guilty of a crime and may be subject field to fines and solitude in prison." VIRGINIA, TENNESSEE, MAINE "Information technology is a criminal offence to knowingly provide fake, incomplete or misleading data to an insurance visitor for the purpose of defrauding the company. Penalties may include imprisonment, fines or denial of insurance benefits." COLORADO "It is unlawful to knowingly provide simulated, 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. Whatsoever insurance visitor 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 Segmentation of Insurance within the Department of Regulatory Agencies." DISTRICT-OF-COLUMBIA "WARNING: It is a crime to provide simulated or misleading data to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In improver, an insurer may deny insurance benefits if false information materially related to a claim was provided past the applicant." FLORIDA "Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of merits 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 whatever insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning whatever fact fabric thereto commits a fraudulent insurance human action, which is a crime." NEW JERSEY Insurance applications must comprise this argument: "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 "Whatever PERSON WHO KNOWINGLY PRESENTS A Faux OR FRAUDULENT Merits FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE Information IN AN APPLICATION FOR INSURANCE IS GUILTY OF A Criminal offense AND MAY Be SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES." NEW YORK "Any person who knowingly and with intent to defraud whatever insurance company or other person files an awarding for insurance or a statement of merits containing any materially false information concerning whatever fact material thereto, commits a fraudulent insurance human activity, which is a crime, and shall too be subject to a civil penalization 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: Whatever person who knowingly, and with intent to hurt, defraud or deceive any insurer, makes whatever 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 whatsoever materially false information or conceals for the information concerning any fact fabric thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties."

I take the terms I do not accept the terms *

Do you have a risk management plan?

Yep No * Yous MUST HAVE A Gamble MANAGEMENT Plan IN EFFECT AT THE TIME OF PURCHASE CLICK Hither TO OBTAIN One

I hereby certify that all to a higher place
information is truthful and correct
Signature (Typed name indicates signature)

Today'due south Date * (April/26/2022)

Thank you for choosing Martial Arts Group. Processing your application.
Please be patient; this may take several minutes.

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Source: https://www.igomag.com/martial_arts_insurance_application.php?payinfull=1

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