GET INSURANCE FOR YOGA

Which type of Professional Therapy insurance are you seeking?(*)

Enter the type of therapy!

If you perform other in the business, list them here

Enter the other type of activities you may involved in.

Website Address

Invalid Address.

APPLICANT

Applicant Full Name(*)

Please type your full name.

Company Name (or Individual)

Invalid Input

Phone Number(*)

Invalid Input

E-mail(*)

Invalid email address.

Address 1:(*)

Please tell us your address

Address 2:

Invalid Input

City(*)

Please enter all required fields!

Province(*)

Please enter all required fields!

Postal Code:

Please enter all required fields!

Please provide the following details:

Is this a new company (company formed within the past 3 years)?(*)

Yes

No

Please enter all required fields!

Is the applicant currently enrolled as a student?(*)

Yes

No

Please enter all required fields!

Are any of the employees currently enrolled as students?(*)

Yes

No

Please enter all required fields!

Does the applicant have locations or operations outside of Canada?

Yes

No

Invalid Input

BUSINESS OPERATION

Please provide the fees from all of applicant’s operations:

Last 12 months (expiring)(*)

Please enter all required fields!

Next 12 months (estimates)(*)

Please enter all required fields!

How many business activities/specializations and duties performed is the coverage being requested for?(*)

Invalid Input!

Provide details on all applicants (please attach resumes). Please enter each applicant for each field in the exact same order.

Provide names of applicants, separated by new line

Invalid Input

Provide professional qualifications for applicants, separated by new line.

Invalid Input

Provide the date qualified, separated with new line.

Invalid Input

Provide the years in practice

Invalid Input

Provide the years as partner

Invalid Input

PREVIOUS INSURANCE

Has the Applicant ever had insurance refused or cancelled for this Company?

Yes

No

Invalid Input

Please explain the reasoning

Invalid Input

Medical Malpractice – Alternative Therapists

GET INSURANCE FOR YOGA

APPLICANT

BUSINESS OPERATION

PREVIOUS INSURANCE