049 438 0020
Treatment Risk and Public Liability Insurance
Treatment Risk Insurance
Answer all of the questions below to begin.
Once you have completed the form we will be able to provide you with a quotation.
If your application is successful you can proceed to purchase your insurance online.
When the transaction is completed you will receive your policy documents by email.
It is essential you provide us with
ALL MATERIAL FACTS
, including: any previous insurance claims made by you for the type of insurance sought. Failure to disclose any material fact may invalidate this insurance, may result in the insurance not operating fully, claims may not be paid, and you may encounter difficulty in trying to purchase insurance elsewhere.
Name of Insured
Are you a ROSTI Member?
The Register of Orthopaedic and Soft Tissue Therapist of Ireland
Please enter your ROSTI Membership Number:
Are you an ARTI Member?
Athletic Rehabilitation Therapies Ireland
Please enter your ARTI Membership Number:
Are you a NRRI Member?
National Register Of Reflexologists Ireland
Please enter your NRRI Membership Number:
Your Postal Address
Address of Practice
Same as postal address
Trading Title or Company Name
Please select your therapies:
Massage, Strapping, Cryotherapy
Massage, Strapping, Cryotherapy, Mobilisation & Stretching, Electro Therapy including Ultrasound Therapy, Faradism or Interferential, Heat Therapy, Rehabilitation, Dry Needling
Massage, Strapping, Cryotherapy, Mobilisation & Stretching, Electro Therapy including Ultrasound Therapy, Faradism or Interferential, Heat Therapy, Rehabilitation, Dry Needling, Manipulation
Access The Bars
Anti Natal Care
Aroma Touch Technique
Auricular Candle Therapy
Bio Energy Healing
Chinese Herbal Medicine
Counselling - Emotional Freedom Technique
Cutting The Ties That Bind
Diet and Nutrition
Emotional Freedom Techniques
Energetic Massage Therapy
Energy Field Healing
Exercise and Fitness
Exercise to music for Older/ Disabled Persons
Finger Tip Blood Testing
Fitness and Sports Therapy
Fitness Instruction Gym Based
Food Intolerance Testing
Foot Care Technician
Forging Elite Fitness
Frequency Specific Microcurrent
Golf Coaching and Performance
Hawaiian Lomi Lomi Massage
Health and Personal Development
Hopi Ear Candles
Hot Stone Massage
Infant Massage Instructor
Injury Management and Fitness in Sport
Integrated Energy Therapy
Life and Business Coaching
Low level laser Therapy
Manual Lymph Drainage
Meditation Metamorphic Technique
Neuro Development Therapy
Neuro Linguistic Programming
Neuro Structural Integration Technique
Parenting Support Group
Pulsed Magnetic Field
Rahanni Celestial Healing
Rainbow Kids Yoga
Reflex Zone Therapy
Reflexology For Cancer
Self Defence Instructor
Somatic Trauma Therapy
Speech and Language Therapy
Sports Therapy Equipment
Stone Therapy Massage
Student Case Work
Tai Chai Non Combat
Tai Chi/ Chi Kung-Non Contact
Taping and Strapping
Tera Mai Reiki
Thai Foot Massage
The Naked Voice
Thermo Aurical Therapy
Touch For Health
Vitamin D Testing
Yoga For The Special Child
Yoga Teaching/ Therapy
Please enter your occupation:
Do you have a recognised qualification for the Occupation you are seeking cover for?
Please enter your qualification title(s):
Please upload you qualification certificates:
Drop files here or
Accepted file types: doc, pdf, jpg, png, gif, docx.
Please provide more details:
What is you annual turnover?
Is the client fully qualified?
Who is your current insurer?
Cover Start Date
Public Liability, Products Liability and Treatment Risk Liability is covered up to:
What level of Public Liability cover do you require?
Is Employers Liability cover required?
How many full time staff do you employ?
How many part time staff do you employ?
The Premises and Buildings
Is cover required for Property /Material damage? (e.g. Buildings, Contents, Stock, Fixtures & Fittings etc.)
Are the buildings? (Select as required)
Built of brick, stone or concrete and roofed with slates, tiles, asphalt, metal or asbestos
In a good state of repair and maintained to keep it in good condition
Select if more than 25% non standard or flat roof
Please give details:
Is the premises entirely self-contained with its own means of access?
What age is the oldest part of the building:
1946 - 1979
1920 - 1945
1900 - 1919
Are the premises protected by intruder alarm?
Alarm Details (Select as required)
Central Station Monitored Agreement in Force
Mobile Phone Notification
How long are the CCTV records kept, number of months?
Is there a fire alarm?
Is the fire alarm monitored?
Is there a sprinkler system?
Are there smoke detectors?
What type of Heating is in place? (Select as required)
Open fire place /open stoves
Does the premises provide accomodation for any staff, management, proprietors or directors?
If yes, please give details:
Is any food prepared on the premises?
Type of Cuisine
What % of turnover relates to outside catering?
1% - 25%
26% - 50%
51% - 75%
76% - 100%
Is all kitchen equipment cleaned regularly and under an annual maintenance contract?
Do you carry out deep frying on the premises?
What % of deep frying?
1% - 25%
26% - 50%
51% - 75%
76% - 100%
Cover Required & Sums to be Insured
Buildings (including outbuildings) - sum insured:
Representing full cost of reconstruction in their present form and debris removal and professional fees.
Buildings SI Rate
Buildings Net Premium
Fixtures and fittings - sum insured:
Including contents of common parts, furnishings, fitted carpets and domestic appliances.
Fixtures & Fittings SI Rate
Fixtures & Fittings Net Premium
Tenants Improvements - sum insured:
Value for property maintenance (as per your rental agreement).
Tenants Improvements SI Rate
Tenants Improvements Net Premium
Value of stock on the premises - sum insured:
Stock SI Rate
Stock Net Premium
Value of contents - sum insured:
Contents SI Rate
Contents Net Premium
Value of Computer Equipment - sum insured:
Computer Equipment SI Rate
Computer Equipment Net Premium
Value of Household Contents - sum insured:
Household Contents SI Rate
Household Contents Net Premium
Do you hold money in excess of €10,000 on the premises and do you require cover for this money?
Amount in excess of €10,000
Money in excess SI Rate
Money in excess Net Premium
Do you require cover for Business Interruption /Gross Profit?
Enter Business Interruption /Gross Profit Amount:
Indemnity period for Business Interruption /Gross Profit:
BI /GP SI Rate
BI /GP Net Premium
Is cover required for Goods /Customer Goods in Trust?
Goods /Customer Goods in Trust - sum Insured:
Goods /Customer Goods SI Rate
Goods /Customer Goods Net Premium
Is cover required for Goods in Transit in excess of €10,000?
Goods in Transit in excess of €10,000 - additional sum insured:
Goods in Transit SI Rate
Goods in Transit Net Premium
Is cover required for own plant, tools and machinery?
Own plant, tools and machinery - sum insured:
Plant, tools and machinery SI Rate
Plant, tools and machinery Net Premium
Is cover required for hired in plant?
Hired in plant - sum insured:
Hired in plant - SI Rate
Hired in plant Net Premium
Is cover required for Mobile Units?
Mobile Units - sum insured:
Mobile Units SI Rate
Mobile Units Net Premium
Is cover required for Fire Brigade Charges in excess of €10,000?
Fire Brigade Charges in excess of €10,000 - additional sum insured:
Fire Brigade SI Rate
Fire Brigade Net Premium
Is cover required for Glass in excess of €5,000?
Glass in excess of €5,000 - additional sum insured:
Glass SI Rate
Glass Net Premium
Is cover required for rent you pay?
What is your annual rental payment for the premises?
Rent Payable SI Rate
Rent Payable Net Premium
Is cover required for rent you receive?
Value of annual rent you receive.
Rental Income SI Rate
Rental Income Net Premium
Financial & Claims History
Are you aware of any claims, losses or incidents in the last five years whether insured or not?
Please provide details of claims or losses:
Ever been convicted of, cautioned or have a prosecution pending for any criminal offence other than motoring offences?
Been prosecuted under the health and safety at work act?
Been declared bankrupt, or been a director of a company that went into liquidation?
Ever had insurance cover refused, cancelled or special terms imposed?
Please give details
Please use this area if you need more space to provide information to the questions or need to provide any material fact that may influence acceptance or assessment of this proposal of Insurance
Claim Show Premium
Admin Show Premium
Date of Issue
PL Increase or Decrease
PL Net Premium
EL Increase or Decrease
EL Net Premium
MD Increase or Decrease
MD Net Premium
MD Net Prem
Frost Underwriting Fee
Live & Paid
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