Apply for insurance (Complementary)

Acceptance Criteria
  • I agree to maintain client’s records and retain them for at least 5 years. If I have not done this in the past or am just starting in business, I agree to do this now.
  • I have never had any claims made against me.
  • I have not been subject to nor have any pending disciplinary hearings against me.
  • I am not aware of any incidents that have occurred which may have given rise or may give rise in the future to a claim under the policy.
  • I have never had suits for negligence, error or omission made against me.
  • Under current or any previous trading titles, I have never been convicted of any criminal offence, other than motoring, or have any prosecution pending.
  • I have never had any insurer cancel, decline, refuse to renew or only accept on special terms, my liability insurance.
  • I have read and agree to the Insurance Product Information Document. Click here to read the Insurance Product Information Document.
  • I have read and agree to the Terms of Business of BMIB. Click here to view our Terms of Business.
  • I have read and agree to the Data Protection of BMIB. Click here to view our Data Protection.
  • I hereby declare and warrant that all the statements and particulars in this application are in all respects complete and true, that they are material, and that I have not suppressed or misstated any material facts and I agree that this proposal form shall be the basis of the contract with the underwriters and deemed to be part of the insurance coverage issued to me.
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Please fill in the form below, then click "Next". The fields marked * must be completed, other fields may be left blank.

Title* e.g. Mr/Mrs/Ms..
Your First Name*
Your Last Name*
Trading Name (leave blank if none)
Postal Address Line 1*
Postal Address Line 2*
Postal Address Line 3
Postal Address Line 4
Eircode
Country
Email Address*
Telephone Number
Mobile Number
Association
Inception date Date when you would like insurance cover to start
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Treatments*
Please tick the treatments for which you require cover.
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Data Protection Here at BMIB Ltd we take your data protection seriously and will only use your data as set out in our privacy statement. However, from time to time we may wish to contact you in relation to the services we provide.

Please tick the box if you wish to be contacted by email in relation to the other services we provide.

Treatment Declarations

  • I understand that I must hold an approved qualification to carry out the treatments I have requested cover for.
  • I am not a student but a fully qualified therapist.
  • I do not hold qualifications from distance learning or online courses.
  • I understand cover for CPD qualifications will not be accepted as stand-alone qualification.
  • I understand that the name of the therapy I require cover for appears on my certificate of qualification.