Nominate

unlimited

therapies

on the one

policy!

Combined Professional Indemnity/Public & Products Liability Insurance Policies

Robust Professional & Products Liability Insurance for Complementary Health Practitioners

Policy BenefitsThe CGU Professional Risks policy for Alternative Therapy is quick and hassle free to arrange. We keep administration to a minimum and do not waste your time asking you to complete pages of unnecessary questions.

The policy features:• Unlimited retroactive cover (this provides cover for work done

by you in the past)• Extended definition of “Insured” includes cover for

employees, former employees, incoming principal’s, prior corporate entities and entities merged or acquired by an Insured

• Worldwide territorial limit – so, work you do outside of Australia is also covered

• Automatic reinstatement of the Professional Indemnity Sum Insured• Run off cover (continuous cover even after you have ceased trading

or sold your business)• Teacher’s liability• Legal representation costs

You should refer to the policy for the full policy terms and conditions applicable.

Why CGU?CGU Professional Risks, is one of Australia’s leading Professional Indemnity and Directors and Officers insurers. For over the past 20 years CGU Professional Risks has:• Underwritten over $1.2b in premium• Managed over 32,000 claims for it’s policyholders• Insured each year over 35,000 Australian businesses or individuals

Choosing to insure with CGU through TherapySure guarantees you will be dealing with a trusted group of companies, along with the security that you are insured with one of Australia’s leading general insurance companies.

Insuring over 255 therapies.

270 organisations covered.

1, 2, 5 & $10 Million cover options

available.See reverse

Insuring over 255 therapies.Covering 270 organisations.See reverse

Does your Professional Indemnity and Public and Products Liability Insurer provide you cover for Hypnosis? Acupuncture? How about Herbal Therapies? Are you too worried to explore other methods of therapy or expand your business to use other methods in case your Insurer restricts your cover, or even worse, excludes cover?

CGU Professional Risks have combined their Professional Indemnity Insurance (Malpractice) with their Public and Products Liability Policy for TherapySure to create a Policy specifically for Alternative Therapists at a fantastic price!!

In arranging this insurance Physiobase.com® ABN 98 7403 81921 is acting as an agent of the insurer CGU Insurance Limited ABN 004 478 371

Proposal Form

Should you decide to accept the insurance quote offered, the information that you provide here will form the basis of that contract of insurance. Information that CGU need to know about you, the applicant1. a) In respect of the Therapist seeking cover under this

Proposal, please state:

Firstname

Middlename/s

Surname

Date of Birth (dd/mm/yyyy)

b) Are you registered for GST purposes? Yes No

What is your ABN?

c) Is the therapist named in 1.a) above registered to practice the indicated therapy/therapies in Australia? Yes No

Please indicate the therapies you wish covered by this policy (refer to our website for those covered). Also indicate the percentage of practice for each.

2. Names of any partnership and/or trading name, company or other legal entity through which therapy services are provided and for which cover is required.

3. Contact address

4. E-mail (This is the primary way we will send information, such as renewals to you, the applicant)

5. Have you, or any principal, director or partner under a current or any previous trading titles:

a) been declared bankrupt or insolvent? Yes No b) been convicted of arson or other criminal offence (other than motoring) or is any prosecution

pending? Yes No

6. In respect of any of the risks against which you now wish to insure:

a) had special terms imposed by any Insurer or suffered loss or damage by any cause or incurred any liability during the last 5 years? Yes No

b) Do you provide therapy services outside of Australia or New Zealand? Yes No

c) Have any claims ever been made against you? Yes No d) Are you aware of any circumstances which may give

rise to a claim being made against you? Yes No e) Has any insurer ever declined, cancelled or imposed

special conditions in relation to this type of insurance? Yes No

f) Have you ever been subject to disciplinary proceedings by a statutory registration board or any professional body for professional misconduct, or been called upon to respond to a complaint made against you? Yes No

If yes, please provide details:

7. When would you like cover to start?

(Cannot be in the past) (dd/mm/yyyy)

8. What Limit of Indemnity would you like? (Please tick Note: Each option automatically includes $10,000,000 Public and Products Liability cover.)

$1,000,000 $2,000,000 $5,000,000

$10,000,000 $20,000,000

Therapy 1

Training Organisation

%

Therapy 2

Training Organisation

%

Therapy 3

Training Organisation

%

Therapy 4

Training Organisation

%

Therapy 5

Training Organisation

%

If you have answered either “No” to question 1c, or “Yes” to any point in Questions 5 or 6Physiobase.com will need to submit your Proposal to CGU for separate assessment and rating.

I hereby declare:1. That the information submitted in this proposal is

true and correct and that I have not suppressed nor misstated any facts.

2. That I have read and understood the Important Notice attaching to this Proposal.

3. I authorize CGU Professional Risks Insurance, a division of CGU Insurance Limited, to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service. Where I have provided information about another individual (for example, an employee, or client), I declare that the individual has been or will be made aware of that fact and the section in the Policy on “The way we handle your personal information”.

4. I also confirm that the undersigned is authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Proposal form and I complete this Proposal form on their behalf.

To be signed by the therapist named in this application.

Signature

Date

Please provide at least one phone number contact should we need to clarify or discuss an aspect of your application.

Work

Mobile

After completing the proposal form you may pay for the insurance in the following ways:

a) Cheque – make out a cheque payable to Physiobase.com Ltd. Please mail it to: Physiobase.com Limited, PO Box 48, Strawberry Hills NSW 2012.

b) Credit Card – scan the completed proposal form and email to admin@physiosure.com

c) Phone – call Physiobase on (02) 8399 3744 to pay by credit card over the phone.

Declaration Payment Options

Don’t Delay – Get On-line today!

So why don’t you simply go on-line today to see the our competitive pricing with fantastic extras? You will be pleasantly surprised.

At Therapysure we believe you are more than a customer, you are part of our therapy community

It’s as easy as 1-2-3. Simply go to www.therapysure.com where you can purchase your policy immediately. No Fuss!

Net-savvy, but not sure about buying on-line? Simple. We’ve got that covered too!

For more information, please do not hesitate to email us at admin@physiosure.com or phone (02) 8399 3744.

This information is a general description of cover only. For the full terms and conditions, please refer to the policy wording.

Contact us today to see if we can provide cover for your therapy or organisationCheck us out online today at www.therapysure.com

Insuring over 255 different complementary therapies.

270 organisations are already covered by our policies.

1, 2, 5 and $10 Million cover options available

From the company who brought you Physiosure.com® we’ve got over 17 years experience in providing Professional Indemnityand Public Liability insurance for Australian health care professionals. Be sure with TherapySure today!

Nominate

unlimited

therapies

on the one

policy!