Javascript is disabled on your browser and this site won't work properly without Javascript enabled.
Personal Trainer & Instructor Insurance :: KlaptonOnline
Buy your policy online today Get a quote
Personal Trainer Insurance Application Form
Note: * Indicates required field.

Applicant Information

Requested Third Party and Professional Indemnity Insurance Limits and Deductible

Limit Per Claim* :
Deductible Per Claimant* :

Applicant Information

Insured Information

Use the Applicant's name and address

Insured Business Name

Business and/or corporate name to be included in the Name of Insured.

The policy will show the insured's name, which will include the name of the owner (applicant), the corporate name and trading name. This is in order to provide coverage for your business, as well as yourself.

Professional Information

Choose the group where your practice is listed*. If any of your practices appears in more than one group, choose the higher group (A is lower risk, and C is the highest risk)

A B C
  • 5 Minute Series
  • Advanced Personal Consultant
  • Casting/Angling Instructor
  • Child Care Coordinator
  • Child Care Worker
  • Children and Teenagers Dance Instruction
  • Circuit Training
  • Coaching
  • Cooking Instructor
  • Core Stability Trainer
  • Corrective Training
  • Dance Instructor
  • Dressage Trainer
  • Executive Coaching
  • Exercise to Music
  • Feng Shui
  • First Aid Trainer
  • Fishing Guide
  • Fitness Assessment
  • Hospitality Trainer
  • Meditation
  • Personal Training
  • Pilates (mat)
  • Pilates Instruction
  • Senior Fitness Specialist
  • Spinning (Indoor Cycling) Instruction/Training
  • Sports Conditioning Specialist
  • Sports Nutrition Consultant
  • Step Classes
  • Stretch Exercises
  • Tai Chi Instruction
  • Tantra Instruction
  • Transference Healing
  • Yoga
  • Yoga Instruction
  • Yoga Training
  • Aerobic Instruction
  • Aerobic Trainer
  • Aqua Yogilates Trainer
  • Archery Coaching
  • Athletic Conditioning
  • Autogenic Training
  • Baby Massage Instructor
  • Balance Ball Instructor
  • Body Sculpt Upper Body/Lower Body
  • Body Work Counsellor
  • Certified Functional Trainer Specialist
  • Children and Teenagers Fitness Program Instruction
  • Crossfit Trainers & Instructors
  • Exercise Ball Instructor
  • Exercise and Aerobics
  • Exercise Instruction
  • Exercise Therapy/Rehabilitation
  • Fit Ball Instructor
  • Fitness Ball Instructor
  • Fitness Dance
  • Fitness Trainer & Instructor
  • Football (Soccer) Coach
  • Group Exercise Instructor
  • Gym Trainer
  • Gyrotonic Instructor
  • Keep Fit Instructor
  • Kettleball Training
  • Muay Thai
  • Netball Coach
  • Outdoor Group Camping and Guiding
  • Physio Ball Instructor
  • Pole Dancing and Fitness
  • Remedial Exercise
  • Remedial Massage
  • Resistance Bands
  • Sports Trainer
  • Sports Yoga Trainer
  • Stability Ball Trainer
  • Stalking & Tracking
  • Street Luge Instructor
  • Swiss Ball Instructor
  • Tennis Instructor
  • Toning Tables
  • Treadmill
  • TRX Training/Instruction
  • Warm Ups
  • Water Safety Instructor
  • Zen Karate Instruction
  • Boxercise Instructor
  • Cardio Kickboxing
  • Extreme Sports Instruction & Training
  • Freestyle Motorcross Riding Coaching
  • Futsal (Indoor Football)
  • Green Woodwork
  • Horse Riding Trainer
  • Lifeguard Instructor
  • Martial Arts Instructors
  • Parkour Trainer/Instructor
  • Rugby Coach
  • Strength Training
  • Swimming Instructor/Coach
  • Zumba Instructor

*If your trade does not appear in the list, please refer to our team for a personal quote.

Coverage Extensions

Occurrence Retroactive Date Coverage for the following previous period:

Claim Made Date Coverage for the following future period:

Coverage and include additional professionals/practitioners to this cover:

Coverage and include additional administrative employees to this cover:

Acknowledgement and Declarations

I hereby declare that within the last 5 years:

I had not been revoked, suspended, refused, cancelled or voluntarily surrendered any of the following:

  1. State license, certification or registration
  2. Malpractice insurance
  3. Public liability insurance

No claim or suit for alleged malpractice or public liability has been brought against me and I am not aware of any incident that might reasonably lead to such claim or suit. I have never been convicted (as an adult) of a felony and there isn’t any such case pending. No complaints or charges were brought against me by any licensing board or professional ethics body.

I hereby confirm that I have read and agree with the above statement.

I, the undersigned declare that all answers in this application form are complete and accurate. I understand completely that the answers provided are the basis for the provision of Insurance Cover. Furthermore, I declare that I do not have any supplementary information, in respect of this application, which could influence the outcome of your decision regarding my application request. My signature warrants that my application is submitted in all good faith.

I hereby confirm that I have read and agree with the above statement and it applies both to me and to any additional professional/practitioner and administrative employee included in this application.

Premium Payment Information: I hereby confirm that I understand that after completing and submitting this application form, I must pay the required premium before any cover will become effective.

Submitted Date: 16 Sep 2019