The below application form relates to insurance cover for students enrolled in the various beauty, hairdressing, holistic therapy and massage courses provided by Vocational Training Charitable Trust (VTCT). Should you have any questions in respect of your suitability, please contact the helpline below before completing.
Our Business Development Team will send you a written quotation and other relevant documents by post within 48 hours of receiving your valued enquiry.
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| Full Name |
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| Address |
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| Postcode |
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| Telephone Number |
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| Mobile |
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| Email |
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| Date Of Birth: |
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| Training Centre: |
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| Training Centre Address: |
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| Postcode |
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| Candidate Number |
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| Course(s) for which Insurance is required (please quote course name and reference number) |
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| Therapy or Therapies to be covered (Please refer to the list below and quote the title and corresponding reference number) - to qualify for insurance cover the treatments should be accredited by VTCT,NVQ,SVQ,IHBC,IIHHT or IIST. If you are studying a qualification accredited by another organisation please provide details as you may be still be eligible for cover. |
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1 Acupressure
2 Application of Fake Tanning
3 Aromatherapy/Mixing and Blending of Oils
4 Audio Sonic
5 Baby Massage
6 Bleaching of Superfluous Hair
7 Body Electrical
8 Body Massage
9 Body Wrapping
10 Camouflage Make-Up
11 Cathiodermie
12 Colour Therapy
13 Colour Therapy with Crystal Torch
14 Crystal Therapy
15 Depilatory Creams
16 Ear Piercing (Ear Lobes Only)
17 Electrical Depilation
18 Electrolysis
19 Epilpro
20 Exercise & Aerobics
21 Eyelash Perming
22 Eyelash Tinting
23 Face & Body Painting
24 Facial Electrical
25 Facial Massage
26 Facial Massage & Skincare
27 Facials
28 False Eyelashes
29 Faradic Treatments
30 Flower Essences
31 Galvanic Treatments
32 Hair Dressing
33 Heat Treatments
34 High Frequency Treatments
35 Hydrotherapy
36 Indian Head Massage
37 Infra Red Treatments
38 Make Up
39 Manicure
40 Mendhi Henna Skin Paint |
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41 Micro-Current Treatments
42 Nail Art
43 Nail Extensions
44 No Hands Massage
45 On-Site Massage
46 Paraffin Wax
47 Pedicure
48 Reflexology - Foot
49 Reflexology - Hand
50 Reiki
51 Remedial Camouflage
52 Retail of Essential Oils and Blends
53 Sauna/Steam
54 Sports Therapy
55 Stone Therapy
56 Stress Management
57 Sugaring
58 Sunbeds
59 Thermal Auricular Therapy
60 Ultrasound
61 Vacuum Suction
62 Waxing |
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| If you have selected "Aromatherapy/Mixing and Blending of Oils", do you require Mixing and Blending of Oils? |
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| Cover required (Yes / No) |
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| Public / Treatment Liability only |
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| Have you suffered any loss, made any claims or been involved in any incidents which have or could have resulted in a claim in respect of the risks proposed or any other therapy you have been involved in within the past 3 years? |
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| Public / Treatment Liability & Business Equipment 'All Risks' |
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| Date insurance is to operate from (Duration of course - maximum period 12 months): |
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Declaration.
1 I / We declare that to the best of my / our knowledge and belief
a) the above statements and particulars, whether written by me / us or by others on my / our behalf, are true and complete.
b) I / We have not withheld any Material Fact*.
c) No insurer has declined my / our proposal, cancelled or refused to renew my / our policy or increased the premium or required special terms or conditions in respect of any of the risks proposed.
d) I / We have not been convicted of or charged (but not yet tried) with a criminal offence other than (road traffic) motor offences.
e) I / We have not received an official caution for a criminal offence within the last 3 years other than a (road traffic) motoring offence.
f) I / We have not been declared bankrupt and/or are or have been subject of any winding up order, insolvent liquidation or administration or have made any composition or arrangement with creditors. |
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| g) I / We have not been a director or partner of a company which has gone into insolvency, liquidation, receivership or administration |
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| h) I / We wish to modify the above statements in the following respects: |
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2 I / We agree that this proposal and declaration and any particulars given separately shall be the basis of the contract between Allianz Insurance plc and Myself / Ourselves.
3 I / We agree to accept Allianz Insurance plc's standard form of policy for this type of insurance. A specimen copy of the policy is available on request.
4 I / We understand that Allianz Insurance plc reserves the right to decline any proposal.
5 I / We understand that Insurers share information with each other, credit reference agencies and other information agencies primarily to help assess risks, handle claims and prevent fraud. I consent to this. |
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*Material Facts
Failure to disclose a material fact (any fact likely to influence the Insurers acceptance or assessment of this proposal) will render this Insurance voidable. If you are in any doubt about the facts which might be considered material you should disclose them. |
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Your Records
You should keep a record (including copies of letters) of all information supplied to Allianz Insurance plc which relates to this proposal. A copy of this proposal will be supplied on a request made within 3 months after its completion. |
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Data Protection
We may use the personal details you give us, or which are supplied by third parties, to provide you with a quotation, to administer your policy, to search the files of credit reference agencies who may keep a record of the search, to support the development of our business by including your details in customer surveys and for market research and compliance business reviews. We may also share these details with other insurance organisations to help offset risks, to help administer the policy and to handle claims and prevent fraud. Your personal details may be transferred to countries outside the EU. They will at all times be secure and handled with the utmost care in accordance with all the principles of the UK law. We will store your details on computer but will not keep them longer than necessary. Under the terms of the Data Protection Act 1998, you are entitled to a copy of all the information we hold about you. |
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| I confirm I have read and fully understood the above (by entering Yes, you have agreed to the above statements and authorise the submission of this proposal) |
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| Date: |
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Policy Underwritten by
Allianz Insurance plc. Registered in England number 84638.
Registered Office: 57 Ladymead, Guildford, Surrey, GU1 1DB, United Kingdom.
Allianz Insurance plc is a member of the Association of British Insurers and the Financial Ombudsman Service.
Allianz Insurance plc is authorised and regulated by the Financial Services Authority, registration number 121849. |
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