• Activities Covered: Personal Training, Group Training, Health and Fitness Professionals
    Administered By: LSG Insurance Services -+27 (0)21 701-0840
    Jurasdiction: Worldwide Excluding USA and Canada
    Excess: R 1,000.00 each and every claim

    • Inclusive of R1 000 000 Public Liability cover
    • Inclusive of VAT and R80.00 broker fee
    • Inclusive of collection fee R11.40
    • Excess: R 1,000.00
    • Inclusive of VAT and R80.00 broker fee
    • Excess: R 1,000.00
    • Extensions:
      • Statutory Defence Costs - R100 000.00
      • Wrongful Arrest - R100 000.00
      • Defamation - R100 000.00
  • Cover
  • (Only applicable if a REPSA member)
  • (Tick Relevant Box)
  • I hereby authorise LSG Insurance Services Pty (Ltd) and or its authorised administrators to debit my account with a one off premium payment at:
  • NOTE: Debits cannot be raised through FNB Savings, Master Card Holders, or account numbers exceeding 13 digits
    • I/we declare that after proper enquiry the statements and particulars given above are true and that I/we have not miss-stated or suppressed any material fact.
    • I/we agree that this Proposal Form, together with any other material information supplied by me/us shall form the basis of any contract of insurance affected thereon.
    • I/we undertake to inform underwriters of any material alteration to these facts occurring before the completion of the contract.
    • I/We understand that submitting this electronic declaration form will from the basis of this contract.
    Copy of policy wording available on request.