Step 1: General Information

Proposed Insured Name

Inception Date

Expiry Date

Situation Address

Suburb

Postcode

State

Occupation

Does this occupation accurately describe the proposed insured’s profession, work role or title? Yes No

It is important that the occupation accurately describes the proposed insured’s profession, work role. Do not proceed and contact:

FD Beck Insurance Brokers

1300 155 338

enquiry@fdbeck.com.au

Step 2: Product Information

Requires a choice of Occupation and Postcode for the Insured

What percentage of the proposed Insured’s turnover is from the sale of products:

Please select all the treatments provided by the proposed Insured, either by searching or ticking the boxes below:

ESSENTIALS

Acid/Chemical Peels (up to a maximum strength of 40%)
Acupuncture
Alkaline Hair Removal
Alpha Hydroxy Acids
Anal Bleaching
Aromatherapy
Biomesosculpture
Bleaching
Body Wrapping
Caci Facial
Calendula Eye Baths
Ceya
Cosmetic Injecting (performed by contractors that have their own insurance)
Counselling
Crystal Healing
ELOS Pitanga Hair Removal and Rejuvenation
Ear Piercing
Eyebrow Grafting/Extension
Eyebrow Shaping
Eyebrow Threading
Eyelash Extensions

Eyelash Lift
Eyelash Tinting
Facials
Hairdressers
High Frequency Facial
Hydrotherapy
Hyfrecator for Wart Removal
ION Detoxification Treatment
Kinesiology
Life Coaching
Light Heat Therapy (LED)
Lip and Facial Hair Bleaching
MM Slim
Make Up (including stage and movie)
Manicure
Massage
Microcurrent Treatment
Milia Extractions
Nail Extensions
Naturopath
Oxygen Therapy/Cold Atmosphere Plasma Treatment

Paraffin Wax Treatment
Pedicure
Reflexology
Reiki
Relabeling of Australian Sourced Products
Retail of Products
Sauna (including Infrared)
Semipermanent Mascara
Shellac Manicure
Shellac Pedicure
Spa Treatment
Spray Tan
Sugaring
Tesla Former
Tooth Jewels
Vibroslim
Waxing
Weight Loss Management
Whole Body Vibration Therapy

ESSENTIALS PLUS

Acid/Chemical Peels (up to a maximum strength of 60%)
Bipolar Fractional Radiofrequency Machine
Carboderm (Needleless Carboxy Therapy)
Carboxy CO2 Active Gel Mask
Cosmecanique
Cyroprobe Treatment (excluding diagnosis)
Depilatory Hair Removal
Dermaplaning
Dermatherapy
Diathermy
E2 Sublative Treatments

Electrical Epilations
Electrolysis
Electroporation Treatment
Electrotherapy
Epidermal Levelling
Galvanic Treatment
Hydrodermabrasion
Iontophoresis Treatments
Lamprobe Treatment
Lymphatic Drainage/Massage
MTS (Micro-Needle Therapy System) PEEL

Medilift
Microdermabrasion
Muscle Manipulation Therapy
Phototherapy
Plasma Skin Regeneration
Skin Remodelling System
Sonophoresis
Teeth Whitening

PREMIUM

Body Piercing
Brow Lamination
Carbon Facial (not Carbon Laser)
Collagen Induction Therapy
Cosmetic Tattoo/Micropigmentation
Cryolipolysis (inc Fat Freezing, CoolSculpting, HIFU)
Dermarolling
Electro Collagen Therapy
Fat Reduction Laser Therapy
Hyaluronic Pen
HydraFacial

Intense Pulse Light (Fitzpatrick Skin Types 1, 2, 3 and 4 Only)
Laser Treatments (Fitzpatrick Skin Types 1, 2, 3 and 4 Only)
Lipo Laser
Lipodissolve
Mesotherapy
Mesotix Skin Rejuvenation
Microblading
Microsclerotherapy
Non Laser Tattoo Removal (excluding Surgical Removal)
Para-Medical Cosmetic Tattooing
Radio Frequency Skin Treatments

Red Vein Treatment
Scalp Micropigmentation
Sclerotherapy
Semi-Permanent Micro Needling BB Cream
Skin Needling
Skin Tag Removal
Ultrasonic Cavitation
Vampire Facelift
VascuLyse Treatment

OTHER

Carbon Laser (CO2 Laser Resurfacing)
Carboxy Therapy
Cosmetic Injecting (when directly conducted by the insured)
Facial Thread Lifting

Fibroblast Plasma Therapy
Intense Pulse Light (Fitzpatrick Skin Types 5 and 6)
Intravenous Therapy
Laser Tattoo Removal

Laser Treatments (Fitzpatrick Skin Types 5 and 6)
Laser and Radio Frequency (Thermiva) Treatments – Vagina
Professional Training Course(s)

Please select all the treatments provided by the proposed Insured, either by searching or ticking the boxes below:

Cosmetic Injecting (when directly conducted by the insured)

Does the proposed Insured currently have a valid professional indemnity policy?

NoYes

Allied Health (combined)

Does the proposed Insured currently have a valid malpractice/professional indemnity policy?

NoYes

Property

Property Damage

Money

Theft

General Property

Glass?

NoYes

JOURNEY ACCIDENT (Please check box if you want to include this cover in your Quick Quote)

Journey Cover

Journey - Weekly Accident

Journey - Capital Benefits

PERSONAL ACCIDENT & SICKNESS (Please check box if you want to include this cover in your Quick Quote)

Personal Accident & Sickness

Enter the details of insured to be covered under this Personal, Accident & Sickness Policy

Insured First & Last Name

Insured Date of Birth

Enter the the amounts of Personal, Accident & Sickness Policy you require.

Weekly Accident

Weekly Sickness

Capital Benefits

Step 3: Business Information

Estimated Annual Revenue

Number of Employees including Directors

Provide a percentage split of revenue by state or territory:

VIC

NSW

ACT

TAS

QLD

Foreign/Overseas

Is the proposed Insured a Capital Gains Tax small business entity (within the meaning of section 152-10 (1AA) of the Income Tax Assessment Act 1997 of the Commonwealth) and a small business individual / partnership / company and/or trust, which is carrying on a business that has an aggregated turnover of less than $2 million?

Yes No N/A

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