APPLICATION FOR DIETARY SUPPLEMENTS

Instructions to the Applicant:

  • For any questions answered in “YES”, please provide an explanation on the page titled “EXPLANATIONS”
  • Provide a fully completed application, signed and dated by the owner, partner, or officer not earlier than 90 days before the proposed effective date of coverage.
  • Completion of this application neither binds coverage nor guarantees that a policy will be issued.
  • Copy of your current products liability insurance declarations page
  • 5‐year company loss runs, valued within the last 60 days