BHTA Program

BHTA Program

CFC Underwriting Limited is Authorised and Regulated by the Financial Conduct Authority
The purpose of this application form is for us to find out more about you. You must provide us with all information which may be material to the cover you wish to purchase and which may influence our decision whether to insure you, what cover we offer you or the premium we charge you.

How to complete this form

The individual who completes this application form should be a senior member of staff at the company and should ensure that they have checked with other senior managers and colleagues responsible for arranging the insurance that the questions are answered accurately and as completely as possible. Once completed, please return this form to your insurance broker.

Submitting this application form does not constitute binding of coverage or the renewal of coverage.
Which organization are you a member of?*

HSCGIBN
Membership ID*
Your HSCG or IBN member ID
Member Name*
Member Email Address*
Section 1: Company Details

Please state the name and address of the principal company for whom this insurance is required. Cover is also provided for the subsidiaries of the principal company, but only if you include the data from all of these subsidiaries in your answers to all of the questions in this form.
1.1 Company name*
Primary address*
Address, County, Postcode, Country
Primary address (Line 2)
Address, County, Postcode, Country
Online storefront website address
https://www....
1.2 Date the business was established*

MonthDayYear
DD/MM/YYYY
1.3 Date of company financial year end*

MonthDayYear
DD/MM/YYYY

1.4 Please state your gross revenue in respect of the following years: *

	Last completed 12 months	Estimate for the next 12 months
Domestic Revenue
USA Revenue
Other Territory Revenue
Total Gross Revenue
Profit(Loss)

Section 2: Product Information

Please only complete this section if you have any products sales

2.1 Please state whether your products

	Yes	No
a) meet all applicable product safety standards in the territories where they are sold: Yes
b) are labelled with all applicable product safety warnings
c) are supplied with clear instructions for their use:
d) have sufficient product quality controls in place:

If “no”, to any of the above please refer
2.2 Please state whether you provide any infant or child products*

YesNo
If "yes", please provide full details
2.3 Please state whether your products contain any pharmaceuticals or drugs*

YesNo
2.4 Please state whether your products contain any sunscreen*

YesNo
2.5 Please state whether your products

a)must be manipulated by hand or created entirely by hand rather than a machine;

b)include cosmetics intended to be applied to the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance without affecting the body's structure or functions;

c)include cosmetic products which may be considered decorative cosmetics or care cosmetics, depending upon application and purpose;

d)include skin care products used to improve the appearance and health of skin, formulated for different types of skin and associated characteristics (i.e. cleansers, creams, essential oils, hair care products, lipstick or lip gloss, lotions and moisturizers, perfume and body fragrances, skincare bases, oils and materials, serums, skin care products – adult, toiletries, toners, tools and accessories – bags, brushes, mirrors, grooming supplies); or

e)include topical products for animals (i.e. shampoos and ointments
2.5 Please state whether your products (description above)*

YesNo
If "no", please provide full details
Section 3: Insurance Requirements
3.1 Please state whether commercial property cover is required*

YesNo
If "yes", please confirm which limit options you would like quotes for Aggregate limit of liability

$10,000$25,000$50,000
3.2 Please state your cope information, including any fire and theft protections
3.3 Please state whether commercial general liability cover is required:*

YesNo
If "yes", please confirm which limit options you would like quotes for Aggregate limit of liability*

$1,000,000$2,000,000$5,000,000
Section 4: Claims Experience
4.1 Please state whether you are aware of any incident:
a) Which may result in a claim under any of the insurance for which you are applying to purchase in this application form*

YesNo
b) Which resulted in legal action being made against any of the companies to be insured within the last 5 year

YesNo
c) Which resulted in your account for any online market place being suspended*

YesNo
If you have answered “yes” to any of the above then please describe the incident, including the monetary amount of the potential claim or the monetary amount of any claim paid or reserved for payment by you or by an insurer. Please include all relevant dates, including a description of the status of any current claim which has been made but has not been settled or otherwise resolved.
Important Notice
By submitting this form you agree that the information provided is both accurate and complete and that you have made all reasonable attempts to ensure this is the case by asking the appropriate people within your business. CFC Underwriting will use this information solely for the purposes of providing insurance services and may share your data with third parties in order to do this. We may also use anonymised elements of your data for the analysis of industry trends and to provide benchmarking data. For full details on our privacy policy please visit https://www.cfc.com
Should be Empty:

Section 1: Company Details

Section 2: Product Information

Section 3: Insurance Requirements

Section 4: Claims Experience

Important Notice