Application for Nutraceuticals and Cosmetics

Instructions to the Applicant – please complete this application in ink and answer all questions completely.
Attach extra sheets as necessary should you run out of space provided. An incomplete or illegible application cannot
be processed. Completion of this application neither binds coverage nor guarantees that a policy will be issued.
Provide a fully completed application, signed and dated by the owner, partner, or officer not earlier than 45 days
before the proposed effective date of coverage.

If a question is not applicable, then state “N/A”.
The following information must be submitted with the completed application:

  • Copy of your labels, brochures and marketing
  • Copy of your current products liability insurance declarations page
  • Copy of your current financial statement including balance sheet and income statement
  • 5-year company loss runs, valued within the last 60 days