Veracity Insurance Solutions
Veracity Insurance Solutions
  • Products
    • Product Liability Insurance
      • Beauty & Cosmetics
      • Vitamins & Supplements
      • E-Cigarette Insurance
      • Sporting Products MFG.
      • Consumer Products Insurance
      • Industrial Products Insurance
      • Product Recall Insurance
      • Discontinued Products
      • Medical Devices
      • 3d Printing Insurance
      • CBD & Hemp
      • Cannabis and Marijuana
      • Cyber Liability
    • General Liability
      • Contractors
      • Chimney, Hearth & Patio
      • Security Guard
      • Alarm & Security
      • Environmental & Pollution
      • Residential Homebuilders
    • Outdoor & Recreation
      • Climbing Wall
      • Ropes & Challenge Courses
      • Zip Line & Canopy Tours
      • Sports & Recreation
      • Fishing Outfitters
      • Kayak & Row Boat Tour/Rental
      • Guided Snowmobile Tour
      • Bicycle Tour & Rental
      • Guides & Guided Tours
      • Rock Climbing Guides
      • SUP Guides
      • River Rafting Guides
      • Hunting Guides
      • UTV Tour & Adventure
    • Property Insurance
      • Builder's Risk
      • Inland Marine
      • Vacant Property
      • Contractor's Equipment
      • Small Commercial Property
      • General Property
      • Vacant Land
    • Professional Liability
      • Technology
      • Architects
      • Engineers
      • Manufacturers E&O
      • Interior Design
      • Media
    • Additional Product Lines
      • Allied Health & Medical
      • Workers Compensation
      • Excess & Umbrella
      • Online Programs
      • Special Events
      • Research & Development
      • Pharmaceuticals
      • Directors & Officers
      • Drone Insurance
      • Foreign Liability
  • About
    • Veracity Gives Back
    • Blog
    • Career Opportunities
    • Know Your Broker
      • Cameron Allen
      • Chris Martin
      • Morgan Cole
    • Wholesale Broker
  • Contact
  • Quick Pay
  • Agent Resources
    • Hiscox Now
    • Insurance Applications
    • Product Pack
      • View Online
      • Download
    • Request For Loss Run
    • Certificate & AI Request
    • Become an Agent
    • CNA Small Business
    • Veracity Online Programs
    • Agent Licensing
    • Program Mgt & Development
      • Franchise Insurance
      • Association Insurance
    • Risk Purchase Group Mgt
    • USLI

866.395.1308

Facebook Blog LinkedIn Youtube
  1. Home
  2. Beauty Products Insurance Application

Beauty Products Insurance Application

Instructions: Answer all questions. If the answer is NONE, please state “NONE.” Attach copies of all labels including the ingredients with the application. Application must be signed and dated by an officer of the company
 

Applicant

Include all DBA's (doing business as). If Sole Proprietor, First and Last Name of the Owner and DBA's.

Business Details

At any time have you manufactured, sold, distributed, or imported any of the following products?

- Acetone Products

Please confirm the following are true:

- Acetone sales are below $1M

- Acetone products' end use are for cosmetic or beauty product purposes only

- Acetone products do not contain parabens or phthalates

Please confirm the following are true:

1. You maintain record of design changes and reasons justifying these changes.

2. Your designs are subject to independent external review, testing or certification.

3. Warranties are obtained from all suppliers.

4. Quality control records are kept so that you can identify at a later date what tests you applied to a given product at a given time.

5. Warning labels comply with federal statutory warning labeling requirements.

6. All product labeling complies with FDA guidelines.

7. You expressly disclaim or limit warranties for your products.

8. You provide specific training/instructions for the user in the proper use of your product.

9. You have a procedure to record data on product related complaints, accidents, or injuries.

10. Your procedure provides for examining and preserving any allegedly defective product, with the results of such examination recorded.

11. You maintain copies of old instruction or operation manuals and advertising material.

12. Your products have not been investigated for safety by any government agency.

You understand the following are excluded from the policy and there will be no coverage for claims arising out of these products:

Consumable alcoholic products, any product containing cannabidiol (CBD), any product developed with or containing human stem cells or human stem cell media, drugs, medicines, or products requiring a prescription, Formaldehyde or products containing Formaldehyde, furniture, hand sanitizer not in compliance with "The United States Food & Drug Administration's Temporary Policy for Preparation of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency (COVID-19) Guidance for Industry",invasive body inks or permanent cosmetics, invasive products intended to remain within the body, inversion tables, nail curing lights, Nutraceuticals, Pharmaceuticals, plugin electrical products, suppositories, tanning beds or equipment, toys (except when sold in conjunction with an eligible beauty product),

Coverages

Cyber Coverage Options (Data Breach/Privacy Insurance)

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects that person to criminal and civil penalties (In Oregon, the aforementioned actions may constitute a fraudulent insurance act which may be a crime and may subject the person to penalties). (In New York, the civil penalty is not to exceed five thousand dollars ($5,000) and the stated value of the claim for each such violation). (Not applicable in AL, AR, AZ, CO, DC, FL, KS, LA, ME, MD, MN, NM, OK, PR, RI, TN, VA, VT, WA and WV).

Applicable in AL, AR, AZ, DC, LA, MD, NM, RI and WV: Any person who knowingly (or willfully in MD) presents a false or fraudulent claim for payment of a loss or benefit or who knowingly (or willfully in MD) presents false information in an application for insurance is guilty of a crime and may be subject to fines or confinement in prison.

Applicable in Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the department of regulatory agencies.

Applicable in Florida and Oklahoma: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony (In FL, a person is guilty of a felony of the third degree).

Applicable in Kansas: Any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or belief that it will be presented to or by an insurer, purported insurer, broker or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act.

Applicable in Maine, Tennessee, Virginia and Washington: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.

Applicable in Puerto Rico: Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall incur a felony and, upon conviction, shall be sanctioned for each violation by a fine of not less than five thousand dollars ($5,000) and not more than ten thousand dollars ($10,000), or a fixed term of imprisonment for three (3) years, or both penalties. Should aggravating circumstances be present, the penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are present, it may be reduced to a minimum of two (2) years.

THE UNDERSIGNED IS AN AUTHORIZED REPRESENTATIVE OF THE APPLICANT AND REPRESENTS THAT REASONABLE INQUIRY HAS BEEN MADE TO OBTAIN THE ANSWERS TO QUESTIONS ON THIS APPLICATION. HE/SHE REPRESENTS THAT THE ANSWERS ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF HIS/HER KNOWLEDGE.

 
Officer, partner, owner, etc.


Terms & Conditions

Insurance Fraud Warning

Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime in certain jurisdictions, and subjects the person to criminal and civil penalties.

State Specific Fraud Warning Statements

The fraud warnings listed below are applicable in the following states: AL, AK, AZ, AR, CA, CO, DE, DC, FL, HI, ID, IN, KY, LA, ME, MD, MA, MN,NE, NH, NJ, NM, NY, OH, OK, OR, PA, TN, TX, VT, VA, WA, or WV. If you are located in one of these states, please take time to review the appropriate warning prior to submitting your claim.

Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution, fines, or confinement in prison, or any combination thereof.

Alaska: Any person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim containing false, incomplete, or misleading information may be prosecuted under state law.

Arizona: For your protection, Arizona law requires the following statement to appear on this form: Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.

Arkansas: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

California: For your protection, California law requires the following to appear on this form: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

Delaware: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.

District of Columbia: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete or misleading information is guilty of a felony.

Florida: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

Hawaii: For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment, or both.

Idaho: Any person who knowingly, and with intent to defraud or deceive any insurance company files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony.

Indiana: A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete, or misleading information commits a felony.

Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.

Louisiana: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Maine: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines, or a denial of insurance benefits.

Massachusetts: Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, may be committing a fraudulent insurance act, which may be a crime and may subject the person to criminal and civil penalties.

Minnesota: A person who files a claim with intent to defraud, or helps commit a fraud against an insurer, is guilty of a crime.

Nebraska: Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, may be committing a fraudulent insurance act, which may be a crime and may subject the person to criminal and civil penalties.

New Hampshire: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in RSA 638:20.

New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.

New Mexico: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties.

New York: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Ohio: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

>Oklahoma: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

Oregon: Any person who knowingly and with intent to defraud or solicit another to defraud an insurer: (1) by submitting an application, or (2) by filing a claim containing a false statement as to any material fact thereto, may be committing a fraudulent insurance act, which may be a crime and may subject the person to criminal and civil penalties.

Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent act, which is a crime and subjects such person to criminal and civil penalties.

Tennessee: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.

Texas: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Virginia: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.

Washington: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines, or denial of insurance benefits.

West Virginia: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

*APPLIES TO GEORGIA, VIRGINIA APPLICANTS ONLY: The Insured represents that the information furnished in this application is complete, true and correct. It is further agreed that if the above described declarations and statements are not true, accurate and complete, and are deemed material to the issuance of this Policy, any claim arising from any matter not truthfully, accurately or completely disclosed, or disclosed at all, shall be excluded from coverage.

© 2013 veracityinsurance.com | All rights reserved.

All policies have conditions, limitations and exclusions, please read the policy for exact verbiage. Claim scenario circumstances vary in nature and similar claims do not guarantee coverage.

  • info@veracityins.com
  • Applications
  • Privacy
  • Terms
  • Contact
  • Careers
  • Transparency In Coverage