Fenton Green Insurance

Income Details

Total Annual Income

$

Do you employ staff (excluding yourself)?

Yes No

Please state the total number of staff including yourself

Are any of the above staff students?

Yes No

Select your Modalities from the list below

In respect of Total Annual Income, please provide a breakdown by State:

Total must be 100%:

NSW

ACT

QLD

VIC

TAS

SA

WA

NT

Overseas

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Are you a member of an association?

Yes No

Please select the practitioners primary association of which they belong to

Please Note: If you are obtaining health fund provider numbers through AMT, the minimum requirement for professional indemnity insurance is $2,000,000 and $10,000,000 for public liability

Do you authorise Fenton Green Pty Ltd, to provide your policy documents to the Association of Massage Therapists (AMT)?

Yes No

Please provide the Association name

Business Details

Employee Numbers

Modalities

Association