OnlineApplication for Registered Massage Therapists Insurance

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Apply for New RMT Coverage Online * Choose one of the following 3 options:
Price: $199.80 Purchase NEW RMT Policy (Annual premium incl. $25 fee)
Price: $135.00 Purchase NEW GRADUATE Policy (Annual premium incl. $25 fee)
* By choosing this option, I certify that I have completed the requirements of registration with CMTO in the last 6 months.
Price: $105.30 Purchase NEW RMT Policy (Annual premium incl. $17.50 fee)
Price: $415.80 Purchase NEW RMT Policy plus Acupuncture (Annual premium incl. $25 fee)
* Designates mandatory fields. These MUST be filled in. (If you have no email address please enter "none" and you will NOT receive email notification of this transaction.)
Business name (if applicable)
First Name	*
Last Name	*
Street Address	*
City	*
Province	*
Postal Code	*
Phone Number with Area Code	*
Fax Number with Area Code
Email Address	*
Verify Email Address	*
* If you are a new graduate and do not know your number, please enter "unknown".
College Registration Number	*
Coverage will be in effect the day after the application is received and accepted in our office. If you wish a different start date please indicate here:
Example: Oct. 1 05
Do you practice any modalities other than Massage Therapy?
No Yes
Many RMT's find it convenient to have there professional Liability insurance renew automatically each year. If you would like to have your policy renewed automatically in the future, with payment on your credit card check yes. If you would like to receive a renewal notice by mail check no.
No Yes
If you check yes to have your policy automatically renewed please enter your credit card number and expiry date. BE SURE YOUR CREDIT CARD IS GOOD FOR AT LEAST ONE YEAR. (FAQ)
* Must be credit card number with no spaces (16 digits), then space and expiry (month year; 4 digits)
Example: 1234123412341234 0209
Do you sell any products?
No Yes
Do you have any knowledge or information of any negligent act, any error or omission, or breach of duty that might give rise to a claim against you, or any reason to anticipate that a claim might be brought against you?
No Yes
If Yes to any of the above, please provide details below:

I am an active member in good standing with the College of Massage Therapists of Ontario or I am a new graduate applying for registration with the college of Massage Therapists of Ontario. By submitting this application, you attest that the application has been completed accurately and honestly. No disciplinary action has been taken or is pending against you. You have never been the subject of any investigation, either civil or criminal, in connection with any sexual act, conduct, molestation, and/or assault. You understand that your insurance certificate will provide evidence that you have been added as an individual participant with respect to the coverage and limits of the Master Policy. You understand that the coverage provided by your insurance certificate is subject to all the terms, conditions and exclusions contained in the Master Policy. You further understand that the Insurance Company will rely on the information you have provided in the application. Failure to pay required premiums and/or false statements on this application or subsequent renewals shall void this application and render your insurance coverage null and void, and you may be subject to further legal action if making false statements. I Disagree I Agree
Note: This is just an order form; it does not confirm insurance. If you require immediate documentation please provide your fax number.Your policy must be renewed prior to the expiry date. If your expiry date has passed please contact the office at 1-877-RMT-CANADA (1-877-768-2262).

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