Facial Aesthetics Form

Step 1 of 6

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This field is for validation purposes and should be left unchanged.

Please select cover type:(Required)

A retro date (retroactive date) is the date from which we need to cover your activities from. This is typically where your previous Indemnity has been provided to you on a Claims Made basis as those types of policies do not offer retrospective cover in terms of the activities undertaken when that policy was in force. For example, if you have been insured on a Claims Made policy since 1st August 2018, then the Retroactive Date on your policy going forward needs to be 01/08/2018. This ensures that cover is provided for claims that arise from your activities undertaken after this date i.e. we are ensuring you have continuous cover. If you are switching to All Med Pro from a Claims Occurrence policy, such as the ones offered by the defence organisations, then you do not need to have a backdated retroactive date as their policy will continue to indemnify you for your historic activities.

Cover

Limit of Indemnity - £2,000,000 Basis of Cover – Claims Occurrence

Excess

£1,500 each and every claim and each and every claimant including legal costs is applicable in respect of Aesthetic Procedures unless specified otherwise.

How would you prefer to pay?(Required)

Pay in full

Pay in instalments

£585.00 or £54.94 per month

£697.00 or £65.46 per month

£585.00 / Credit Charge £74.30 (12.70%) / Total Payable £659.30 / 12 x £54.94

£697.00 / Credit Charge £88.52 (12.70%) / Total Payable £785.52 / 12 x £65.46

The above premium includes insurance premium tax at 12% and our Professional Service Fee of £25.00.

Pay in full

When would you like your cover to start?(Required)

Please note that you can choose for cover to commence on any date within 30 days of completing this proposal. The commencement date cannot be in the past or more than 30 days in the future. Please note that cover will only commence once you have received confirmation from All Med Pro.

Retro-active date required(Required)

Bank details for Direct Debit

Date of birth(Required)

Bank Account Name(Required)

Account Sort Code(Required)

Account Number(Required)

Please note we will require you to sign a credit agreement and delay in returning this to us could result in catch up payments

Statement of fact

Total: £54.94 per month

Total: £65.46 per month

The below premium includes insurance premium tax at 12% and our Professional Service Fee of £25.00.

£585.00 / Credit Charge £74.30 (12.70%) / Total Payable £659.30 / 12 x £54.94

£697.00 / Credit Charge £88.52 (12.70%) / Total Payable £785.52 / 12 x £65.46