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All Med Pro
Quotes for Dental & Medical Insurance
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Home
Insurance
Dental
Life Sciences
Hospitals
Commercial
About AMP
Why All Med Pro?
Our Story
Our Team
Careers
Partners
Our Sustainable Vision
Client area
Claims
Online Payment
Refer a Friend
Education
Past webinars
Podcasts
Contact
Vicarious Liability Quote
Step
1
of
3
33%
Phone
This field is for validation purposes and should be left unchanged.
General Information
Your Name
*
Title
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
First
Last
Trading Status
Limited Company
Partnership
Sole Trader
Trading Name
Phone
*
Email
*
Practice Address
*
First Line of Address
Town
Postcode
Claims and Conduct
Please read the following questions carefully and answer all of them fully and truthfully.
1 - Have any complaints or claims been made, brought or threatened against the practice?
*
Yes
No
Please provide further details on the above including circumstances, dates and costs
2 - Are you aware of any acts, errors, omissions, incidents, events, circumstances or requests for notes which may give rise to a complaint or claim against you?
*
Yes
No
Please provide further details on the above including circumstances, dates and costs
*
3 - Are you aware of any complaints, claims, acts, errors, omissions, incidents events or circumstances which may lead to an investigation, suspension, the imposition of conditions or restrictions on your registration or license to practice or your removal from a professional register or the removal of your license by a relevant registration body?
*
Yes
No
You and Your Practice
What is the expected annual turnover for the practice over the forthcoming 12 months?
*
What date do you require the policy to incept/start?
DD slash MM slash YYYY
Do you require retrospective cover? If so please input the appropriate date
DD dot MM dot YYYY
Your Cover
The level of indemnity you will receive is £5,000,000
*
Confirm
Declaration
*
You declare and warrant that after enquiry all statements and particulars contained in this Proposal and addendum are true and that no information whatever has been withheld which might increase the risk of The Company or influence the acceptance of this Proposal and should the above particulars alter in any way you will advise The Company as soon as practicable.
You understand that failure to disclose any material facts which would be likely to influence the acceptance and assessment of this Proposal may result in The Company refusing to provide indemnity or voiding the Policy in every respect. You hereby agree and accept that this Declaration shall be the basis of the contract between both parties if entered into.
I agree to the above declaration
If you wish to supply additional information please provide below
Supporting Information
You may wish to supply supporting information such as your CPD log
Drop files here or
Select files
Max. file size: 10 MB.
Marketing Consent
*
By ticking yes, you consent to receive email updates and other marketing communications from All Med Pro. We respect your privacy and will never share your information with third parties without your explicit consent. You can unsubscribe at any time by clicking the link provided in our emails. For more information on how we use and protect your data, please refer to our Privacy Policy.
Yes, I would like to receive email updates and marketing communications from All Med Pro.
No, I would not like to receive email updates and marketing communications from All Med Pro.
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