pdf Proposal Form for Doctor's - Professional Indemnity Insurance Popular

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How  to   fill  the  insurance  proposal  form  for  personal  professional  indemnity (Private  doctor)

6              Write  whatever is your specialization  ie  Urologist / Physician / GI Endoscopist / Pathologist / Radiologist   but  also  add  “doing  interventional procedures / minor surgeries  or doing  consultation  only”

7

  1. Answer  always  yes  whether true  or  not  true
  2. Always  answer  as   No
  3. Add  names  of  current  employees along  with a  line  stating “ & other employees  who  are  hired on a  contractual or on daily basis  as  needed  who  keep  changing”
  4. Yes

8      Add  names  of  current  employees along  with a  line  stating “ & other employees  who  are  hired on contractual or on daily basis  as  needed  who  keep  changing”

9              a)

i)             Yes  I  am  called  to  various  clinics  and  hospitals  wherever  needed  all  over  the  country        

ii)            Yes  or  no  depending  on  actual  situation

                b)            Not  all  of  them

10           50

11           This  question  needs  to  be  answered  boldly if  any  case  is  ongoing. Do  not  hide  deliberately  any  such  information   (If  you  have  a  copy  of front  page  only  of  notice  or  judgment  attach  it  to  proposal  form  otherwise  just  write  Yes  and  let  insurers  demand  it  if  they  need  it)

12           Yes  Give  Policy  number , Company  through  which  insured, preferably  a  photocopy  of  policy  should  be  attached  and  specify  the  retroactive  date  mentioned  in  previous  policy  document  if  it  is  known            

13           a)            No

                b)            No

                c)            No

                d)            No

14           20 lacs  for  GP, 30  lacs  for  physician, 50 lacs for surgeon anesthetist  (OR  MORE)

15           Leave  blank  or  write  date  10  days  after  delivering  proposal  form / cheque

MLAG INDEMNITY
In Association with THE UNITED INDIA  INSURANCE CO . LTD
PROPOSALS FORM FOR DOCTORS AND MEDICAL PRACTITIONERS
PROFESSIONAL INDEMNITY INSURANCE