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Professional Indemnity For Dental Nurses

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Renewal Details      
Commecement Date   Renewal Premium if applicable  
Customer Details      
Contact Name Name Of Practice
Telephone Number   Email  
Home Building Name/Number   Post Code
Surgery or Practice Address    
       
Applicants Name    
Smoker   Height  
Weight   Sex  
Occupation   Date Of Birth
       

OPTIONS AVAILABLE:

 

Option 1:                 4 week excess period / 48 week benefit period  

Option 2:                26 week excess period / 26 week benefit period  

Option 3 :               13 week excess period / 39 week benefit period  

Option 4 :               4 week excess period / 22 week benefit period  

Option 5 :               8 week excess period / 44 week benefit period

Option 6:                6 week excess period / 46 week benefit period    

Option 7:                2 week excess period / 50 week benefit period    

 

Example: Clare Fox requires a weekly benefit of £950. This is required to pay for the practice overheads. However, her colleagues can cover her for the first 4 weeks, so option 1 is chosen. Benefits are payable for up to 48 weeks

 

Please ensure that the level of benefit you request does not exceed the total of your normal gross weekly earnings.

When providing locum insurance for practice staff e.g. receptionists, assistants etc., the weekly benefit requested should not exceed 50% of the employee’s normal gross weekly earnings form the practice.

Cover is provided for practice employees on the assumption that each individual is employed to work at least 20 hours per week and that they are not gainfully employed elsewhere.

How much benefit do you require (in units of £25) Which option do you require
Do you engage in sports If Yes provide details  
Do you ever go skiing      
Have you sustained injuries, illness or conditions during the past 5 years (other than normal childhood ailments where no after effects remain that:
Incapacitated you for longer than 2 weeks?    Were of a recurring nature?
If Yes, please provide details of nature, dates and duration of disability   Have you received any medical, surgical or psychiatric advice or treatment within the past 12 months?

If Yes, please provide details of the Nature, dates and Medication received or continuing