Medical Indemnity

Step 1 of 6

Name(Required)

First Last

Date of Birth(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 Postcode Country

What date do you require cover?

Country of qualification

Year of qualification

Post Graduation qualifications/training

Medical school of qualification

Employment details(Required)

What best describes your employment status?

Practice owner

Associate

Employed

Performer

Self-employed

Not currently employed

Contractor

Provider

How many hours per week do you work?

What % of your work is NHS?(Required)

What was your income or the turnover of the business for the previous year?

Gross income (before expenses) if self employed. Gross income (before tax and national insurance) if employed.

What would you anticipate your income or the business turnover to be for the upcoming 12 months?

Gross income (before expenses) if self employed. Gross income (before tax and national insurance) if employed.

What % of your work is Private?(Required)

What was your income or the turnover of the business for the previous year?

Gross income (before expenses) if self employed. Gross income (before tax and national insurance) if employed.

What would you anticipate your income or the business turnover to be for the upcoming 12 months?

Gross income (before expenses) if self employed. Gross income (before tax and national insurance) if employed.

What limit of indemnity do you require?(Required)

If you require retroactive cover please input the relevant date

A new era of medical indemnity.