Professional Indemnity Doctors

Doctor Details
Name of the Doctor *
Medical Registration No. *
Year of Registration *
Name of Medical Association/Council *
Specialization *
Category of Specialization *
Branch of Medicine *
Is Visiting Physician *
Territory *
Jurisdiction *
AOA Amount *help
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AOY Amount *help
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AOA/AOY Ratio *help
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Address Details
Employee Details
Cover Details
Basic Cover Sum Insured *
Unqualified Employees Cover
Select your branch office  help
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OICL Office State *
City/Town *
Branch/Office *
Please select a role to continue
Whether any agent is involved for this proposal?
* If 'NO' is selected, the policy will be issued under code of Development Officer without an Agent.