Surgery Quotation – PDI - PDI - Professional Dental Indemnity

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Practice Details

Policy Start Date

DD slash MM slash YYYY

What date would you like your cover to start?

What Type Of Practice?*

If you selected 'Other' please specify

What Is Your Legal Trading Status?

Insured Name*

Business name (if trading as company) or full name (if applying as individual)

Is the trading name different to the above?

Trading Name*

Main Contact Name

First Name Surname

Policyholder Date of Birth*

DD slash MM slash YYYY

Practice Address*

Address Line 1 Town Postcode

Email*

Phone*

Business Details

What year did you purchase the practice?

DD slash MM slash YYYY

Do you have three years or more practice management experience?

How Many Surgeries Does The Practice Have?

Is The Practice Under a Partnership?*

Yes

Partners Name*

First Last

Partners Date of Birth*

MM slash DD slash YYYY

Second Partners Name

First Last

Second Partners Date of Birth

MM slash DD slash YYYY

What Is The Expected Turnover For The Next 12 Months?

How Many Employees Does The Practice Have?

Has your business been involved in any losses, claims or incidents that may result in a claim within the last 5 years?

Yes

Claims Information*

Date

Type of claim

Claim cost

Premise Details

What type of location is this premises in?*

Is the construction of superior build?

Superior build means a purpose built medical/dental practice

Is this a listed building?*

Does the practice have a flat roof?

Yes

Please advise the % of flat roof

Please enter a number from 0 to 100.

What type of construction is the flat roof?

Is the premises protected by an intruder alarm?*

Yes

Does the alarm contract include the following:

Does the alarm have a maintenance contract in force?

Does the alarm have a police response?

Who will be contacted first should the alarm be activated?

Does the premises have a basement?

Yes

Your Insurance Cover

Do You Require Buildings Insurance?*

Yes

Buildings sum insured*

This is the full cost of rebuilding the premises, not the market value.

Are there any residential dwellings at the property?*

Yes

Do You Require Tenanats Improvements Cover?*

Yes

Tenants improvements insurance covers you if you rent or lease a property and have refurbished or improved the property at your own expenditure because your modifications or additions will not be covered under the landlord's buildings insurance.

Tenants Improvement Sum Insured

Contents Sum Insured*

Unspecified contents are item that are not covered under specified contents.

Do you require cover for any specified contents items?

Yes

Specified contents insurance covers high risk items specified by yourself. Such items might include artwork, electronic equipment and precious metals.

Specific items list

Type of Item

Sum Insured

Do you require computers insurance?*

Yes

Computers sum insured

Do you require cover for stock?*

Yes

Stock sum insured*

Assumptions

The following assumptions have been made and will form the basis of the quote provided:*

The business is self contained with its own means of access

The property is not in an area with a history of flooding

The property is of standard construction [built of brick, stone or concrete, roofed with slate, tiles or concrete].

No insured or adjacent property suffers from or shows any visible signs of damage from subsidence, landslip or ground heave

The proposer is the sole occupant

All properties are heated by radiators (hot water) only

The property has no other commercial and/or residential units at the property

No proposer/director/partner of the Trade or Business or its Subsidiary Companies have ever, either personally or in any business capacity*

Had any convictions or criminal offences which are not spent under the Rehabilitation of Offenders Act or has any prosecutions pending

Been declared bankrupt or insolvent or been the subject of bankruptcy proceedings or insolvency proceedings

Had a proposal refused or declined

Had an insurance cancelled

Had a renewal refused

Had special terms imposed

Who is your existing insurer?

What is your current premium?

All Med Pro offer a variety of addtitional insurance solutions. If you wish to be provided with additional information on the any of our products please select below:

Indemnity Insurance

Practice Overheads or Locum Insurance

Cyber Liability Insurance

Pressure Vessels Inspection

Directors and Officers Insurance

Home Insurance

High Value Motor Insurance

But to Let Insurance

Marketing Consent*

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.

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.