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Policy Details
Policy Type *
Proposal Details
Name Of Clinics *
Proposer's Business Address *
Proposer's Emirates *
Office Tel No (971 XXXXXXXX)
Phone
Email ID *
Mobile # * (971 XXXXXXXXX)
Phone
No Of Staff *
Law / Jurisdiction - UAE *
Territorial Limit *
Proposer's Remarks
Policy Limit
Any one Claim(AED) *
In the Aggregate(AED) *
Policy Period
From *
To *

Total Number of Days:

365
Additional Details
Is the proposer involved in any cosmetic/aesthetic procedures?
Has a previous application been declined?
Has a previous insurer required increased premium or special restrictions?
Has a previous insurance been terminated/not been renewed by insurer?
Have any Claims or suits for malpractice been made against the proposer or any of the partners,assistants,nurses or technicians during the past five years?
Wp