Medical Malpractice
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Policy Details
Policy Type
*
Individual
Clinics
Proposal Details
Name Of Clinics
*
Name Of Clinics
Name Of Clinics
Proposer's Business Address
*
Proposer's Business Address
Proposer's Business Address
Proposer's Emirates
*
select emirates
Abu Dhabi
Ajman
Fujairah
Sharjah
Dubai
Ras Al Khaimah
Umm Al Quwain
select emirates
Office Tel No (971 XXXXXXXX)
Phone
Email ID
*
Email ID
Email ID
Mobile #
*
(971 XXXXXXXXX)
Phone
No Of Staff
*
No Of Staff
No Of Staff
Law / Jurisdiction - UAE
*
Law / Jurisdiction - UAE
United Arab Emirates
Law / Jurisdiction - UAE
Territorial Limit
*
Territorial Limit
United Arab Emirates
Territorial Limit
Proposer's Remarks
Proposer's Remarks
Proposer's Remarks
Policy Limit
Any one Claim(AED)
*
Any one Claim(AED)
AED 250,000
AED 500,000
AED 1,000,000
AED 2,000,000
AED 3,675,000
AED 5,000,000
Any one Claim(AED)
In the Aggregate(AED)
*
In the Aggregate(AED)
In the Aggregate(AED)
Policy Period
From
*
From
From
To
*
To
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?
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