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Before you can apply you must
agree to disclaimer below:
Disclaimers and Eligibility
I understand that I am not covered by this insurance if I am any of the
following: physician, surgeon, dentist, nurse midwife, chiropractor,
podiatrist, osteopath, cytotechnologist, electroneurodiagnostic
technologist, perfusionist or psychiatrist. I understand that these
professional occupations are excluded from coverage. I understand that this
insurance will not apply to any partner, principal or owner of a
residential/overnight facility. This insurance described herein is subject
to the terms, conditions and exclusions of the insurance certificate. This
insurance is excess when other insurance applies to a loss.
This application is subject to the underwriter’s approval. Your completion
of this application and premium payment does not bind coverage or obligate
the insurance company to issue you insurance coverage. Coverage will become
effective following the receipt of your acceptable application and premium
payment. Your application cannot be processed unless it is completed in its
entirety. The application is subject to the company’s underwriting rules.
I declare the information contained in this application is true and that no
material facts have been suppressed or misstated. I understand that
incorrect information could void protection. Any person who knowingly and
with intent to defraud any insurance company or other person files an
application for insurance containing any false information, or conceals, for
the purpose of misleading, information concerning any fact material thereto,
commits a fraudulent insurance act.
Click
"Accept" button below to apply, or click "Do Not Accept"
to go back to products page with additional Professional Liability Insurance
options.
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