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
Click here for details
AOY Amount *help
Click here for details
AOA/AOY Ratio *help
Click here for details
Address Details
Employee Details
Facilities
Cover Details
Basic Cover Sum Insured *
Unqualified Employees Cover
Select your branch office  help
Click here for details
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.
Please select a role to continue
Continue Direct
* If 'Yes' is selected, the policy will be issued under code of BDE without an Agent and Broker.
If LoV is NULL, kindly check BDE maping in INLIAS