Individual Doctor Membership

Info
Calculate Your Insurance
Medical Expertise
Personal details

Full Name *

E-mail *

Phone *

Category *
Premium for Professional Indemnity Insurance by NIAC:
Amount of Professional Indemnity Coverage *
Coverage of Unqualified Staff (5% of Basic Premium) *
Coverage of Radioactive Treatments (Additional 5% on) *
Worldwide Jurisdiction (including/excluding US/Canada) *
Total Insurance Premium for 1 year
Choose tenure of membership *
Coupon Code
Discount
Total LegalMD Fees & Insurance Premium
GST @18%
Net Amount Payable

Qualification *

Specialization *

Medical Registration Number *

Medical Registration City*

Medical Registration Year *

Residential Address*

Residential Pincode*

Practice Centre Name*

Practice Location Address*

Gender*

Nationality*

Date of Birth*

Aadhaar Number *

Pan Number*

Date of Anniversary

Previous Indemnity Policy Start Date

Previous Indemnity Policy End Date

Previous Indemnity Policy Retro Date

Previous Indemnity Policy Number

Cover Amount

Previous Policy Insurance Provider