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Policy Holder Details




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Policy Details

Has a previous insurance

Has your previous medical malpractice insurance application declined, premium increased, special restrictions imposed, terminated or not renewed?
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Have any claims or suits for malpractice been made against the proposer or any of his partners, assitants, nurses or technicians during the past five Years?

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Is the proposer or any of his partners, assistants, nurses or technicians aware of any circumstances or incidents which may result in a claim?

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Are You Politically Exposed Person (PEP)?

PEP is a member of the royal family or has currently in a public position or tasks in the state such as a head of state - senior government official - minister - senior military - judge - the senior executive for an institution or a state owned corporation - person who’s assigned for an administrative position in an International organization– or a first degree relative of the mentioned above.

Summary and Payment

Product Summary

  • ProductProduct Name
  • ID NumberID Number
  • NameName
  • Policy Start Date12/12/2020
  • Profession12/12/2020
  • Policy Duration12/12/2020
  • Policy Expiry Date12/12/2020
  • Liability LimitText

  • Insurance Premium1000 SAR
  • Extended Reporting Period Fees1000 SAR
  • Policy Issuance Fees1000 SAR
  • Promotion Disc.1000 SAR
  • Value-added Tax (15%)1000 SAR
  • Total Insurance Premium1000 SAR
  • Total Amount1000 SAR

Payment Details

IBAN No

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Debit/Credit Card.

About Medical Malpractice insurrance
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