Pre-registration trainee or student pharmacist professional indemnity insurance

General questions and details

Thank you for your application

General questions and details

Important Information – Please read the Important Information below, Important Note and the fact sheet Information about our Insurance Services before completing this form.

1. Your cover will not start until we have accepted this application. We reserve the right to refuse acceptance of any application for insurance. No liability is undertaken by us in connection with this proposal until cover has been issued with our authority.

2. By completing this application, you consent to accept the Insurance Policy Terms & Conditions. A copy of the Policy Document is available on request. You also agree that you have read the policy summary and the leaflet about our insurance services.

Your insurance
You are about to apply for a Pre-Registration Trainee or Student Pharmacist Policy from NPA Insurance Ltd. The name of the insurer: NPA Insurance Ltd. Registered in England 64269. Mallinson House, 38-42 St Peter's Street, St Albans, Herts, AL1 3NP. The policy is underwritten by NPA Insurance Ltd and DAS Legal Expenses Insurance Company Ltd who are both authorised and regulated by the Financial Services Authority and are entered into their register www.fsa.gov.uk. NPA Insurance firm number 202069 DAS firm number 202106

Price to be paid (including IPT)
This policy is offered free of charge for the duration of the pre-registration year. If the policy holder graduates within this period then this insurance cover will cease and an alternative NPA Insurance product should be sought.

Cancellation Rights
If we accept your application, your policy documentation will be sent to you in the post. If after reading the policy you wish to cancel it, you may do so by writing or calling the number shown on the policy schedule within 14 days of receiving the policy documentation.

Telephone number or address to which a claim may be notified
To report an incident that may give rise to a professional indemnity or public liability claim on your policy, please contact our Customer Service Centre, NPA Insurance Ltd, Mallinson House, 38-42 St Peter’s Street, St Albans, Hertfordshire, AL1 3NP, or telephone 01727 795914.

To report an incident that may give rise to a legal expenses claim on your policy, please contact the Legal Claims Centre, DAS Legal Expenses Insurance Company Ltd, DAS House, Quay Side, Bristol, BS1 6NH, or telephone 0117 934 0408.

This information will be confirmed to you by email.

* Title

* First name of Proposer

* Surname of Proposer

* Postal Address line 1

Postal Address line 2

* Town/City

* Postcode

* Home/Evening Tel No.

Fax No.

* Mobile/Daytime Tel No.

* Email Address

* Date of Birth

* University

* Date you wish this insurance to commence

* Where did you hear about NPA Insurance Ltd?

* Are you a Pre-Registration Trainee or Student Pharmacist?

For the purposes of this proposal your occupation is described as follows:

'Pre-Registration Trainee or Student Pharmacist (full or part-time, employed or self-employed) engaged in community pharmacy and/or hospital work only'. All other activities including consultant pharmacy work are excluded.

Professional Indemnity & Legal Expenses cover is free of charge.

General questions

*1. Are you ever engaged in extended or ‘new’ role activities under the supervision of a pharmacist (including PACT analysis, formulary development prescribing analysis, clinic administration or non-dispensing services)?