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PharmaTax application form
General questions and details
Please note: You are about to purchase PharmaTax Insurance for £100.80 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.
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 Keyfacts and leaflet about our insurance services.
Fields marked with an asterisk (*) are required.
Data Protection Notice
It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read our Privacy Statement, which you can find at
NPA member no
Is this your own business
First name of Proposer:
Surname of Proposer:
Registered company name
Postal Address line 1:
Postal Address line 2:
Home/Evening Tel No.
Name of all directors/partners
Cover start date
Date Format: DD slash MM slash YYYY
Please enter a number from
Before you complete the following declaration, please make sure that you have answered all the questions relating to the cover and not deliberately ignored information. It is essential that you disclose accurately all facts which influence acceptance of this application or terms to be applied. If you are not sure whether to include certain information, please do so anyway. If you do not tell us something relevant, your insurance may not be valid.
I have read this proposal form and checked the answers given. As far as I know, the information on this form is accurate, true and complete. This proposal and declaration will be the basis of the Policy.
You are about to purchase PharmaTax insurance from NPA Insurance Ltd.
The insurance for PharmaTax cover is provided by Brit Syndicate 2987 at Lloyd’s, The Leadenhall Building, 122 Leadenhall Street, London, EC3V 4AB and administered by ARAG plc whose registered offices are 9 Whiteladies Road, Clifton, Bristol, BS8 1NN. ARAG plc is authorised and regulated by the Financial Conduct Authority, firm registration number 452369.
We reserve the right to cancel the policy if you have made untrue statements, acted fraudulently or failed to disclose any material fact in connection with the issue of the policy, its continuance or any claim. By material fact we mean any information which would have influenced:
Our assessment and acceptance of your application to take out this policy
Our decision to continue the policy
Our decision to pay a claim
You may cancel the policy at any time by giving at least 21 days’ written notice to the National Pharmacy Association, Membership Department, Mallinson House, 38 – 42 St Peters Street, St Albans, Herts. Tel.: 01727 795914 or email firstname.lastname@example.org. We will refund part of the premium for the unexpired period unless you have notified a claim which has been or is subsequently accepted under this Policy in which case no return of premium shall be allowed. We may cancel the policy at any time by giving at least 21 days’ written notice to you. We will refund part of the premium for the unexpired period.
We aim to provide a high level of service at all times and to handle your claim quickly and fairly and to settle claims within the shortest possible time.
If you need to make a claim, you should notify the insurer as soon as possible. You can report your claim between 9.00 a.m. and 5.00 p.m. Monday to Friday by telephoning 0117 917 1698 and you will be sent a claim form. Alternatively you can find further details at www.arag.co.uk/newclaims.
Under no circumstances should you instruct your own solicitor or accountant as the insurer will not pay any costs incurred without our agreement.
Your completed claim form and supporting documentation can be submitted to ARAG by email, post or fax. Further details are set out in the claim form itself. We will send you a written acknowledgment by the end of the next working day after the claim is received.
Within 5 working days of receiving all the information needed to assess the availability of cover under the policy you will be written to either
a) appointing a suitably qualified representative who will promptly progress the claim for you, or
b) if the claim is not covered, explaining in full why and whether we can assist in another way.
Please refer to the Policy Wording for full terms and conditions.
Please proceed to our online payment systems to complete your application. To ensure your security we use a secure credit card authorisation system provided by HSBC.
Click the 'Pay online' button below to continue.
[Archived – 29.4.19 NJ] Applications
Locum pharmacist application form
Technician application form
Hospital pharmacist application form
PharmaTax application form
Dispensary assistant application form
Student Membership application form