PharmaTax

1 General questions and details

2 Your insurance

3 Payment Information

Please note: 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.
NPA member no*
Is this your own business*
Title*
First name of Proposer:*
Surname of Proposer:*
Registered company name*
Company*
- Sole proprietorship
- Limited company
Postal Address line 1:*
Postal Address line 2:
Town/City*
Postcode*
Home/Evening Tel No.*
Email Address*
Fax No:
Name of directors/partner
Cover start date*
Quantity
Please enter a value between 1 and 1.
Pharmatax
Price: £ 98.55
Total
£ 0.00
Important Notes
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.

Declaration
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.
I agree*
- I agree

You are about to purchase a PharmaTax insurance from NPA Insurance Ltd.

The insurance for PharmaTax cover is provided by Brit Insurance Ltd, 55 Bishopsgate, London, EC2N 3AS, administered by ARAG plc and their registered offices are: 9 Whiteladies Road, Clifton, Bristol, BS1NN and is authorised and regulated by the Financial Services Authority and their FSA registered number is 452369.

Cancellation Rights
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 membership@npa.co.uk. 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.

Telephone number which a claim may be notified
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.
1. 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.
2. Under no circumstances should you instruct your own lawyer or accountant as we will not pay the costs incurred and it could invalidate your cover.
3. Please have your policy Schedule to hand when contacting the Claims handler.
4. You will receive a written acknowledgement within one working day of receiving the claim.
5. 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.
6. 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.