Get Insurance And Membership Application Form - Miga

Filling out the Insurance And Membership Application Form - MIGA online is a straightforward process that allows users to apply for medical indemnity insurance, membership with the Medical Defence Association, and enrol in the Risk Management Program. This guide provides clear instructions to ensure that you can complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to obtain the form and access it in the online editor.
2. Begin with the 'Commencement Date' field. Enter the date you wish your insurance to commence, ensuring the format is correct.
3. Provide your full name in the designated fields: First Name, Middle Name (if applicable), and Last Name.
4. Fill in your date of birth using the specified format, ensuring accuracy as it is essential for your application.
5. Select your gender by marking the appropriate box.
6. Input your contact information, including your principal practice address and various phone numbers. Ensure all details are accurate.
7. List your medical qualifications including the degrees, diplomas, or college accreditations followed by your graduation year and the institution's name and country.
8. Complete the Medical Board Registration section. Input the year you were first registered to practice medicine in Australia and your registration number.
9. Answer the questions regarding prior practices, restrictions, or criminal offences truthfully, providing details in the additional information section if required.
10. Select the category of insurance you require, referring to the Categories of Insurance Guide for clarity.
11. If practicing in multiple categories, indicate the percentage of work in each category.
12. Declare if you currently undertake or have ever performed any cosmetic procedures, and specify details if applicable.
13. Indicate whether you require retroactive cover if applicable, and complete the relevant date and details.
14. Provide your previous insurance history, including details of any declined proposals or requests for terms that were not standard.
15. Complete the financial details regarding your estimated gross income and sessions per week if relevant.
16. Indicate your participation in the Risk Management Program and the Premium Support Scheme if applicable.
17. List any employees in your practice and their relevant details as required by the form.
18. Specify the state of practice and contextual information if you are practicing in multiple states.
19. Fill in any additional information in the relevant section.
20. Read and sign the declaration at the end of the form, confirming that all provided information is accurate.
21. After completing the form, save the changes, and choose to download, print, or share the completed application.

Take the first step in securing your medical indemnity insurance by filling out the Insurance And Membership Application Form - MIGA online today.