Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the application form and open it in the editor.
2. Begin with the General Information section. Fill in your first name, middle name, last name, and any maiden or other names. Provide your date of birth, Texas medical license information, and contact details including home and professional emails. Specify your preferred method of contact.
3. In the next part of the General Information section, list all Texas office locations where you practice or plan to practice. Include the address and the percentage of time spent at each location.
4. Indicate your preferred billing address. Select from home, primary office, or specify another address.
5. Proceed to the Professional Liability Coverage section. Document your previous insurance history for the past three years, including the insurance company, coverage dates, and limits of liability.
6. Select the requested coverage effective date, ensuring accuracy in the month, day, and year formats.
7. Specify the type and limits of liability for your Professional Liability Coverage. Choose between occurrence or claims-made coverage and select appropriate options provided.
8. Answer any questions regarding prior acts coverage; confirm if you are planning to purchase a reporting endorsement or prior acts coverage from TMLT.
9. Fill in the section on your medical practice history, including education, training, and any gaps in your work history.
10. Complete the underwriting and rating information by indicating your medical practice structure, operations, and details about your specialty and procedures.
11. Carefully respond to all additional information queries, including any investigations, treatments, or legal actions applicable to your practice.
12. Conclude the application by reading the Authorization and Warranty statement. Ensure you understand the implications of the information provided.
13. Sign and date the application to confirm accuracy and acceptance of terms. Review all entries for completeness before final submission.
14. Once finished, you can save changes, download or print the application, and share it as needed.

Complete your TX TMLT Individual Application for Professional Liability Coverage online today!