Post code TownCountyGDC Registration NoPolicy NumberDental Professional Indemnity Insurance and Liability Cover and Legal Expenses are arranged by Lockton Companies LLP
and underwritten by Omnyy LLP writing on behalf of Royal & Sun Alliance Insurance plc and ARAG plc
Section A - Your DetailsDisclosure - IMPORTANT NOTICE CONCERNING DISCLOSURE - It is your duty to disclose all material facts. A material fact is one that would influence our decision as to whether or not to accept your proposal for insurance, and, if we were to accept your proposal, the terms on which we would insure you and the premium we would charge you. If you are in any doubt as to whether a fact is material you should disclose it.If you hold a current Lockton Dental policy please enter your Policy Number and Post CodeA copy of the proposal should be retained by you for your own records.

Financial or Trade Sanctions - Omnyy LLP and ARAG plc are unable to provide insurance in circumstances where to do so would be in breach of any financial or trade sanctions imposed by the United Nations or any government, governmental or judicial body or regulatory agency.Please note that for the purposes of this Dental Professional Indemnity Insurance Public/Products Liability Policy and Legal Expenses policy, cover will be on a Claims Occurrence basis.NameIf so, please advise:Registration Number* Denotes a mandatory field