NurseWise

Renewals

Fill out the form below to renew your indemnity insurance to ensure you’re always covered.

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Contact Information

Name*

Your Address

Address*

Your Details

Date of Birth*

Choose Your Coverage

Choose Your Coverage*
$ 0.00
Includes GST
Click here to see our rates table, with breakdown of fees and taxes

History

Are there any claims alleging a negligent act, error or mission or malpractice currently lodged against you?*
Are you aware of any circumstance which has already occurred which may give rise to a negligent act, error or omission or a malpractice claim being lodged against you?*
Have you been involved in any action which could have or did give rise to a legal dispute arising out of your employment?*
Have you ever been involved in professional discipline procedures?*
Have you ever been refused any insurance, or had a requirement for hasher terms and conditions imposed upon your application for insurance?*

Payment Information

Payment Method
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