Your details
Insurance Cover
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Acceptance Criteria
  • I agree to maintain client’s records and retain them for at least 7 years. If I have not done this in the past or am just starting in business, I agree to do this now.
  • I have never had any claims made against me.
  • I have not been subject to nor have any pending disciplinary hearings against me.
  • I am not aware of any incidents that have occurred which may have given rise or may give rise in the future to a claim under the policy.
  • I have never had suits for negligence, error or omission made against me.
  • Under current or any previous trading titles, I have never been convicted of any criminal offence, other than motoring, or have any prosecution pending.
  • I have never had any insurer cancel, decline, refuse to renew or only accept on special terms, my liability insurance.
  • I have read and agree to the Insurance Product Information Document. Click here to read the Insurance Product Information Document.
  • I have read and agree to the Terms of Business of BMIB. Click here to view our Terms of Business.
  • I have read and agree to the Data Protection of BMIB. Click here to view our Data Protection.
  • I hereby declare and warrant that all the statements and particulars in this application are in all respects complete and true, that they are material, and that I have not suppressed or misstated any material facts and I agree that this proposal form shall be the basis of the contract with the underwriters and deemed to be part of the insurance coverage issued to me.

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Insurance Cover
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Please fill in the form below, then click "Next". The fields marked * must be completed, other fields may be left blank.

Title* e.g. Mr/Mrs/Ms
Your First name*
Your Last name*
Trading name (leave blank if none)
Limited company
Postal address line 1*
Postal address line 2*
Postal address line 3
Postal address line 4
Eircode*
Country
Email address*
Telephone number
Mobile number*
Previous insurance*
Association*
Inception date Date when you would like insurance cover to start

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Your details
Insurance Cover
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Please tick what you require cover for.

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Your details
Insurance Cover
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Data Protection Here at BMIB Ltd we take your data protection seriously and will only use your data as set out in our privacy statement. However, from time to time we may wish to contact you in relation to the services we provide.

Declarations

  • I am not a student but fully qualified.
  • I understand that I hold an appropriate qualification for the cover I have applied for.
  • Please note that in the event of a claim proof of qualification and/or any such relevant industry experience may be requested.
  • I am fully qualified to perform the insured activities.
  • I maintain registration with the NMBI.
  • I am working as a General Practice Nurse.
  • If in the course of your work you carry out any of the following or you wish to be covered to carry out any of the duties outlined below, then this on-line application is not suitable for you – see note 1 below
    • Diagnosis and/or prescribing
    • Work in an out of hours and/or walk in clinic setting
    • Local Analgesic Infiltration
    • Mole mapping
    • Pre-Natal, Pregnancy, Maternity, Obstetrics care and/or scans (excluding preconception advice) * See Note 2 Below
    • Any Advanced Practice Nursing activities

    Note 1: If any of the Exclusions above relate to you and the care you provide, whilst this online application may not be suitable to meet with your requirements, please email us at info@bmib.ie providing us with your details and we will make contact with you to gather more information and work towards securing a bespoke quotation for you.

    Note 2: This policy does not provide cover in respect of a General Practice Nurse (GPN) providing prenatal care however it does not exclude cover in respect of a GPN providing their normal duties/care to a woman whilst she is pregnant.