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Dentists Professional Liability Application

Dentists Professional Liability Application AMERICAN CASUALTY COMPANY OF READING, PA. 333 S. Wabash, Chicago, IL 60604. NOTICE: THERE MAY BE BOTH OCCURRENCE COVERAGES AND CLAIMS MADE COVERAGES IN THIS POLICY. CLAIMS MADE COVERAGE IS LIMITED. TO Liability FOR CLAIMS FIRST MADE AGAINST AN INSURED AND REPORTED IN WRITING TO US DURING THE POLICY PERIOD OR ANY EXTENDED. REPORTING PERIOD, IF APPLICABLE. PLEASE READ THE POLICY CAREFULLY AND DISCUSS THE COVERAGE THEREUNDER WITH YOUR INSURANCE. AGENT OR BROKER. A. GENERAL INFORMATION. Please type or print. EVERY ITEM MUST BE COMPLETED.

Consent Waiver (May not be available in all states): Do you wish to waive the provision in the policy requiring us to obtain your consent in order to settle a claim ...

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