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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your Applicant Name, Email, and Phone number in the designated fields. Ensure accuracy as this information is crucial for communication.
  3. Fill in your AIPB # if applicable, as this may qualify you for a discount on your premium.
  4. Review the Estimated Premium Ranges based on your revenue. Select the appropriate limit of liability that suits your business needs.
  5. Complete the Coverage Information section by checking the limits of liability you wish to be quoted and providing any necessary details regarding prior acts and effective dates.
  6. Provide detailed information about your Areas of Practice by percentages, ensuring they total 100%. This helps tailor coverage to your specific services.
  7. Answer all questions regarding claims history and risk management practices thoroughly, as these will impact your eligibility for coverage.
  8. Once completed, review all entries for accuracy before submitting the application via fax or email as indicated at the end of the form.

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