It's easy to do!
Ready to apply? You can take care of it right now; simply follow the steps below. You'll want to have the following information handy as you complete your application:
- Licensure information – A copy of each active state license and certification you hold.
- Previous/current insurance information – A copy of your current Declarations Page (if you are currently insured).
- Payment information – Bank account or credit/debit card account information
- Professional Entity/Corporation Coverage information– If you plan to add your entity to your malpractice policy, a copy of a declarations page (proof of insurance) for each licensed professional within your professional entity, as well as all licensed officers and/or directors, will be required.
1. Click below to select AND PRINT the correct application OR FORM:
Malpractice Insurance Applications
- Other Forms
2. complete THE ENTIRE APPLICATION, READ THE FRAUD WARNING AND sign
If you have any questions while completing the application, please call an NCMIC client representative at 1-800-769-2000, ext. 8198.
3. Send it to NCMIC:
Scan and email: firstname.lastname@example.org
Mail: NCMIC Insurance Company
PO Box 9118, Des Moines, IA 50306