How to Apply

Getting coverage in place isn't difficult or complicated.

Please have the following information available to complete your application.

• Licensure Information – A copy of each active state license and certification you hold.
• Previous Insurance Information – A copy of your current Declarations Page (if you are currently insured).

Apply Online Today

It's easy to apply online. Get started today.

---

For Agents and Brokers

1. Click below to select the correct application:

   Applications for Connecticut, Florida and Nevada

   • PSIC RPG Professional Liability Application
   • PSIC RPG Professional Liability Entity Application
   • PSIC RPG Professional Liability New Graduate Application
   • PSIC RPG Locum Tenens Application
   • PSIC RPG Dental Anesthesia Supplement
   • PSIC RPG Mobile Dentistry Supplement
   • PSIC RPG Dental Claim Information Form
   • PSIC RPG Request for Dental Policy Limit Change
   • PSIC RPG Request to Add the Employee Endorsement

   Applications for Minnesota

   • PSIC Professional Liability Application
   • PSIC Professional Liability Entity Application
   • PSIC Professional Liability New Graduate Application
   • PSIC Locum Tenens Application
   • PSIC Dental Anesthesia Supplement
   • PSIC Mobile Dentistry Supplement
   • PSIC Request for Dental Policy Limit Change
   • PSIC Dental Claim Information Form

   Applications for North Dakota

   • PSIC Professional Liability Application
   • PSIC Professional Liability Entity Application
   • PSIC Professional Liability New Graduate Application
   • Locum Tenens Application
   • PSIC Dental Anesthesia Supplement
   • PSIC Mobile Dentistry Supplement
   • PSIC Request for Dental Policy Limit Change
   • PSIC Dental Claim Information Form

   Applications for All Other States

   • PSIC Professional Liability Application
   • PSIC Professional Liability Entity Application
   • PSIC Professional Liability New Graduate Application
   • PSIC Locum Tenens Application
   • PSIC Dental Anesthesia Supplement
   • PSIC Mobile Dentistry Supplement
   • PSIC Request for Dental Policy Limit Change
   • PSIC Dental Claim Information Form
2. Complete, print and sign the application.
3. Send it to PSIC Dental:
   • Please follow the submission instructions found on the PSIC Dental application.