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| Pennsylvania Applicants | Delaware Applicants |
| Requirements and application files are listed below. Please fax or mail completed applications to the PMSLIC Marketing Department: | For requirements and applications, please contact Zutz Insurance Group: |
| Fax: 717 796-8080 |
Phone: 302 658-8000 |
| Mail: PO Box 2080 |
Mail: 300 Delaware
Avenue |
Application Requirements for Pennsylvania Physicians
- Physicians and Surgeons Application
- Claims Supplement and Business Associate Agreement
- A copy of the Declarations page from the physician's most recent policy if Prior Acts coverage is requested
Application Requirements for Pennsylvania Entities
- Professional Corporation and Partnership Application
- Claims Supplement and Business Associate Agreement
- A copy of the Declarations page from the entity's most recent policy if Prior Acts coverage is requested
- A copy of the signed and date stamped Articles of Incorporation
Download
Pennsylvania Applications:
| instructions | Pennsylvania Applications |
| To download the Pennsylvania application files, you must have Acrobat Reader installed on your computer. To install Acrobat Reader, click on the icon below to download it from Adobe's Web site.
electronic completion:
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I UNDERSTAND THAT THIS APPLICATION IS SUBJECT TO ACCEPTANCE BY PMSLIC AND DOES NOT BIND COVERAGE. Please note that the following applications are for Pennsylvania-based medical professionals and practices.
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If you have any questions, contact PMSLIC's Sales and Marketing Department.
| Always With You | |
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Applications Center |
| Coverage Options for Pennsylvania Physicians | |
| Premium Discounts | |
| Why Claims-Made | |
| Claim Philosophy | |
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| Applications Center |
| Certificate of Insurance |
| For Defense Counsel |
| Loss Prevention Discount Program |