Applications Center

Note: PMSLIC writes professional liability insurance in Pennsylvania and Delaware only.

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
Mechanicsburg, PA 17055-0787

Mail:

300 Delaware Avenue
Suite 1600
Wilmington, DE 19899

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.
 

conventional completion:
  • print out the application(s)
  • complete by hand

electronic completion:

  • download the electronic application(s) to your computer's hard drive
  • answer all questions electronically by checking the appropriate boxes and filling in the "fields" or blanks
  • save your changes
  • print and sign the application
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.

 

 

If you have any questions, contact PMSLIC's Sales and Marketing Department.

Contact Information

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For More Information
Applications Center
Certificate of Insurance
For Defense Counsel
Loss Prevention Discount Program