Professional Liability Insurance

Application Note

Your application form and all other documentation pertaining to your policy will be available for viewing and printing at any time in your customer portal.

Personal Information

First Name
Last Name
Date of Birthmm/dd/yyyy
DAN Member ID
Non-Member
Professional Status
Previous Claims?

What activities do you currently participate in:

--Scuba Instruction
--Assistanting Scuba Instructors
--I'm an Instructor in Training
--Divemastering
--I'm a Divemaster in Training
--Skin Diving Instruction
--Free Diver Instruction
--Swimming Instruction

Contact Information

Email
Mailing Address
City
State
Zip/Postal Code
Phone
Country

Agency Affiliations

All agencies declared here will automatically be aded as Additional Insured on your final application.
Primary Agency
Personal Agency ID
Training agency will not be notified if you leave this blank.

Effective Date

Select Start Date for Your Coverage
12:01AM ESTformat: mm/dd/yyyy
 
Coverage effective date begins at 12:01AM EST on the date selected. Coverage ends 1 year later at 12:01AM EST.
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