Application and Proposal

Application for Membership of MDA National Limited

Proposal for Professional Indemnity Insurance

Welcome to MDA National's online application service.

Thank you for choosing MDA National for your professional indemnity needs.

By completing an application, you are applying for Membership of MDA National Limited (MDA National) ABN 67 055 801 771 and a Professional Indemnity Insurance Policy underwritten by MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417, AFS Licence No. 238073.

In this form ‘we’ ‘our’ and ‘us’ means MDA National and/or MDA National Insurance and ‘you’ and ‘your’ means the person seeking Membership and insurance.

It is important that you ensure that this application and insurance proposal is accurate and complete.  The information requested in this form is used by us for the purpose of considering your application for Membership and deciding whether we can offer you insurance and, if so, on what terms.

Failure to disclose material information relevant to our decision to accept your Membership and the terms of insurance could invalidate the Membership and insurance contract. If you have any doubt as to whether any information is relevant please disclose it.

Please review the Important Notice information:  


Important Notice

To have a thorough understanding of the cover provided under your policy please read the following information in conjunction with the current Professional Indemnity Insurance Combined Financial Services Guide, Product Disclosure Statement and Policy Wording and any applicable Supplementary PDS and Policy Wording.

Your duty of disclosure

Before you enter into an insurance contract, you have a duty, under the Insurance Contracts Act 1984 (Cth) to tell us anything that you know, or could reasonably be expected to know, may affect our decision to insure you and on what terms. You have this duty until we agree to insure you. You have the same duty before you renew, extend, vary or reinstate an insurance contract.

You do not need to tell us anything that:

  • reduces the risk we insure you for; or
  • is common knowledge; or
  • we know or should know as an insurer; or
  • we waive your duty to tell us about.


If you do not tell us something

If you do not tell us anything you are required to, we may cancel your contract or reduce the amount we will pay if you make a claim, or both.

If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

Claims made cover

The Professional Indemnity Insurance Policy is a claims made contract of insurance. This means that the policy responds to matters that have occurred on or after the retroactive date and that you first become aware of and notify to us in writing during the period of insurance.

Requirement to notify us

You must notify us in writing as soon as practicable of any material alteration of the risk during the period of insurance including any material change in:

  • your field of practice or the nature of the professional services provided by you, or
  • the risk category or billings you have previously declared.

You must also notify us as soon as practicable after you become aware of:

  • any claim, investigation or inquiry;
  • any circumstance that might lead to a claim against you or to an investigation or inquiry involving you;
  • any other matter which might give rise to a claim for indemnity under this policy.


Rights under section 40(3) of the Insurance Contracts Act

If you have a policy with us and you notify us in writing of circumstances which may give rise to a claim during your period of cover, the fact that you do not give us written notice of a claim relating to those circumstances before your policy has expired will not, of itself, relieve us of liability in relation to the claim. However, you must notify us of a claim, investigation or inquiry as soon as you become aware of it.


All monies received will be paid into an Australian bank account and held in trust on your behalf until we agree to accept your proposal. If we do not accept your proposal, all monies will be refunded to you.

MDA National is entitled to the interest earned on this bank account.


We collect, hold and use personal information in order to conduct our business of providing assistance, medico-legal advice, education services and insurance. If personal information we request is not provided, we may not be able to supply the relevant product or service to you. Any information you provide will be held and used by us, and any third parties who assist us in providing these products and services (including but not limited to reinsurers, medical specialists, solicitors and barristers) in accordance with the MDA National Group Privacy Policy which is provided on our website MDA National Group Privacy Policy. Personal information is also used by us to administer government schemes such as the Premium Support Scheme and Run-off Cover Scheme.

We may disclose personal information to third parties located outside Australia including, but not limited to, information on claims, cases and insureds to reinsurers, brokers and others who assist us to manage or administer our business. We take reasonable steps to ensure that such recipients respect your privacy by abiding by equivalent privacy laws and act in a manner consistent with Australian Privacy Principles contained in the Privacy Act 1988 (Cth).

* Required

In order to proceed with this application, you must confirm you have reviewed the Important Notice