Apply Now Fill out the form below to apply for the indemnity insurance nurses can afford. Please note: All prices are shown in Australian Dollars. INSURED PERIOD for prices below is from 15/05/2022 to 15/11/2022. Contact Information Your Name Mr Mrs Ms Miss * Email Address * Home Phone Bus. Phone Mobile * Address Your Address * Suburb * Postcode * State * Your Details Date of Birth * AHPRA Registration No * Qualifications * Employer * Choose Your Coverage Nurse Practitioners & Students $257.02 (includes GST $21.65) Nuclear Medicine Technologists, Radiographers $289.69 (includes GST $24.55) Cardiac Technologists $289.69 (includes GST $24.55) Employed Midwives (including Prenatal and Birthing Suite, employed in Public or Private Hospitals only) $462.11 (includes GST $38.60) Registered Nurse DIV 1 (EMPLOYEE) $195.31 (includes GST $16.55) Enrolled Nurse DIV 2 Medication Certified $180.18 (includes GST $15.55) Enrolled Nurse DIV 2 Non Medication Certified $171.11 (includes GST $14.45) Self-Employed Registered Nurse DIV 1 $257.02 (includes GST $21.65) Personal Care Attendant $171.11 (includes GST $14.45) Volunteer Registered Nurse $159.61 (includes GST $13.60) Occupational Therapists $159.61 (includes GST $13.60) Paramedics $257.02 (includes GST $21.65) History Yes No Are there any claims alleging a negligent act, error or mission or malpractice currently lodged against you? Yes No Are you aware of any circumstance which has already occurred which may give rise to a negligent act, error or omission or a malpractice claim being lodged against you? Yes No Have you been involved in any action which could have or did give rise to a legal dispute arising out of your employment? Yes No Have you ever been involved in professional discipline procedures? Yes No Have you ever been refused any insurance, or had a requirement for hasher terms and conditions imposed upon your application for insurance? Payment Information Internet Transfer/Deposit Credit Card (Bank credit card charge to apply .87%) Cheque or money order is payable to Gamman Insurance Brokers. Account Name GAMMAN INSURANCE BROKERS BSB 083004 Account no. 901683638 Card Type Mastercard Visa Card Number Cardholder Name Expiry Date /