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We make the process of finding the right professional liability insurance coverage as quick and easy as possible. We can work with you to provide professional liability insurance quotes.

 If you have any questions regarding your application, please contact us at:

Email: ata-questions@alliant.com

Toll Free: (855) 393-2874

Fax: (703) 563-1510

 

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(*Membership is required to bind coverage in the ATA program. However, a premium quotation will be provided subject to receipt of membership information. If you have applied for membership, type in “pending” in the space provided for membership number.)



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(Startups must furnish projected figure for first year):
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Please indicate approximate % of split of type(s) of services you provide: (Combined percentage should equal 100%)

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Please indicate approximate % split of services by discipline (Combined percentage should equal 100%)

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(If No, please provide copy of the contract you do use)


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Applicant represents and warrants to the best of their knowledge that the particulars and statements contained in this application are true and agree that these particulars and statements are the basis of the policy that may be issued, and will constitute a part of the policy. By Submitting this Application, the Applicant agrees that in the event the application contains misrepresentations or fails to state facts materially affecting the risk assumed by the insuring company under a policy issued, the policy may be deemed null and void.