Corporate dental application form

Set up new a corporate indemnity solution

Apply for your corporate dental indemnity solution by completing this form.

Corporate membership benefits are provided on a “claims made” basis which means requests for assistance, arising from incidents when you were a corporate member, can only be made during a membership year and not after you have left corporate membership.

Please enter your company details below (the entity to be indemnified - company or LLP).

NOTE: Throughout this form, please do not use the back button in your browser as you may lose the details you have entered on your form. If you need to return to a previous page, please use the button at the bottom of this page.

As an organisation, we understand that data must be handled securely. For more information about how we collect, store and use data please see our privacy policy at themdu.com/privacy

Name of company *This question is required.

Company number *This question is required.

Trading name

Length of time trading *This question is required.

Previous corporate/business names and reasons for change (if applicable)

Primary practice address *This question is required.

Additional practice addresses (if applicable)

Company website *This question is required.

MDU Services Limited (MDUSL) is authorised and regulated by the Financial Conduct Authority for insurance mediation and consumer credit activities only. MDUSL is an agent for The Medical Defence Union Limited (MDU). MDU is not an insurance company. The benefits of MDU membership are all discretionary and are subject to the Memorandum and Articles of Association. MDU Services Limited, registered in England 3957086. Registered Office: One Canada Square, London E14 5GS