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General Practice Medical Indemnity Application

All London and KSS GP Trainees employed who are entering a placement from the 1st August 2019 MUST complete the relevant sections of the form below

Medical indemnity, provided as a benefit of membership of The Medical Defence Union Limited (MDU) and arranged by London and KSS (MDU Indemnity Arrangement), is open to all London and KSS GP trainees.

How the MDU will use and share your data

Please read important information about how the MDU will use your data for the purpose of administering your MDU membership at https://www.themdu.com/privacy

In addition, MDUSL will share details of your MDU membership and its status (including any termination of it) to London and KSS for payment and compliance verification purposes in order to administer your membership.

(Please note the MDU or MDUSL will only discuss and/or amend information relating to your membership on completion of MDUSL’s standard security checks).

Data protection and communications

By submitting the form I consent to London and KSS sharing my personal data with the MDU and MDU Services Limited (MDUSL), for the purposes of arranging and administering my membership of the MDU, which includes the provision of medical indemnity for my training placements from or after the 1st August 2018.

By submitting the form I authorise London and KSS to instruct MDU and/or MDUSL to amend my contact and/or placement details in my MDU membership record.

I understand and acknowledge that:

- Benefits of membership of the MDU are discretionary and are subject to its memorandum and articles of association;

- Benefits may be granted to me only as long as I comply with the laws on registration and licensing in force in any country where I practise or engage in postgraduate study;

- Removal from a professional register (even if voluntary) or any change in registration should be notified to MDUSL as this will affect membership;

- With the exception of Good Samaritan acts, the benefits of membership do not extend to any practice undertaken in the USA or Canada or any litigation which may arise in these countries or in the territories and principal island groups under their sovereignty. Restrictions also apply for other countries;

- I must notify London and KSS and MDUSL in writing of any change in email address, address, country or practice or any other circumstance which may be relevant to membership;

- A condition of membership of the MDU is that any misrepresentation or misstatement in, or omission of, any information which is likely to influence the acceptance for membership of a body offering discretionary indemnity (a “material fact”), whether intentional or not, is cause for termination of membership and that in such circumstances all benefits of membership of the MDU may be withdrawn or denied.

Your answer should be no more than 7 characters long.

7.7. Please select your communication preferences below to ensure you receive important information from the MDU: Optional

Please select at least 1 answer(s).

By completing this form you confirm that you wish to become a member of the MDU in accordance with its memorandum and articles of association.

By completing this form you are confirming that the below statement is correct;

"I declare that to the best of my knowledge and belief the information provided in connection with this proposal, whether in my own hand or not, is true and I have not withheld any material facts."