TAYLOR DEFENCE SERVICES LTD (TDS LTD) PROPOSAL ACCEPTANCE FORM Dental Advisory Services provided by TDS Ltd EMPLOYER INDEMNIFIED SUBSCRIPTIONS Services provided by TDS Ltd: For practitioners who are in full time employed posts with full employer indemnification, assistance and representation with all disciplinary matters, including any allegation made by Hospitals, NHS Board or Trusts, Health Boards Practice Boards; representation at all Tribunal, Health Board and General Dental Council Hearings, assistance and representation at Inquests, advice on complaints including assistance with any associated Hearings, assistance with reporting of adverse incidents, Disputes with your employer and Internal disciplinary procedures Dealing with complaints Regular quarterly updates on legal issues relevant to the practise of dentistry Advice on matters relevant to dental practitioners in Scotland Available assistance 24 hours a day, 365 days a year directly with adviser For practitioners who are in part-time private practice and part-time employed posts, introduction to indemnity for dentists practising in private practice in Scotland against costs and damages in dental negligence claims for dental malpractice for all general dentistry, sedation, relative analgesia, orthodontics, endodontics, facial rejuvenation treatments and placement of implants ( 10% of working week). assistance and representation with all disciplinary matters, including any allegation made by Hospitals, NHS Board or Trusts, Health Boards Practice Boards; representation at all Tribunal, Health Board and General Dental Council Hearings, assistance and representation at Inquests, advice on complaints including assistance with any associated Hearings, assistance with reporting of adverse incidents, Disputes with your employer and Internal disciplinary procedures Dealing with complaints Regular quarterly updates on legal issues relevant to the practise of dentistry Advice on matters relevant to dental practitioners in Scotland Available assistance 24 hours a day, 365 days a year directly with adviser Section 1 | Details Forename(s) Surname Practice Address/ Employed post address Postcode Telephone Fax Email GDC Number Preferred Method of Communication Letter/e-mail (delete as applicable) Tick the appropriate box for the cover required. Payments are made on an annual basis. Employer indemnified only Employer indemnified and 1 session in private practice* N/A Employer indemnified and 2-3 sessions in private practice* N/A Employer indemnified and 4-6 sessions in private practice* N/A 1st Year graduate Free [ ] 2nd Year graduate Free [ ] £140** [ ] £150** [ ] £150** [ ] 3rd Year graduate Free [ ] £140** [ ] £375** [ ] £500** [ ] 4th Year graduate £150 [ ] £290** [ ] £525** [ ] £600** [ ] 5th Year graduate and subsequent years £250 £390** £625** £800** [ ] [ ] [ ] [ ] *Private practice denotes the practise of dentistry out with that of community services, Hospital and armed services. **Practitioners who practise dentistry on a part-time basis in private practice will be introduced to a policy of insurance for dentists practising in Scotland against costs and damages in dental negligence claims. For practitioners who fall into these categories, the price above reflects the total price for services provided by TDS and the policy of insurance( including insurance premium tax) provided by Hiscox. An additional form will be provided for these practitioners for the insurance cover. 1 Session in private practice means a maximum of five hours per week. Data Protection TDS Ltd will hold the information that you provide on its system for administration of your membership, marketing, risk assessment and advisory purposes. We may disclose the information to legal or other advisers and other defence organisations as part of our advisory and claims handling process. In order to provide you with the best possible service we would like to inform you of other products and services offered by us, that we believe may be of interest to you. If you do not wish your information to be used for this purpose, please tick the box next to your signature below. You have the right to apply for a copy of your file and to have any inaccuracies corrected. Declaration: • I confirm that the information provided within this form is complete and accurate • I consent to TDS Ltd processing my information for advisory services • It is a requirement by TDS Ltd, in order that we might adequately look after your interests, that you sign and return this form to enable us to comply with the Data Protection Act 1998 I wish to be provided with dental advisory services offered by TDS Ltd Signature……………………………… Date ………………… Section 2 | Payment Please make payment by cheque (please cross your cheque and make payable to Taylor Defence Services Ltd). Or complete the standing order form provided. Please note: If a practitioner practises dentistry in private practice then services will only be provided by TDS Ltd if the appropriate insurance policy with Hiscox Insurance Company Ltd and Giles Insurance Brokers Ltd is in force Important notice for your protection Within 30 days of receipt of payment, you will be sent your client card with all contact details and other information. Please ensure that your details are accurate. Please complete all sections and return this form to: Taylor Defence Services Ltd, 4 Miller Walk, Bishopbriggs, Glasgow G64 1FF. Taylor Defence Services Ltd is a limited company incorporated in Scotland, Registration Number SC415218. Registered address: 4 Miller Walk, Bishopbriggs, Glasgow. G64 1FF Telephone 07826550594 or 07577486909 email: neil@taylordefenceservices.com Web address: www.taylordefenceservices.com