Personal Liability Insurance Application Form  - click to open 

Every General RDT member must fill out these forms for the new insurance company this year and return it to DTABC by January 10, 2023.

Please PRINT CLEARLY on the forms.  Print out or download forms to fill them out and forms must be signed.

Note:                                                                                                                                      Member number is your RDT License number.                                                                 Loss Experience area - no need to fill this out as you are renewing from Intact PLI.

E-mail forms to:                                                                                                         or                                                                                                                  Mail forms to: DTABC                                                                                                                               #273 -12100 Riverside Way                                                                                               Richmond, BC. V6W 1K5

Register for the Free Early Bird Registration for the Pacific Dental Conference by January 10th, 2023.  If you register after this date you will have to pay the full $375.00 PDC Registration Fee!  

If you have any concerns you can email us or call us at 604-278-6279   _________________________________________________________________