Students applying for clinical rotations in the United States who require medical professional liability insurance coverage:

AMPIE RRG can provide visiting foreign medical students with medical professional liability insurance coverage for the specific period of time coverage is required. The quotation for cost of this coverage will be determined after a completed application is submitted. Once the quotation is accepted, proof of coverage can be issued.

A quotation can sent out within 4 days after completed application is received.

The insurance policy will be issued after receipt of all material including payment.

Upon accepting the quotation, Academic can issue a letter indicating that we will insure student upon
acceptance to program (if required for application).

Complete the following application, click on “send” and Academic will respond to your application by email.

Medical Professional Liability Insurance for (Visiting) Medical Students

First Name:
Last Name:
Home Address:
Date of Birth (mm/dd/yyyy):
Email Address (required)
Medical School Currently Attending:
Expected Graduation Date:
Name of medical school where elective will take place:
Department supervising clinical activities:
General description of clinical activities:
Address and Location of Institution where clinical activity will take place:
Start Date of Rotation (mm/dd/yyyy):
End Date of Rotation (mm/dd/yyyy):
Total Number of Days of Coverage Required:
Printed name / Signature:
Date (mm/dd/yyyy):
Type characters from picture:

Note to Applicants:  Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any material fact hereto, commits a fraudulent insurance act, which is a crime and shall be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.