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20.124.223.86  Public Scan

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Submitted URL: https://u8216571.ct.sendgrid.net/ls/click?upn=u001.1PfPDU6pxVOyTFbynlbnxKqu8Au63J4vdNeK5MH84Mnzzx-2BSswESJDqzv0QOLvBD1-2BIGbSTRCD...
Effective URL: https://external.trustrms.com/coveragepage.aspx?clientid=616
Submission: On July 09 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST APASL/Quote.aspx

<form class="cmxform" method="post" onsubmit="return this.validate();" action="APASL/Quote.aspx" id="Form1">
  <div class="section-header"><span class="section_label">Coverage Information</span></div>
  <div class="row justify-content-center">
    <div class="col-md-6 col-12 mb-3">
      <div class="card"><label id="lbl_requestEffDate" for="requestEffDate" class="card-header "> Desired Effective Date</label><input name="requestEffDate" id="requestEffDate" type="text" class="datepicker inputmargin" data-provide="datepicker"
          data-date-start-date="+1d" data-date-end-date="+90d" data-date-max-view-mode="month" autocomplete="off" data-date-autoclose="true" data-date-disable-touch-keyboard="true" value=""></div>
    </div>
    <div class="col-md-6 col-12 mb-3">
      <div class="card h-100"><label id="lbl_state" for="state" class="card-header "> State of Residence</label><select id="state" name="state" class="inputmargin">
          <option value="" selected="TRUE">Choose...</option>
          <optgroup label="US States">
            <option value="AK">Alaska</option>
            <option value="AL">Alabama</option>
            <option value="AR">Arkansas</option>
            <option value="AZ">Arizona</option>
            <option value="CA">California</option>
            <option value="CO">Colorado</option>
            <option value="CT">Connecticut</option>
            <option value="DC">District of Columbia</option>
            <option value="DE">Delaware</option>
            <option value="FL">Florida</option>
            <option value="GA">Georgia</option>
            <option value="HI">Hawaii</option>
            <option value="IA">Iowa</option>
            <option value="ID">Idaho</option>
            <option value="IL">Illinois</option>
            <option value="IN">Indiana</option>
            <option value="KS">Kansas</option>
            <option value="KY">Kentucky</option>
            <option value="LA">Louisiana</option>
            <option value="MA">Massachusetts</option>
            <option value="MD">Maryland</option>
            <option value="ME">Maine</option>
            <option value="MI">Michigan</option>
            <option value="MN">Minnesota</option>
            <option value="MO">Missouri</option>
            <option value="MS">Mississippi</option>
            <option value="MT">Montana</option>
            <option value="NC">North Carolina</option>
            <option value="ND">North Dakota</option>
            <option value="NE">Nebraska</option>
            <option value="NH">New Hampshire</option>
            <option value="NJ">New Jersey</option>
            <option value="NM">New Mexico</option>
            <option value="NV">Nevada</option>
            <option value="NY">New York</option>
            <option value="OH">Ohio</option>
            <option value="OK">Oklahoma</option>
            <option value="OR">Oregon</option>
            <option value="PA">Pennsylvania</option>
            <option value="RI">Rhode Island</option>
            <option value="SC">South Carolina</option>
            <option value="SD">South Dakota</option>
            <option value="TN">Tennessee</option>
            <option value="TX">Texas</option>
            <option value="UT">Utah</option>
            <option value="VA">Virginia</option>
            <option value="VI">US Virgin Islands</option>
            <option value="VT">Vermont</option>
            <option value="WA">Washington</option>
            <option value="WI">Wisconsin</option>
            <option value="WV">West Virginia</option>
            <option value="WY">Wyoming</option>
          </optgroup>
          <optgroup label="Military States">
            <option value="AA">AA</option>
            <option value="AE">AE</option>
            <option value="AP">AP</option>
          </optgroup>
        </select></div>
    </div>
  </div>
  <div class="section-header"><span class="section_label " id="lbl_selection">Type of Coverage You Are Requesting</span></div>
  <fieldset>
    <div class="row justify-content-center ">
      <div class="col-12 col-md-3 bottomMarginSmall">
        <div class="outlineDark ">
          <div class="outlineDark"><label class="labelBold d-flex  smallYPadding" for="APASL"><input type="radio" name="selection" value="APASL" id="APASL" class="inputmargin align-self-center" action="CoveragePage.aspx"> Psychology Student </label>
          </div>
          <div class="blockText px-3"> Student Liability Insurance designed specifically for graduate students to cover practicum, internship activities, and school board investigations. <br> For those who prefer to apply manually, forms are
            available for <a href="https://www.trustinsurance.com/Products-Services/Student-Liability/Download-Application">download here</a>. </div>
        </div>
      </div>
      <div class="col-12 col-md-3 bottomMarginSmall">
        <div class="outlineDark ">
          <div class="outlineDark"><label class="labelBold d-flex smallYPadding" for="APARA"><input type="radio" name="selection" value="APARA" id="APARA" class="inputmargin align-self-center" action="CoveragePage.aspx"> Research or Academic
              Psychologist </label></div>
          <div class="blockText px-3"> Professional Liability Insurance designed specifically for those in academia or conducting research. <br> For those who prefer to apply manually, forms are available for
            <a href="https://www.trustinsurance.com/Insurance-Programs/Research-Academician-Liability/Download-Application">download here</a>. </div>
        </div>
      </div>
      <div class="col-12 col-md-3 bottomMarginSmall">
        <div class="outlineDark ">
          <div class="outlineDark"><label class="labelBold d-flex smallYPadding" for="APAPL"><input type="radio" name="selection" value="APAPL" id="APAPL" class="inputmargin align-self-center" action="CoveragePage.aspx"> Individual Psychologist
            </label></div>
          <div class="blockText px-3"> Professional Liability Insurance designed specifically for practicing psychologists or post-doctoral, pre-licensed individuals. <br> For those who prefer to apply manually, forms are available for
            <a href="https://www.trustinsurance.com/Products-Services/Professional-Liability/Download-Application">download here</a>.</div>
        </div>
      </div>
      <div class="col-12 col-md-3 bottomMarginSmall">
        <div class="outlineDark">
          <div class="outlineDark"><label class="labelBold d-flex smallYPadding"><input type="radio" name="selection" value="APAGRP" id="APAGRP" class="inputmargin align-self-center" action="CoveragePage.aspx"> Group Coverage </label></div>
          <div class="blockText px-3"> Professional Liability Insurance designed specifically for organizations, LLCs, Corporations, and Group Practices. There must be one or more psychologist and may include other mental health professionals working
            together. To receive a comprehensive quote for group coverage, please complete the paper application, <a href="https://www.trustinsurance.com/Products-Services/Professional-Liability/Download-Application">download here</a>. </div>
        </div>
      </div>
    </div>
    <div id="message" style="display:none"><span id="sub-content-validation" style="margin-top: 20pt;">
        <div class="section-header"><span class="section_label">Errors Occurred...</span></div><iframe id="errorwindow" name="errorwindow" src="tpl/ErrorMessage.html" width="99%" height="100%" frameborder="0" style="overflow: scroll;"></iframe>
      </span></div>
    <table width="98%" id="Table1" style="margin: 10px;">
      <tbody>
        <tr>
          <td><input type="button" class="btn" value="Cancel" id="Submit1" name="Submit1" onclick="cancel();"></td>
          <td align="right"><input type="button" value="Next" class="btn btn-next " id="applyNewBiz" name="applyNewBiz"><input type="hidden" id="ObjectID" name="ObjectID" value=""></td>
        </tr>
      </tbody>
    </table>
  </fieldset>
  <div><input type="hidden" name="Submit2" id="Submit2" value="Next"><input type="hidden" name="day" id="day" value="07/10/2024"><input type="hidden" name="d90" id="d90" value="10/07/2024"><input type="hidden" name="clientIDs" id="clientIDs"
      value="616"></div>
</form>

Text Content

Trust Sponsored Professional Liability Policy
1-(877)-637-9700
Mon - Fri : 8:30AM - 6PM ET
Coverage Information
Desired Effective Date
State of
ResidenceChoose...AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict
of
ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth
CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew
YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth
DakotaTennesseeTexasUtahVirginiaUS Virgin IslandsVermontWashingtonWisconsinWest
VirginiaWyomingAAAEAP
Type of Coverage You Are Requesting
Psychology Student
Student Liability Insurance designed specifically for graduate students to cover
practicum, internship activities, and school board investigations.
For those who prefer to apply manually, forms are available for download here.
Research or Academic Psychologist
Professional Liability Insurance designed specifically for those in academia or
conducting research.
For those who prefer to apply manually, forms are available for download here.
Individual Psychologist
Professional Liability Insurance designed specifically for practicing
psychologists or post-doctoral, pre-licensed individuals.
For those who prefer to apply manually, forms are available for download here.
Group Coverage
Professional Liability Insurance designed specifically for organizations, LLCs,
Corporations, and Group Practices. There must be one or more psychologist and
may include other mental health professionals working together. To receive a
comprehensive quote for group coverage, please complete the paper application,
download here.
Errors Occurred...





Underwritten by ACE American Insurance Company. Administered by Trust Risk
Management Services, Inc. (License Producer - Sheila LeBeau, CA #OF77147, FL
#PO99941). The completion of this application or the tendering of premium does
not bind coverage. The application is subject to the Company's Underwriting
Rules.

Questions? Call toll-free: 1-(877)-637-9700
Hours: Mon-Fri, 8:30AM-6PM ET

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