Indemnity enquiry form

RCN indemnity scheme may cover you against the financial consequences of a claim against you for clinical negligence. It is very important that you check the terms and conditions as outlined on our RCN indemnity scheme page.

There’s no need to pay anything extra. RCN indemnity is included in your membership fee, provided you meet the eligibility criteria.

If you have read our terms and conditions and would like to ask us a question about the scheme or you have been contacted about a claim, please complete our form below.

Contact details

Full name: RCN membership number: Address: Best contact number: Where an onward referral is required, we will provide these contact details to another department in the RCN. Do you give us your consent to pass on this information? Yes No Can we leave you a voicemail? Yes No Can we contact you on this matter by email? Yes No If we need to pass your enquiry to your local RCN office or a specialist RCN department, would you like any emails from them to be password protected? Yes No Email address you would like us to reply to Please confirm the email address you would like us to reply to Please list any times that you are unavailable for calls during the next week (9am-5pm):

Employment details

Place of work Employer When did you start working with your current employer? Ward or department Job category Job title Weekly contracted hours Do you have any meetings scheduled? Yes No If yes, please give date, time and location: Are you already being supported by a rep? Yes No If yes, please include details below: Are you in the UK on a visa? Yes No If yes, please include details below (including how long you have been in the UK):

Have you received any correspondence regarding a claim? Yes No Is there a deadline? Yes No If yes, please include details: Please give full details of the claim: Are any other member subject to proceedings: Yes No If yes, please include details:

By submitting this form, you are giving the RCN permission to contact you about your submission.

You can control the information you receive from the RCN by updating your preferences at MyRCN.

We don’t update your contact details unless you ask us to. The best way to check and update the details we hold for you is by visiting MyRCN.

Protecting your privacy is very important to us. Please view our privacy policy to find out more about the information we collect and how it is used.

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