Forms and Applications | TDIC (The Dentists Insurance Company)
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Forms and Applications

Below you’ll find links to download all necessary forms and applications by category. When a specific form is required by state, download the form listed under your state name.

Professional & Dental Business Liability
AZ, CA, IL, MN, NV
Professional & Dental Business Liability Application (experienced dentists)
Professional & Dental Business Liability Application (new grads/newly licensed)
Professional & Dental Business Liability Coverage for Volunteer Events for CDA members
Volunteer Dentist Supplemental Application
TDIC Automatic Payment Withdrawal Form
Commercial Property 
AZ, CA, IL, MN, NV
Commercial Property – Business Owner's Application
Commercial Property – Lessor's Risk Application
Cyber Suite Liability
Workers' Compensation 
California 
Workers' Compensation Application
Workers' Compensation Claims Kit:
CA WC Medical Provider Network Employee Notification & Guide (English)
CA WC Medical Provider Network Employee Notification & Guide (Spanish)
Division of workers' compensation Time of Hire Pamphlet (English)
Division of workers' compensation Time of Hire Pamphlet (Spanish)
DWC-7 poster (required posting)
Employer's report of occupational injury or illness (Form 5020)
MPN Employee Implementation Notification
Pre-designation of Personal Physician Form
What to expect when a workplace injury occurs chart
Workers' compensation claims form & notice of potential eligibility (DWC-1)
Workers' compensation frequently asked questions
Business Overhead Expense
California
BOE Application
Employment Practices Liability 
CA, IL, NV
Employment Practices Liability Application
Disability
CA, NV
Disability Quote Request
Health
CA, NV
Small Group Quote Request
Additional Coverage
IL
Dental Hygienist Professional Liability Application
Professional Liability
Commercial Property
Workers' Compensation
Disability
Business Overhead Expense