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AOHT Membership Application (Ordinary / Associate)

* First Name

* Last Name

* DCR No.

* Contact No.

* Date of Birth

* Citizenship

* Address

Preferred mailing address

* Email

* Company Name and Address

* Education Institution

* Qualification/Year of Graduation

* Password

Strength: Very Weak

Declaration for QBE Indemnity (Ordinary Members Only)

Have you ever been subjected to disciplinary proceedings for professional misconduct?

YES

Have any claims for negligence or breach of professional duty been made in the last ten (10) years against you or have circumstances been notified to insurers that might give rise to a claim?

YES

Are you aware of any claims or circumstances that might give rise to a claim which is not referred to in the Question above?

YES

If yes for any of the above, please email to secretariat@aoht.org.sg

Supporting Documents and Payment

Supporting documents to be submitted (hard or soft copy):

For ORDINARY membership: Practising Certificate

For ASSOCIATE membership: Identity Card / Passport / Qualification Certificate/ Student Matriculation Card OR Practising Certificate (where applicable)

Supplemental Consent

I hereby agree

To receive newsletters and upcoming event(s) details and related information.

I hereby agree:

To receive emails with regards to job opportunities and related information.

* I hereby agree

To disclose my personal information to QBE for the purpose of Dental Indemnity.

Disclaimer

* Disclaimer

I certify that my answers are true and complete to the best of my knowledge.

* Disclaimer

I understand that false or misleading information in my application may result in cessation of AOHT membership and QBE Indemnity coverage without notice.

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* Email

* Password

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