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Workmen Compainsation/Employer Liability

Name of Insured/Principal/Correspondence*
Address of Insured/Principal/Correspondence*
Location of work*
Email*
Mobile*
Previous Insurance Company if any*
Bussiness of the insured(specify exact nature of work)*
The total amount of wages salaries and other earning paid by me during the past twelve months was rs*
Do you provide specific training to your employees on how to perform their respective job?*
Does all employees are acquitted with standard safety procedures?*
Does the insured instruct all workers in proper lifting techniques?*
Does the insured provide heavy-duty work gloves for all employees performing rigorous manual labour?*
State what acids, gases chemicals or explosives will be used and to what extent?*
Are you at present insured or have your ever proposed for an insurance in respect of your liability to your employees?*
Has any proposal for an insurance in respect of your liability to your employees or renewal thereof even been declined or withdrawn? *
Is their any incidence of injury/ accident including death to workers/ employee for the last 3 years? even though not reported to insurance compnay or there is no insurance.*
Coverage required ?*
Please download file, input data and upload for premium*
Attachment*