Employer’s Liability Proposal Form

Employer’s Liability Proposal Form

Step 1 of 4

  • Particulars of Proposing Employer

  • Period of insurance

  • Date Format: DD slash MM slash YYYY
  • Date Format: DD slash MM slash YYYY
  • LIMITS OF INDEMNITY

    Specify below the Limits of Indemnity for which you wish to be covered:
  • Limit of Indemnity for every Employee (Minimum amount in accordance with the provisions of the Law EUR160.000):

  • Limit of Indemnity for every Event or series of Events (Minimum amount in accordance with the provisions of the Law EUR3.415.000):

  • Aggregate Limit of Indemnity for any Period of Insurance (Minimum amount in accordance with the provisions of the Law EUR5.125.000)

  • Insurance Record