HomeProductsMotorMarineAviationFireBondEngineeringGeneral AccidentWorkmen CompensationSpecial ProductsClaimsAboutOur StoryInnovationBoard of DirectorsManagementSocial ResponsibilityContactFind an AgentSign In/Up Get Quote Workmen Compensation Insurance Form A. PERSONAL DETAILSFull Name of ProposerAddressTelephoneBusiness or Occupation B. PARTICULARS OF WORK1. Does the schedule overleaf include (a) All persons in your service? and (b) All your Sub-Contractors?Please describe your answer starting with (A) or (B)2. If the insurance is to extend to the employees not within the scope of the Law, do the Schedules include all such persons in your service?3. Do your premises come within the meaning of any Law Regulation governing the conduct of maintenance of such premises?(a) If so, name such Law or Regulations(b) Have you carried out all the obligations imposed on you by such Laws or Regulations?4. (a) Have you any circular saws or other machinery driven by stream, gas, water, electricity or other mechanical power. If so give full details?(b) Are your machinery, plant and ways properly fenced and guarded and otherwise in good order and condition?5. What Boilers have you?6. State what acids, gases, chemicals or experiences will be used and to what extent.7. State the total wages paid and give full details of accidents to your employees, incidental to their occupation during the past 3 years.8. Are you at present insured, or have you ever proposed for an insurance in respect of your liability of your Employees? If so, please give name of Company or Companies.9. Has any proposal or renewal ever been declined or withdrawn or has an increased rate been required?