Create | FBIA

Create | FBIA

Employers Liability Quotation

Personal Details

Insurance Company

First Name / Corporate Name

Last Name

Mobile No.

Email Address

Which FBBI branch do you want to be served from?

Insurance Start Date

Insurance End Date

WIBA/WIBA Plus Basic Premium

PARTICULAR OF INSURANCE *

	Any One Person	Any One Occurrence	Any One Year
Option A	2000000	10000000	20000000
Option B	4000000	15000000	30000000
Option C	6000000	20000000	40000000
Option D	8000000	25000000	50000000