Home Protector Application Form

Fire & allied perils (first loss)

Policy holder:

Date of insurance:

Choose one of these three programs: * Private    ** Commercial    

- Option 1:
- Sum insured: $ 250.000

Annual Premium:

*   $85

**  $100
- Option 2:
- Sum insured: $ 500.000

Annual Premium:

*   $125

**  $150
- Option 3:
- Sum insured: $ 1 million

Annual Premium:

*   $250

**  $300
- Option 4:
- Sum insured: $ 2 million

Annual Premium:

*   $300

**  $350

Insured Address

Street:
Street number:
Region:

City:

Building:

Floor:
Plot number:
P.O.Box:

Telephone:

E-mail:

Description / Location

Commercial workshop
Hotel
Home
Office
Pharmacy

Clinic
Showroom
Warehouse
Factory
Workshop
school
Carpentry
Restaurant / Health club
Building
Others:

  .

Click here to go back to the Home Protector page

| Home page | Company profile | Contact us |

Site created by: