SUMMARY OF COVER

Reimbursement for legal liability to pay compensation for bodily injury resulting in death, disablement of any employee and medical expenses incurred arising out of and in the course of employment including legal costs, in accordance with the provisions of Workmen's Compensation Act of 1987 or at common law.

BENEFITS

Death - 3.5 Times Annual Salary

Permanent Disablement - 4.5 Times Annual Salary

Temp. Total Disablement - Monthly Salary

Medical Expenses - Any reasonable amount as confirmed by medical doctor.

CATEGORIES OF STAFF

Administrative staff

Security Officers and Drivers

Other Occupation

EXCEPTIONS

The company shall not be liable under this policy in respect of:

Any injury by accident or disease directly attributable to war invasion act of foreign enemy hostilities (whether war be declared or not) civil war mutiny insurrection rebellion revolution or military or usurped power.

The insured's liability to employees of contractors to the insured.

Any employee who is not a "workman" within the meaning of the law(s).

Any liability of the insured which attaches by virtue of an agreement but which would not have attached in the absence of such agreement.

Any sum which the insured would have been entitled to recover from any party but for an agreement between the insured and such party.

Self inflicted injuries.

APPLY ONLINE   Proposer's Name: Proposer's Business Address: Proposer's Trade or Occupation: Insurance for 12 months Please select January February March April May June July August September October November December Please select January February March April May June July August September October November December SCHEDULE A Description of Employees: Please Select Management Staff Admin/Clerical Staff Engineers/Technicians Drivers/Dispatch riders/Security Officers Apprentice and Masons Others Estimated Number of Employees Please Select 1-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 100-150 151-200 201-250 251-300 Cash