(+268) 2508 5600 ∙ 2404 9932/33 |  info@lidwalainsurance.com | 08:00 – 17:00

  • Follow
  • Follow
  • Follow
LIDWALA HEALTH
PREMIUM CALCULATOR
  • Home
  • About Us
    • Profile
    • Our Team
      • Board Of Directors
      • Executive Team
      • Management Team
  • Lidwala Health
  • Our Products
    • Personal Insurance
    • Corporate Insurance
  • Claims
  • Media
    • News
    • Notices
    • Vacancies
    • Tenders
  • Request A Quote
  • Get in Touch
    • Contact Us
    • Feedback
    • FAQ

Fidelity Guarantee Insurance Proposal Form

1Tell us about you
2Give us details of the cover
3Individual Cover
4Floater Cover
5Cover involving cash
6Cover involving stock
7Declare this proposal

PROPOSER'S DETAILS

Name(Required)
DD slash MM slash YYYY
DD slash MM slash YYYY

COVER DETAILS

Tick all appropriate parameters of the cover below(Required)

DETAILS OF EMPLOYEE (S) TO BE INSURED

List of employees(Required)
Add information into each column and press (+) to add another row
Name
Duties
Year of Employment
Limit Per Occurrence
Aggregate/Annual Limit
 

FLOATER COVER DETAILS

Is there a system to obtain references from previous employer?(Required)

CASH & PAYMENT DETAILS

Do employees pay out money or draw cash from proposer’s account?(Required)
If yes, are such payments/withdrawal authorized by a senior employee?(Required)

STOCK DETAILS

Has any company decline, cancelled, refused or accepted you proposal on special terms and conditions?(Required)
Claims Experience
Year
Premium
Incurred Losses
Loss Ratio
 

DECLARATION

DD slash MM slash YYYY
Declaration
I/We to the best interest of my/our knowledge hereby confirm that the statements contained in this proposal form are true and correct and I/We have not concealed, misrepresented or misstated any material fact. I/We agree that the statements and declaration contained in this proposal form shall be the contract of insurance with the company and are deemed to be incorporated in the contract.

Lidwala HQ (Manzini)
Tel: (+268) 2508 5600
Fax: (+268) 2505 9088
Location: 7th Floor, Sivuno Building,
Manzini, Eswatini

Lidwala Mbabane Office
Tel: (+268)2404 9932/33
Location: Office No: 19, The Mall,
Mbabane, Eswatini

  • Facebook
  • Twitter
  • Instagram
Lidwala Insurance Company
Developed by: Pixel Studios