Workmen Injury Compensation Quotation Request


Company Details

Work Injury Compensation (WICA, more commonly known as Workmen Com) is a compulsory insurance coverage for all employees who has monthly income lesser than $1600 or has manual work.

This workmen insurance will reimburse your business of hospital / surgery cost and salary lost during employee's period of disability from work.

Company Name:
Company Registration No.:
Business Address of Company:
Establishment Date:
Nature of business:
Coverage Start Date (dd-mm-yyyy):
Coverage End Date (dd-mm-yyyy):

Employees to be insured for Act benefits and Common Law

For those involved in manual work and/or earning below $1600 per month.
Categorise foreign workers (Work Permit & S-Pass holders) separately

No. of
Employees		 Occupations Est. Annual wages,
salaries, and
other earnings

Employees to be insured for Common Law (Employers' Liability) only

For those involved in non-manual work and/or earning above $1600 per month

No. of Employees Occupations Est. Annual wages,
salaries, and
other earnings

Are there any employees based outside Singapore? If "Yes", please provide details:

Country Based In No. of
Employees		 Nature of Work Estimated Wages

Claims experience for the past 3 years:

Insurance Period No. of
Employees		 Paid Claims Outstanding Claims
From To Number Amount ($) Number Amount ($)

Description of Risk

Do you wish to insure employees of sub-contractors? Yes No
If "Yes", please give details:
Do you wish to insure against accident sustained during travel to and from place of employment and lunch/meal breaks? Yes No
If "Yes", please give details:
Have you carried out all the obligations imposed on you by the Laws and Regulations governing the conduct or maintenance of your premises? Yes No
Are your boilers, machinery, plant, equipment and ways properly fenced and guarded, and otherwise in good order and condition? Yes No
Has any insurer declined to insure your employees? Yes No
If "Yes", please give name of insurer:
Will any work be carried out on board vessel / in shipyard / in oil refinery? Yes No
If "Yes", please give details:

For Project (Contract) Policy, please answer the questions below:

Project Title:
Extra Coverage for maintenance / defects liability period (months):
Estimated wage roll of contract:

Contact Details

Contact No.:
Email Address:
Remarks: