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Employers Liability Claim Form
Policy No:Claim No:Intermediary:
Insureds Details
Name of Insured:I.D. Card/Co.
Reg. No:Address:Tel/Mobile No(s):Email:Trade or
Occupation (if
more than one
state all):
Employees
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What is intermediary?
Intermediary is a person or entity that acts as a go-between for buyers and sellers in a transaction.
Who is required to file intermediary?
Any person or entity acting as an intermediary in a transaction is required to file intermediary.
How to fill out intermediary?
Intermediary can be filled out by providing details of the transactions, parties involved, and the role played by the intermediary.
What is the purpose of intermediary?
The purpose of an intermediary is to facilitate transactions between buyers and sellers, ensuring a smooth and efficient process.
What information must be reported on intermediary?
Information such as details of the transactions, parties involved, and the fees or commissions received by the intermediary must be reported on intermediary.
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