BKIC Enquiry Form

ENQUIRY FORM

Name of Business:

Postal Address:

Telephone Numbers:

Fax Number:

E-mail Address:

Nature of Business:

Insurance Covers Interested in:

	Private Residence / Office
	Industry (Manufacturing facility)
	Construction
	Professional Indemnity
	Marine (Imports/Exports of Goods)
	Pleasure Crafts
	Motor Vehicles
	Medical / Life
	Others (Please specify)

How did you come in contact with BKIC:

Billboard

Newspaper

Website

Other.