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Civil Liability Insurance Form

1 - Download File Civil Liability Insurance Calculation 2 - Fill in the figures of the document 3 - Complete the form 4 - Attach proof of payment Banco santander en dolares Cta cte 5100090378 Swift: bschclrm Fisa sa 96955780-0 Bombero ossa 1068 santiago de chile Note: send voucher to pcortes@fisa.cl Banco santander en euros Cta cte 5100090360 Swift: bschclrm Fisa sa 96955780-0 Bombero ossa 1068 santiago de chile Note: send voucher to pcortes@fisa.cl

IMPORTANT

ONLY FORMS THAT SEND THE ATTACHED DEPOSIT SLIP WILL BE CONSIDERED PAID. PROJECTS WILL BE REVIEWED FOR APPROVAL UPON RECEIPT OF THE ONLINE FORM.

    ID without periods or dashes

    Data for Total or Partial Return

    Attach proof of payment Please prove you are human by selecting the truck.