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Law 139
The 139 Law of 1968, the Non-Job Related Incapacity Benefits law,
provide the ability to be insured with a private insurance company
instead of the Government's public plan. Click here
to learn more about SINOT
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Important
Note:
This
document is made available to you for your convenience. This document is
only a quote application and does not pretend to cover any of the of the
terms and exclusions of the policy herein presented. This document is not
your policy and does not modify or extend the cover of this policy. the
insurance company, emitter of the quote/policy is subjected to all the
exclusions and terms of the policy. If there are any discrepancy between
this description and the quote or policy, the quote or policy will prevail.
Remember, this is just a quote form.
Please note that due to technical or natural events beyond our control, like
weather, we may not receive your quote. Please confirm that your application
has been received by calling to our toll free number 1-800-981-6545, Monday
trough Friday from 8:30 am to 5:00 PM.
We
are going to process your application in our agency labor hours: Monday
through Friday from 8:30 AM to 5:00 PM, except holydays.
It’s
our honor to serve you,
Nehemías
Toro Insurance Agent.
Fill in this information for a
free quote on a SINOT Policy
*required information
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Employer's Name*
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Business Phone Number*
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Area Code: Number:
Extension Number (optional):
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Alternative Business Phone
Number
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Area Code: Number:
Extension Number (optional):
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Fax Number
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Area Code: Number:
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E-Mail
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Physical Address
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City and Zip Code
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Postal Address
Same as Physical
Address Yes
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City and Zip Code
of Postal Address
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Business Nature
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Dept. of Labor Employer's Number
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Number of Covered Employees*
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% Women
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% Men
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Employees with more than 50
year old
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Average age of Employees
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Do employees contribute to
the plan?*
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Yes
No
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if so, what percent?
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%
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Actual Plan*
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Government Private
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Actual estimated payroll,
excluding salaries in excess of US$ 9,000 per year
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Name and Position of person
in charge*
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Additional Observations
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