Cafaro Group Disability
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  Disability Benefits Law
Enacted in 1949 In New York State if you are an employer and employ 1 or more employees for a least 30 work days in any calendar year you are required to obtain coverage(with few exceptions). DBL Benefit 50% of average weekly wages, maximum $170, with a 26 week maximum benefit per 52 weeks and a 7 day wait for accident & sickness.
 Please fill in all question fields in order for us to give you the most accurate quote possible. Also, please provide a valid phone number. Insurance Quote Forms without phone numbers will not be quoted.
First Name:
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Phone:
Fed Tax ID:
Umemployment Insurance #:
Complete Business
Legal Name:
Address:
City:
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Zip:
Nature of Business:
Type of organization: Corp Partnership Proprietorship
Number of Males/Females: Males Females
Desired Effective Date:
In Force Carrier:

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I understand that this service merely provides a proposal request and is not a Policy of Insurance, Application or Offer to Insure on behalf of any Insurance Company, Agency or Agent. Individual companies reserve the right to accept, reject or modify a proposal after investigation and review.