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Liability Insurance Form

Information for Liability Insurance Payment PAYMENTS IN U.S. DOLLARS BANCO SANTANDER Titular: FISA S.A. RUT: 96.955.780-0 Banco: Itaú Tipo de cuenta: Cuenta Corriente Número: 224900702 Dirección: Nueva Costanera 4040 piso -1, Santiago, Chile

IMPORTANT

SERVICES WILL ONLY BE CONSIDERED PAID IF THE DEPOSIT RECEIPT IS SENT ATTACHED IN THE ONLINE FORM. PROJECTS WILL BE REVIEWED FOR APPROVAL ONCE THE ONLINE FORM IS RECEIVED.

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