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投保单位：                                                                                     
保单号码:   G                                                            
预定生效日:     年  月  日（须为受理日之后，空白视为受理日）                                                                                        
本页人数：     人；第    页 共    页 
                                                    
选项    姓  名    (与身份证件一致)    性别    国籍                                                                                
出生年月日         (非中国居民身份证,此项必填)                                
工作内容描述    职业等级    保险计划    与投保单位关系    眷属被保险人必填栏        
被保险人  签名 
                                                                                                    
被保险人姓名    关系    
                                                                                                
填写说明及签章栏位:                                                                                                               
投保单位签章：                
1.此表适用于短险(一年期)。保单约定，被保险人的身故受益人为其法定继承人。                                                            
6.工作内容描述：指被保险人所从事工作的具体范围或内容。                                                                            
2.预定生效日并非最终确定之生效日，最终确定之生效日由保险公司核保认定。                                                                
7.职业等级：为投保单位之职业等级初步认定，最终结果由保险公司核保认定。