大地产险全球医疗保险团体投保单（3页）.pdf
已下载：0 次 是否免费： 否 上传时间：2016-04-06
投保须知 NOTICE
1. 为使贵单位充分了解投保内容并维护贵单位的权益，投保前请贵单位仔细阅读本保险相关内容和条款，确认已充分理解保险责任、责任免除、如实告知、合同解除等重要事项后做出投保决定。
In order for you to fully understand the insurance
applied for and so as to protect your rights and
interests, please make a decision
about applying for the group health plan after you
carefully read relevant insurance contents and
policy wording and you fully
understand important issues like benefits, exclusions,
honest disclosure and contract cancellation.
2. 投保单、被保险人清单及其它保险人认为有必要的资料（以下简称“投保资料”）是本公司签发保险单的依据，将成为保险合同的重要组成部分，对于本公司提出的各项询问，投保人、被保险人须如实告知，本公司承诺对投保资料内容保密。
The Application Form, List of Insured Members and
other files deemed necessary by the Insurer
(hereinafter “application files”) are
basis for the Insurer to issue the Insurance
Contract and will be an important part of the
Insurance Contract. For all inquires of the
Insurer, the Policyholder and Insured should
disclose honestly, the Insure r guarantee to
keep confidential of the application files.
3. 本投保单须加盖投保人公章并由投保单位法定代表人和授权经办人签名（章）确认。所有投保资料须加盖骑缝章。授权经办人的所有行为将全权代表投保人的意愿。
The Application Form should be sealed by
the Policyholder and signed by the legal
representative or authorized person of the
Policyholder. All the application files should
be sealed on the perforation. All the acts of
the authorized person are fully representing the
Policyholder’s will.
4. 若贵单位已填写投保资料并签章，将视为投保人已充分理解保险条款并同意遵守。
If you fill in and sign/seal the application
files, it should be regard that the Policyholder
is fully understand the policy wording and agree
to abide by it.
投保人信息 APPLICANT DETAILS
团体中文名称 Company or Group Name in Chinese:
团体英文名称 Company or Group Name in English:
邮寄地址 Mailing Address:
电话 Telephone
传真Fax:
行政管理人姓名 Name of Administrator/Director
电子邮件 Email Address
联络人姓名和职位 Name and Position of Contact Person
电子邮件 Email Address
保险信息 COVERAGE
起保日期Policy Effective Date:
(月/日/ 年MM/DD/YYYY)
大陆及港澳台保障（保障地域：中国大陆，香港，澳门和台湾地区）
Greater China (Mainland China, Hong Kong, Macao and Taiwan)
大陆及港澳台增强保障（保障地域同大陆及港澳台保障, 以及在中国大陆，香港，澳门和台湾地区以外地区发生的紧急医疗费用）
Greater China Plus (Emergency Coverage outside
Mainland China, Hong Kong, Macao and Taiwan)
国际保障（保障地域：美国和加拿大以外的所有国家和地区）
International (No Coverage in the U.S. and Canada)
1. 为使贵单位充分了解投保内容并维护贵单位的权益，投保前请贵单位仔细阅读本保险相关内容和条款，确认已充分理解保险责任、责任免除、如实告知、合同解除等重要事项后做出投保决定。
In order for you to fully understand the insurance
applied for and so as to protect your rights and
interests, please make a decision
about applying for the group health plan after you
carefully read relevant insurance contents and
policy wording and you fully
understand important issues like benefits, exclusions,
honest disclosure and contract cancellation.
2. 投保单、被保险人清单及其它保险人认为有必要的资料（以下简称“投保资料”）是本公司签发保险单的依据，将成为保险合同的重要组成部分，对于本公司提出的各项询问，投保人、被保险人须如实告知，本公司承诺对投保资料内容保密。
The Application Form, List of Insured Members and
other files deemed necessary by the Insurer
(hereinafter “application files”) are
basis for the Insurer to issue the Insurance
Contract and will be an important part of the
Insurance Contract. For all inquires of the
Insurer, the Policyholder and Insured should
disclose honestly, the Insure r guarantee to
keep confidential of the application files.
3. 本投保单须加盖投保人公章并由投保单位法定代表人和授权经办人签名（章）确认。所有投保资料须加盖骑缝章。授权经办人的所有行为将全权代表投保人的意愿。
The Application Form should be sealed by
the Policyholder and signed by the legal
representative or authorized person of the
Policyholder. All the application files should
be sealed on the perforation. All the acts of
the authorized person are fully representing the
Policyholder’s will.
4. 若贵单位已填写投保资料并签章，将视为投保人已充分理解保险条款并同意遵守。
If you fill in and sign/seal the application
files, it should be regard that the Policyholder
is fully understand the policy wording and agree
to abide by it.
投保人信息 APPLICANT DETAILS
团体中文名称 Company or Group Name in Chinese:
团体英文名称 Company or Group Name in English:
邮寄地址 Mailing Address:
电话 Telephone
传真Fax:
行政管理人姓名 Name of Administrator/Director
电子邮件 Email Address
联络人姓名和职位 Name and Position of Contact Person
电子邮件 Email Address
保险信息 COVERAGE
起保日期Policy Effective Date:
(月/日/ 年MM/DD/YYYY)
大陆及港澳台保障（保障地域：中国大陆，香港，澳门和台湾地区）
Greater China (Mainland China, Hong Kong, Macao and Taiwan)
大陆及港澳台增强保障（保障地域同大陆及港澳台保障, 以及在中国大陆，香港，澳门和台湾地区以外地区发生的紧急医疗费用）
Greater China Plus (Emergency Coverage outside
Mainland China, Hong Kong, Macao and Taiwan)
国际保障（保障地域：美国和加拿大以外的所有国家和地区）
International (No Coverage in the U.S. and Canada)
立即下载
立即收藏