永诚全球医疗计划申请表(16页).rar
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主被保险人:个人信息
MAIN APPLICANT: PERSONAL DETAILS 2
主被保险人:详细地址
MAIN APPLICANT: ADDRESS DETAILS 3
主被保险人:其他联系信息
MAIN APPLICANT: OTHER CONTACT DETAILS 4
=Main Applicant
=主被保险人
=1st Additional Person
=连带被保险人1
=2nd Additional Person
=连带被保险人2
=3rd Additional Person
=连带被保险人3
=4th Additional Person
=连带被保险人4
Sections 2 and 5:
Personal details
-第2部分和第5部分:个人信息 第7部分:病史信息 第8部分:其他信息 第9部分:选择您的保障选项
Section 7:
Medical history
Section 8:
Additional information
Section 9:
Choose your options
This section asks for health and medical details,
past and present, about the Main Applicant and
each Additional Person named in Section 5. Please
tick Yes or No to every medical
problem for every person. If you tick Yes toa
medical problem, please give full details in
Section 7.Please ensure you tell us about any
known or suspected conditions and symptoms
even if advice has not yet been sought from a
healthcare professional. If you are applying
toincrease cover and the Main Applicant or any
Additional Person are already insured by
Alltrust in Mainland China or byBupa outside
Mainland China, you should also include details
of any conditions for which claims havebeen
made within the last seven years.
You must disclose all material facts which
could infl uence the assessment and acceptance
of this application. If you are in any doubt
as towhether any facts are material, you should
disclose them. If you do not provide full
details, the cover may be terminated and the
claims may not be paid. Please note thatif
a condition or symptom is disclosed, it does
not imply
coverage. The policy terms and exclusions
will normally still apply toany disclosed
condition or symptom.
If you do not provide us with full details
wemay terminatethe cover or it may stop
us from paying claims.
MAIN APPLICANT: PERSONAL DETAILS 2
主被保险人:详细地址
MAIN APPLICANT: ADDRESS DETAILS 3
主被保险人:其他联系信息
MAIN APPLICANT: OTHER CONTACT DETAILS 4
=Main Applicant
=主被保险人
=1st Additional Person
=连带被保险人1
=2nd Additional Person
=连带被保险人2
=3rd Additional Person
=连带被保险人3
=4th Additional Person
=连带被保险人4
Sections 2 and 5:
Personal details
-第2部分和第5部分:个人信息 第7部分:病史信息 第8部分:其他信息 第9部分:选择您的保障选项
Section 7:
Medical history
Section 8:
Additional information
Section 9:
Choose your options
This section asks for health and medical details,
past and present, about the Main Applicant and
each Additional Person named in Section 5. Please
tick Yes or No to every medical
problem for every person. If you tick Yes toa
medical problem, please give full details in
Section 7.Please ensure you tell us about any
known or suspected conditions and symptoms
even if advice has not yet been sought from a
healthcare professional. If you are applying
toincrease cover and the Main Applicant or any
Additional Person are already insured by
Alltrust in Mainland China or byBupa outside
Mainland China, you should also include details
of any conditions for which claims havebeen
made within the last seven years.
You must disclose all material facts which
could infl uence the assessment and acceptance
of this application. If you are in any doubt
as towhether any facts are material, you should
disclose them. If you do not provide full
details, the cover may be terminated and the
claims may not be paid. Please note thatif
a condition or symptom is disclosed, it does
not imply
coverage. The policy terms and exclusions
will normally still apply toany disclosed
condition or symptom.
If you do not provide us with full details
wemay terminatethe cover or it may stop
us from paying claims.