人保健康康源全球医疗保险投保申请表（个人和家庭）（10页）.pdf
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If you have any questions or need any assistance
in completing this form please call us on 400-822-0911
如果您在填写表格时有任何的疑问需要我们协助，请拨打我们的热线400-822-0911，我们将竭诚为您服务。
HPAP1507
Please complete this form clearly
in BLOCK CAPITALS. 敬请用英文大写或中文正楷完整清晰地填写以下内容。
Your duty of disclosure 您的如实告知义务
The questions in this form and any other information
we ask for are essential for us to underwrite and
administer your plan. You must tell us about all
material facts before we can accept an application
or renew the plan. If you do not tell us all
material facts or misrepresent any material facts, it may
affect your rights or your dependants’ rights under
the plan. A material fact is information likely to
influence us in assessing or accepting the insurance. If
there is any doubt about whether a fact is material,
for your own protection, you must tell us. Failure to
answer all questions fully and honestly may
invalidate your insurance. A copy of the completed
application form can be supplied on request, but you
should keep a record of all information you supply
to us, including copies of all letters. 请如实回答申请表上的问题连同我们询问的细节，或是我们认为对于核实您的保险计划所必需的信息和涉及到的事实。您需提供所有的重要事实，我们才能受理 新单申请或续保。如果您所提供的材料不属实或存在任何歪曲事实的情况，可能会影响您及被保险人的权益。属实的材料是我们核保时的重要参考。如果在回答问题时，您不清楚 一个事实是否是我们所需要的资料，为了您的自身权益，您也应该如实告知。您需提供完整的投保申请表，并对提供给我们的所有信息予以保存，包括所有邮件副本。
We must receive all outstanding information
before we can process your application.
If you do not complete this form in full it will cause delays.
若您未能完整填写本投保单将会延长投保流程，我们会在收到完整表格后才继续进行审核。
A -- Main Applicant Details 投保人的信息
Title 称谓： Mr 先生 Mrs 太太 Miss 小姐 Ms 女士 Other 其他：
Family name 姓: First name(s) 名:
Date of Birth 生日 (dd/mm/yy): Sex 性别: M 男 F 女
in completing this form please call us on 400-822-0911
如果您在填写表格时有任何的疑问需要我们协助，请拨打我们的热线400-822-0911，我们将竭诚为您服务。
HPAP1507
Please complete this form clearly
in BLOCK CAPITALS. 敬请用英文大写或中文正楷完整清晰地填写以下内容。
Your duty of disclosure 您的如实告知义务
The questions in this form and any other information
we ask for are essential for us to underwrite and
administer your plan. You must tell us about all
material facts before we can accept an application
or renew the plan. If you do not tell us all
material facts or misrepresent any material facts, it may
affect your rights or your dependants’ rights under
the plan. A material fact is information likely to
influence us in assessing or accepting the insurance. If
there is any doubt about whether a fact is material,
for your own protection, you must tell us. Failure to
answer all questions fully and honestly may
invalidate your insurance. A copy of the completed
application form can be supplied on request, but you
should keep a record of all information you supply
to us, including copies of all letters. 请如实回答申请表上的问题连同我们询问的细节，或是我们认为对于核实您的保险计划所必需的信息和涉及到的事实。您需提供所有的重要事实，我们才能受理 新单申请或续保。如果您所提供的材料不属实或存在任何歪曲事实的情况，可能会影响您及被保险人的权益。属实的材料是我们核保时的重要参考。如果在回答问题时，您不清楚 一个事实是否是我们所需要的资料，为了您的自身权益，您也应该如实告知。您需提供完整的投保申请表，并对提供给我们的所有信息予以保存，包括所有邮件副本。
We must receive all outstanding information
before we can process your application.
If you do not complete this form in full it will cause delays.
若您未能完整填写本投保单将会延长投保流程，我们会在收到完整表格后才继续进行审核。
A -- Main Applicant Details 投保人的信息
Title 称谓： Mr 先生 Mrs 太太 Miss 小姐 Ms 女士 Other 其他：
Family name 姓: First name(s) 名:
Date of Birth 生日 (dd/mm/yy): Sex 性别: M 男 F 女
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