传统计划投保申请书(8页).pdf
已下载:0 次 是否免费: 否 上传时间:2017-04-12
Important Notes 重要事项:
This application is issued in conjunction with
the illustration document.
此申请书连同建议书一併发出。
Please complete this application form in BLOCK
letters and put a “ ” in the appropriate box(es).
请以正楷填写此申请书,并在适当方格内加上「 」号。
PLEASE DO NOT DETACH 请勿撕去
Please affix the policy no. here
请在此贴上保单编号
(For office use only 公司专用)
*OBJTAPPLFORM*
*FORMB03012014*
PART A: PERSONAL DETAILS
第一部份:个人资料
1. Name 姓名
(as shown on Identity card/
Passport/ Business Registration
如身份证/护照/商业登记证上所示)
2. Sex 性别
3. Date of birth 出生日期
5. Relationship to proposed insured
与拟受保人的关係
6. Identity card/Passport/
Business Registration no.
身份证/护照/商业登记号码
11. Name of employer and office
address
僱主名称及办事处地址
(It is optional for application of
ManuGuard Medical Plan
如申请「守护一生医疗保障计
划」可省略此问题)
7. Nationality 国籍
(ii) Policyowner 保单持有人
(need not be answered if policyowner is the same
as the proposed insured
如保单持有人為拟受保人则无须填写)
(i) Proposed Insured 拟受保人
In English 英文姓名
Surname姓 Given name名
In English 英文姓名
Surname姓 Given name名
In Chinese
中文姓名
In Chinese
中文姓名
Not applicable 不适用
(please attach copy
请附上副本)
DD日 MM 月 YYYY 年
< B03 (01/2014) >
(please attach copy
请附上副本)
10. Average monthly income
during the past 12 months
过去十二个月内每月平均收入
8a. Occupation 职业
8b. Business nature 业务性质
8c. Details of job 主要工作职务
9. Are you owner or senior
m a n a g e m e n t o f y o u r
employed company
阁下是否受僱公司的拥有人
或高级管理层?
HKD 港元 /per month 每月HKD 港元 /per month 每月
4. Insurance age 投保年龄(age in whole year
at the nearest birthday
最接近生日之年龄) Not applicable 不适用
DD日 MM 月 YYYY 年
The Chinese version of this application is for
reference only. In the event of conflicts between
the Chinese and the English versions, the English
version shall prevail.
此申请书之中文译本只供参考之用,若与英文有异,一概以英文為準。
This application is issued in conjunction with
the illustration document.
此申请书连同建议书一併发出。
Please complete this application form in BLOCK
letters and put a “ ” in the appropriate box(es).
请以正楷填写此申请书,并在适当方格内加上「 」号。
PLEASE DO NOT DETACH 请勿撕去
Please affix the policy no. here
请在此贴上保单编号
(For office use only 公司专用)
*OBJTAPPLFORM*
*FORMB03012014*
PART A: PERSONAL DETAILS
第一部份:个人资料
1. Name 姓名
(as shown on Identity card/
Passport/ Business Registration
如身份证/护照/商业登记证上所示)
2. Sex 性别
3. Date of birth 出生日期
5. Relationship to proposed insured
与拟受保人的关係
6. Identity card/Passport/
Business Registration no.
身份证/护照/商业登记号码
11. Name of employer and office
address
僱主名称及办事处地址
(It is optional for application of
ManuGuard Medical Plan
如申请「守护一生医疗保障计
划」可省略此问题)
7. Nationality 国籍
(ii) Policyowner 保单持有人
(need not be answered if policyowner is the same
as the proposed insured
如保单持有人為拟受保人则无须填写)
(i) Proposed Insured 拟受保人
In English 英文姓名
Surname姓 Given name名
In English 英文姓名
Surname姓 Given name名
In Chinese
中文姓名
In Chinese
中文姓名
Not applicable 不适用
(please attach copy
请附上副本)
DD日 MM 月 YYYY 年
< B03 (01/2014) >
(please attach copy
请附上副本)
10. Average monthly income
during the past 12 months
过去十二个月内每月平均收入
8a. Occupation 职业
8b. Business nature 业务性质
8c. Details of job 主要工作职务
9. Are you owner or senior
m a n a g e m e n t o f y o u r
employed company
阁下是否受僱公司的拥有人
或高级管理层?
HKD 港元 /per month 每月HKD 港元 /per month 每月
4. Insurance age 投保年龄(age in whole year
at the nearest birthday
最接近生日之年龄) Not applicable 不适用
DD日 MM 月 YYYY 年
The Chinese version of this application is for
reference only. In the event of conflicts between
the Chinese and the English versions, the English
version shall prevail.
此申请书之中文译本只供参考之用,若与英文有异,一概以英文為準。