保险专业资源下载网站

Claim Type 赔偿类别 

□ Medical Beneft

□ Weekly Accident Indemnity

□ Accidental Dismemberment

□ New claim 首次索偿 

□ Pending claim 待决索偿 

□ Further claim 再度索偿 

□ Review/appeal 重批/覆核

Please provide claim no. for reference 请提供赔偿编号以作参考

Part I (To Be Completed by Claimant/Insured) 甲部（由索偿人／受保人填写）

A. Insured’s Particulars 受保人资料

Policy no.

保单编号

Insured’s name

受保人姓名

HKID card/passport no.

香港身份证／护照号码

Date of birth

出生日期

DD日MM月YYYY年

Sex性别

Age年龄

Tel. no.电话号码

B. Employment Particulars 就业详情

1. Present occupation 现时职业 

Duties 工作范围 

Employer’s name, address & tel. no. 

僱主名称、地址及电话

If more than one occupation, state all and exact nature of occupational duties.