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保险中介人姓名

Name of Insurance Intermediary

分行及员工编号

Branch Code & Staff No.

联络电话

Contact Tel No.

注意事项 Notes:

(1) 请用正楷填写。

Please complete in BLOCK LETTERS.

(2) 请于适用处加「 」。

Please tick 「 」 where appropriate.

(3) 保单权益人必须在此表格每页「保单权益人签署」位置签署。 

Policy Owner MUST sign in "Signature of the 

Policy Owner" on each page of this form.

(4) 保单权益人必须在此表格内任何更改或修改的地方签署作实。 

Any changes or amendments in this form MUST be 

countersigned by Policy Owner in full signature.

(5) 保单权益人请于签署日期三十日内递交申请表至本公司。 

Please submit the signed form to the Company within 30 days.

(6) 如为直销产品，请提供保单权益人之身份证明文件核实真实副本。 

For Direct Marketing Products, please submit certified 

true copy of identity document of Policy Owner.

保单编号

Policy Number

受保人姓名

Name of the Insured

第一部份 PART I

取消 增大 级别 / 计划

Cancel Increase

新保额/名义金额/每月保证年金入息 (if applicable)