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申请书编号

Proposed Insured:

准受保人

Applicant/Owner: (if other than Proposed Insured)

保单申请人/持有人(如非准受保人)

Part A – General Information 甲部 – 基本资料

1. Height

身高

centimetres (cm)

厘米OR或feet/inches呎/吋

2. Weight

体重

kilogrammes (kg)

公斤OR或pounds (lbs)磅

Please the appropriate boxes 请在适当方格上填上 Yes 是 No 否

3. Smoking habit 吸烟习惯

Do you smoke or have you smoked in the last 1 year?

您有没有吸烟或在过去一年内曾否吸烟？

For the purpose of this question, the meaning of 

“smoking” includes but is not limited to cigarettes, cigars, tobacco pipes,

chewing tobacco and the use of nicotine replacement 

products (such as e-cigarettes).

「吸烟」在此问题的含义包括但不限于香烟、雪茄、烟斗、嚼烟及使用尼古丁补充剂产品（例如：电子烟）。

If the answer is “Yes”, please answer the following questions

如果答桉属「是」，请回答以下问题