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Name of life insured Name of policyholder/assignee

受保人姓名 保单持有人╱受让人姓名

Important notes重要事项

1. This questionnaire is only applicable where 

the total premium amount is within the cap under the designated product.

此问卷只适用于当指定产品的总保费金额于上限内。

2. You have to disclose ALL material facts and 

information in this questionnaire which shall form 

the basis of our contract, otherwise the policy

issued may be void or voidable. In the event of 

doubt as to whether a fact or information is material, 

it should be disclosed in this questionnaire.

阁下必须在本问卷上如实地填报一切重要事实及资料，而阁下与本公司之合约将以这些事实及资料为根据，否则已缮发之保单将告无效或被视为无效。若 阁下对事实或资料的重要性生疑，请将之披露及说明在本问卷上。

3. The original of this questionnaire and supporting 

documents you have submitted will not be returned.

阁下所递交之正本问卷及所需文件将不获退还。

4. Please ensure all signature boxes are duly signed 

by the policyholder/assignee and life insured (if 

the attained age is 18 or above).

请确保保单持有人╱受让人及受保人（若受保人年龄为18岁或以上）已妥善签署所有签署位置。

5. Please fill the circle in full 

when you select the answer.

当 阁下选择答桉时，请填满整个圆圈。