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This form is applicable to both inpatient 

and outpatient surgical claim

索偿手续 CLAIM PROCEDURE

1. 此申请表须填写有关资料及签署，并于接受治疗后60日内连同收据正本交回中国交银保险有限公司理赔部。如逾期递交或所需资料不全，索偿申请将不受办理。

Claim Form should be

completed & signed before submitted to China BOCOM 

Insurance Co., Ltd. together with original 

bill(s)/receipt(s) within 60 days from date of 

consultation / treatment. NO

reimbursement will be made for late submission 

or with insufficient information.

2. 须附详细医疗费用账单暨收据正本。提供治疗日期，病者姓名，病症名称，收费项目及主诊医生之印鑑及签署。 

Original bill(s) and receipt(s) for the claimed 

expenses must be

attached showing the date of treatment, patient’s 

name, diagnosis, breakdown of services charge and 

the attending registered medical practitioner’s 

stamp and signature.

3. 请连同病理学，内窥镜，诊断性化验/ 检验报告，手术室撮要副本交回。