团体商务旅行意外伤害保险索赔申请表(5页).pdf
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索赔申请人应正确详细填写此申请表,并连同后页所列索赔所需的文件于索赔事由发生 30 天内交至:
Please complete this form as truthfully and accurately
as possible, and return this with the supporting
documents listed in this form below within 30
days after the occurrence to:
发送电子邮件至:
或邮寄至
For Official Use Only
Claims Officer Name:
Claim No.:
Policy Holder Information 投保人资料
Name of Policy Holder:
投保人名称:
Policy No:
保险单号码:
Name of Contact:
联系人名称:
Telephone No.:
电话号码:
Contact Address/Email:
联络地址/电邮:
Insured / Claimant Information
被保险人/索赔申请人资料
Name of Insured:
被保险人名称:
Age:
年龄: