人寿保险复保申请表(全面核保计划适用)

Year
Month
Business Income Inheritance Return on Investment Salary Saving Others, please state:
Business Income Inheritance Return on Investment Salary Saving Others, please state:
Country of Work Employer’s Name &
v) vi)
Hong Kong Other
Address
viBaidu Nhomakorabea) viii)
Date of Employment Main source of income Funding Source
vii) viii)
Year
Month
vii) viii)
Name of Life Insured in English (Surname first) # # ID Type & No.
X ID Type I = Others ✓ Please mark X in the appropriate boxes to indicate the policy number. HKID P = Passport B = Business Registration Certificate Please ✓ the appropriate box and complete in BLOCK LETTERS. Any changes should be initialed by the Policyholder. C= Certificate of
NOTES:
1. * 2. # Incorporation 3. 4.
X=
: To : Hang Seng Insurance Company Limited
A.
1A.
Personal Details of Proposed Reinstated
(a) Life Insured and Policyholder’s employment details (only applicable for age 18 or above) i) Position ii) iii) iv) Industry Job Activities Job Location Life Insured (b) Policyholder/Joint Life Insured
1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0
Name of Policyholder in English (Surname first) # # ID Type & No.
1B.
✓ Life insured and Policyholder’s salary details (Please ✓ the appropriate box) i) Life insured’s salary details (only applicable for age 18 or above) 10,000 10,001 – 20,000 20,001 – 30,001 – 40,000 40,000 Is your total monthly income (include salary and other cash allowance/bonus) or below, HKD10,001 – HKD20,000, HKD20,001 – HKD30,000, HKD30,001 – HKD40,000 or above HKD40,000? Policyholder’s salary details (only applicable for age 18 or above) 10,000 10,001 – 20,000 20,001 – 30,001 – 40,000 40,000 Is your total monthly income (include salary and other cash allowance/bonus) or below, HKD10,001 – HKD20,000, HKD20,001 – HKD30,000, HKD30,001 – HKD40,000 or above HKD40,000? 30,000 HKD10,000
HASEFTX
PICS (06/2014)
Policy Number*
*
Life Insurance Reinstatement Form (Applicable to Full Underwriting Version)
Plan Type
11 22 33 44 55 66 77 88 99 00
1 2 3 4 5 6 7 8 9 0
i) ii) iii) iv) Indoor Work Outdoor Work Indoor & Outdoor Work
i) ii) iii) iv) Indoor Work Outdoor Work Indoor & Outdoor Work v) vi) Hong Kong Other
v) vi)
ii)
30,000 HKD10,000
IL344-R7 (YX) 1-7 01/17 H
A.
Personal Details of Proposed Reinstated (cont’d)
Yes No □ Yes □ No □
2.
Are you covered by any life/medical/hospital cash/critical illness insurance policy (excluding group insurance)? If the answer is “Yes”, please give information below. Name of Insurance Company Year Issued