安盛天平“卓越”环球个人医疗保障投保书-常青藤亲子计划(5页).pdf
重要注释 Important Notes:
1.在填写本投保申请前,您可以要求业务人员向您提供保险条款。请仔细阅读条款,尤其是除外责任、赔偿限额、免赔额、审阅期、保险责任终止等黑体字标注的条款内容,并听取业务人员的说明,如对业务人员的说明有不明白或有异议的,请在填写本投保单之前向业务人员进行询问,如未询问,视同已经对条款内容完全理解并无异议。
Please ask your personal consultant for the
insurance clause before fill in this
application form. Please carefully read
the clause, especially for policy
exclusions, annual limit, deductible, free-look
period, cancellation/termination of cover, and
the others which are all highlighted in bold.
You can enquire of
your consultant if need any clarification before
fill in this application form, otherwise you are
deemed to fully understand the clause and have no objection.
2.请如实填写本表内容并确定所填写的内容全部正确无误,根据保险法和相关规定,如您未履行如实告知义务,则可能会导致保险合同被解除或者本公司不承担相关保险责任。
Under Insurance Law or any subsequent amendment, you
are to disclose in the Application form, fully
and faithfully, all the facts which you know or ought to
know, otherwise the policy issued may be void.
3.投保人对被保险人应当具有保险利益,否则依据保险法合同无效。
A policyholder shall own the insurable interest in
the objects of insurance, otherwise the insurance contract shall be invalid.
4.本投保单为保险合同的重要组成部分。请用蓝色或黑色墨水笔以中文或英文正楷填写,不得涂改,并由投保人、被保险人(或其法定监护人)亲笔签字。
This application form is an important part of the
insurance contract. Please fill in it in Chinese
or English block letters with blue or black ink, and shall not
alter. There must be handwritten signature of the
policyholder and the insured person(s) (or legal guardian).
5.请完整填写下列所有问题,并在适当的空格内填上“X”,如有遗漏,则该问题被视为回答“否”。
Please complete this form by answering carefully
all questions and “X” the boxes where appropriate.
Any question not answered on this form will be taken as
an answer in the negative.
6.退保时,若保险期间内无理赔记录,则按条款列明的退费比例退还保费。若已有理赔记录,则退还保费为零。
For cancellation, premium will be refund
according to “premium refund table” stated
in the clause provided that no claims have
been made during the
insurance period. No premium refund if any claim
has been made.
7.对于直接付费服务,如有任何计算错误或不属保障范围的项目,您有义务接受理赔款的最终调整。
For direct billing service, you are obligated to
accept the final adjustment in charges and actions
if there is any miscalculation or uncovered item according to
the terms and conditions of the Policy.
8.若任何被保险人停止在中国居住超过连续三个月的话,请及时通知本公司。本公司保留改变保费或拒绝承保的权利。
Please inform us immediately if any of the
insureds leave China for a period of three
consecutive months. We reserve the right
to revise the premium or to decline.
9.投保时请提供投保人及所有被保险人的有效的护照或身份证件复印件。
Please provide valid passport / ID copy of
policyholder and all the insureds.
10.若英文译本与中文有异,以中文版本为准。
Should there be any inconsistencies between
Chinese and English versions, the Chinese version shall prevail.