Completion of this report is required when total
amount at risk is over US$1,500,000 on waged
applicants, or over US $500,000
on non-waged applicants (housewife, juvenile,
student, retiree), or as requested by Underwriting
Department. Total amount at
risk is the sum of life coverage, extra pay dread
disease benefits in all companies. 以下情况必须填写本表格：受薪申请人的承
担风险总值超过 1,500,000 美元；或非受薪申请人（家庭主妇、未成年人、学生、退休人士）的承担风险总值超过 500,000美元；或被核保部要求填写本表格。承担风险总值為申请人於所有公司的人寿及额外危疾保额之总和。
Name of proposed insured
Policy no. 保单编号____________________
Background Information 背景资料 背景资料背景资料 背景资料
1. How long have you known the proposed insured?
2. What was the source of this business?
□ Proposed insured contacting agent
□ Agent contacting proposed insured
□ Referred from accountant / lawyer 由会计师 / 律师转介由会计师 / 律师转介
□ Other (please specify) 其他（请註明）
3. Please give a brief background description
of the persons involved in this application.
If the proposed insured is a
merchant, please advise the business structure (e.g.
partnership, limited company … etc), the nature of
of employees, your opinion of the business standing
and operation and details of the skills and acumen that the proposed
insured brings to the business. 请简单描述此项申请之有关人士的背景。如拟受保人為商人，请说明业务架构（例如：合伙经营、有限公司等）、业务性质、僱员数目、你对其业务及经营状况的评语，以及拟受保人与其业务相关的专业技术及管理能力。