YAIC Health Plan Application Form(4页).pdf
NOTICE
1.In order for you to fully understand the insurance applied
for and so as to protect your rights and interests, please
ask sales representative/broker for the policy wording and
detailed explanations of the policy wording, particularly in
terms of important contents such as benefits and exclusions
before apply. Please make your application decision only when
sales representative has explained the policy wording;
you have carefully read relevant insurance contents and policy
wording; and you have fully understood important issues like
benefits, exclusions, honest disclosure and contract cancellation.
2. For all inquiries of the Insurer, the Policyholder and the
Insured should disclose honestly (any option shall be ticked by X)
and any question not answered on this form will be taken as an
answer in the negative. 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. The Insurer
guarantee to keep confidential of the application files.
3. The application form may only be signed by the policyholder.
No other party or person may sign on behalf of the policyholder.
If you fill in and sign the application files, it should be
regard that you fully understand the policy wording and agree
to abide by it. 4.The purpose of the Medical Questionnaire
is to evaluate the health conditions for you and your
dependents (if any) and to determine coverage, please answer
the questions below as truthfully and thoroughly as possible.
Pre-existing conditions, if any, will not be covered unless
approved by the insurer. For the purpose of your health insurance,
Pre-existing conditions are defined as "any Illness or Injury,
physical or mental condition, for which an Insured Person received
any diagnosis, medical advice or treatment, or had taken any
prescribed drug, or where distinct symptoms were evident
prior to the effective date."