I. 保单持有人/受保人(病人)资料
Details of Policy Holder/Insured Person(Patient)
由保单持有人或受保人(病人)填写
To be completed
by the Policy Holder or the Insured Person(Patient)
保单持有人姓名
保单号码
受保人号码(如适用)
Name of Policy Holder Policy No. Insured Person No.
(ifapplicable)
受保人(病人)姓名
聯络电话
香港身份证号码
Name of Insured Person
(Patient)
Contact Telephone No. H.K.I.D. No.
II. 治疗详情及评估
Treatment Details and Assessment
治疗详情由医生填写
Treatment Details to be completed by Doctor
诊断 Diagnosis
入院日期 Date of Admission
医院名称 Name of Hospital
病房级别 Level of Accommodation
预计入住的病房级别
Intended Level ofAccommodation
私家房 Private
半私家房 Semi-private
普通房 Ward
日间/诊所手术 Day Case/Clinical
Insuring AgreementThe Insured having paid or agreed to pay to the Company the premium andthe Company agree to provide coverage during the period of in...
已下载:0次 是否免费:否 上传时间:2024-04-19Insuring AgreementThis is your Golfer Insurance Policy and is the evidence of the contract madebetween you and us (“Paofoong Insurance Company (Hong K...
已下载:0次 是否免费:否 上传时间:2024-04-18Insuring AgrementWheres the Insued by a popsal and declanaian which shall be the basisof this contact and is deemed∞be incoponted herein has applied t...
已下载:0次 是否免费:否 上传时间:2024-04-17Insuring AgreementNow this Policy witnesseth that in consideration of ti汜 Insured having paidor agreed to pay to Paofoong Insurance Co. (H.K.) Ltd. (h...
已下载:0次 是否免费:否 上传时间:2024-04-16(1) Insuring ClauseThe Insured and the Company agree:a. the Proposal and Declaration is incorporated and is the basis of thisinsurance contract;b. the...
已下载:0次 是否免费:否 上传时间:2024-04-12供公司使用 — 保险中介详情及印章For company use – intermediary details and stamp保险中介公司:Intermediary company:传真号码:Fax number:电邮地址:Email address:联络姓名:Contact name:官方印章...
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