IMPORTANT NOTICE 重要提示
You have to disclose in this Insurance Application
Form all material facts, which shall form the basis
of the contract made between CHINA TAIPING INSURANCE
(HK) COMPANY LIMITED (the Company) and you, otherwise
the policy issued may be void or voidable at the option
of the Company. If you are in doubt whether a fact is
material, please disclose it this insurance Application
Form. Please complete this form in ENGLISH/CHINESE AND
BLOCK LETTERS and tick√the appropriate box below.
您必须在本保险申请书上填报一切重要有关之事实,因為您与中国太平保险(香港)有限公司(本公司)之合约将以这些事实為根据,否则签发之保单将根据本公司的选择而无效或可使无效。如您不清楚某一项是否重要,也请将其事实在本保险申请书上说明。请以正楷英文/中文填写此份投保书,并於下列适当之方格填上√号。
(I) Particulars of Proposer 投保人资料
(Proposer must be aged 18 or above 投保人必须年满18岁或以上)
1. English Name 英文姓名
2. Chinese Name 中文姓名
Surname 姓
Given Name 名
3. Document Type
证件类别□
HKID Card香港身份证□
Travel Document港澳通行证□
Passport护照
4. Sex 性别
□Male 男□ Female 女
Document No.
证件号码
5. Date of Birth
出生日期
D日M月Y年
6. Mobile No.手提电话
7. Home Tel.住宅电话
8. Nationality国籍
□China Hong Kong 中国香港
□Mainland China 中国内地
□China Macau 中国澳门□Other 其他
9. Area of Residence 居住地(stay more than 185 days per year 每年居住超过185天)
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