安达产物保险代理问卷-中国居民保险（1页）.pdf

Policy No.: 

Proposed Insured: 

Applicant/Owner: (if other than Proposed Insured)

保单编号 

準受保人 

保单申请人/持有人(如非準受保人)

NB212/0516/CO

Agent’s Questionnaire - PRC Policy

保险代理问卷 - 中国居民保险

1. How do you know the Proposed Insured? 您如何认识準受保人？

□ Approached by the Proposed Insured 由準受保人主动接触

□ Introduced by *Relative / Friend / Existing Client 亲戚 /朋友 / 现有客户介绍

□ Well for 深交认识已 ___________ years 年

□ Casually for 普通认识已 ___________ years 年

□ Relative 亲戚，relationship 关係 ___________

* Please delete the inappropriate item. 请删去不适用者

2. Where did you rst meet the Proposed Insured? 您在哪裡首次会见準受保人？

□ In Hong Kong 在香港

□ In PRC 在中国

I, the agent of the policy application, hereby 

declare and conrm that the entire marketing and 

selling process in respect of the insurance

application has been conducted in Hong Kong 

Special Administration Region (HKSAR), which 

includes but not limited to:

1. I gave all of the insurance related 

marketing materials to the Proposed 

Insured/Applicant/Owner in HKSAR;

2. I did not solicite or approach 

the Proposed Insured/Applicant/Owner 

in PRC or through other means of 

communication initiated from Hong Kong;

3. I explained the details of the insurance 

plan to the Proposed Insured/Applicant/Owner in HKSAR

4. I witnessed the Proposed Insured/Applicant’

s/Owner’s signature(s) on the application in HKSAR

5. I collected the initial premium in respect 

of the insurance application in HKSAR

本人，即本保单的保险代理谨此声明及确认，有关之投保申请之整个宣传及销售过程，包括但不限於以下各项，均在香港特别行政区境内进行：

1. 本人在香港特别行政区境内给予有关保险之宣传刊物予準受保人/保单申请人/持有人

2. 在中国内地，本人没有进行向準受保人/保单申请人/持有人推销或接洽或透过其他形式在香港特别行政区境内向中国内地的準受保人/保单申请人/持有人作出类似销售过程