美商安达产物物业、家居索偿表格（4页）.pdf

Important Information 注意事项:

1. This form must be completed truthfully 

and accurately. If the space is not enough or 

no applicable field is available, please supplement

information by attachment.

请正确填写此申请表。如果表格空间不足或没有适用之栏位，请以附件补充资料。

2. The list of documents required is not exhaustive 

and we reserve our right to request any additional 

information / documentation from you, as

necessary.

各部份之「所需文件」只是概括要求，本公司保留权利在有需要时要求台端提供更多文件以处理有关的索偿申请。

3. The submission of an incomplete form or insufficient 

information or supporting documents may delay the 

processing or result in the denial of

your claim.

如所递交的索偿申请表未填妥或有关资料或文件不足，台端的索偿申请有可能会受到延误或被拒绝。

Part I —General Information 第一部份 —一般资料

Personal Particulars 个人资料

Name of Policyholder 保单持有人名称:

(Eng) (中文)

Name of Insured Person 受保人姓名:

(Eng) (中文)

HKID Card No. of Insured Person 受保人香港身份证号码: Policy No.保单号码:

Date of Birth 出生日期: Gender性别:

M 男 / F 女

Name of Claimant 索偿人姓名: 

(if the Claimant is not the Insured Person 如索偿人不是受保人)