Please tick appropriate box(es) for
request 5 New Request 5 Reply
Policy Number: Full Name of Insured:
* Full Name of Policyowner:
In compliance with the Anti-Money Laundering
and Counter-Terrorist Financing (Financial
Institutions) Ordinance and the Guideline on
Anti-Money Laundering and Counter-Terrorist
Financing which is issued by the OKce of the
Commissioner of Insurance as amended from
time to time and to comply with industry guidelines,
Chubb Life Insurance Company Ltd. is required to
review customer identity information
to ensure they are up-to-date and relevant. You
are required to complete the relevant section(s)
below if (i) there is any change of customer
identity information provided in the original
policy application, any subsequent change of
policyowner identity information you made
previously, or you have become an US citizen
or resident in US for tax purpose; or (ii)
you wish to provide Chubb Life Insurance Company
Ltd. your US-related status (e.g. place of birth,
citizenship and residency). By completing this
form, you may also be required to provide the
identity information and original identiUcation
documents proof, and if necessary, the appropriate
US tax form(s) for identiUcation, veriUcation
and further assessment.
1. Change of Personal Information
5 Insured
5 Policyowner
(Please give documentary proof for
Insured/Policyowner e.g. copy of HKID
[获授权保险人名称]投连寿险保单名称:第一部 : 重要数据声明书阁下应细阅本声明书及产品数据文件(包括产品小册子、产品数据概要及利益说明文件)。若阁下不明白以下的任何一段、或不同意以下的任何特定段落、或阁下的持牌保险中介人的讲述与阁下所阅读或理解本声明的内容有异,请勿签署确认或购买此投连寿险保单。阁...
已下载:0次 是否免费:否 上传时间:2020-03-22Policy 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/COAgent’s Questionnaire - PRC Pol...
已下载:0次 是否免费:否 上传时间:2020-02-17Policy Number:保单编号:Proposed Insured:準受保人:Applicant/Owner: (if other than Proposed Insured):保单申请人/持有人 (如非準受保人)IMPORT NOTE TO APPLICANT/OWNER/BENEFICIAL...
已下载:0次 是否免费:否 上传时间:2020-02-11安达人寿金融机构代缴保险费授权书
已下载:0次 是否免费:否 上传时间:2020-01-18Important 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, p...
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