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Policy Number: Full Name of Insured:
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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
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已下载:0次 是否免费:否 上传时间:2024-01-29保单号码:批单号码:要保人:主被保险人:主被保险人身分证字号:保险期间:自年月日时起,至年月日时止,共日。批改类型□自始退保。适用对象:□全体被保险人适用对象:□以下被保险人:注.须在保单生效日期前提出批改申请。□提前终止保期,保险期间缩短至年月日时终止适用对象:□全体被保险人适用对象:□以下被保险...
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