供公司使用 — 保险中介详情及印章
For company use – intermediary details and stamp
保险中介公司:
Intermediary company:
传真号码:
Fax number:
电邮地址:
Email address:
联络姓名:
Contact name:
官方印章:
Official stamp:
电话号码:
Telephone number:
本投保单应由僱主(投保人)填写。 请使用正楷字体填写本投保单。
投保人必须披露所有重要事实。 如未披露所有重要事实可能会使团体保险保单无效。 重要事实指可能会影响本申请的评估或受理的事实。 如果投保人对于某事实是否重要存在疑问, 投保人应披露该事实。 保险人建议投保人保留一份投保人向保险人提供有关本投保单的所有资料的记录。
如在投保人的投保单填妥后及在保险人的书面接受日期、 支付保费日期或投保人的生效日期/批单签发日(以最迟者为准)前, 发生任何会影响投保人在本投保单中所提供数据的事情(如投保人的任何员工的健康状况发生变化), 投保人须书面告知保险人该等变化。
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