幼童投保问卷（1页）.pdf

(准)保单持有人姓名

Name of (Proposed) Policyholder

(准)受保人姓名

Name of (Proposed) Insured

要保书/保单号码

Application/Policy No.

保险中介人资料 INSURANCE INTERMEDIARY INFORMATION

保险中介人姓名 Name of Insurance Intermediary

保险中介人代码 Insurance Intermediary Code 联络电话 Contact No.

补充陈述资料 SUPPLEMENTARY INFORMATION

本人/我们谨此声明及同意自签署要保书当日至今，本人/我们的职业及健康状况不变，而且没有接受任何诊治或检查，及要保书上的所有答桉

至今真实及不变。 I/WE HEREBY DECLARE AND AGREE that 

there has been no change in my/our occupation and 

health condition, and that I/we have not received

medical attention or consultation or examination 

since the date of the above Application Form was 

signed and all my/our answers as written in the Application Form are

still true and unchanged.

由(准)保单持有人就(准)受保人之情况作答。 To be 

completed by (Proposed) Policyholder on the conditions of (Proposed) Insured.