卓越旅行家个人旅行意外伤害保险投保单（2017版）

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1、卓越旅行家个人旅行意外伤害保险投保单（2017版）SMARTTravelerProtectionProposalForm投保人资料ProposerDetails*投保人姓名NameofProposer:国籍Nationality:职业Occupation:联系电话Tel.No.:*出生日期（日/月/年）DateofBirth(DD/MM/YY)*投保人身份证/护照号码IDcard/passportNo.ofProposer:通讯地址CorrespondenceAddress:邮政编码PostCode

2、:被保险人资料DetailsofTheInsuredPerson(s)（附属被保险人须为主被保险人的配偶或子女TheInsuredpersonsshouldbethespouseorchild(ren)oftheMainInsured）主被保险人MainInsured附属被保险人（1）InsuredPerson(1)附属被保险人（2）InsuredPerson(2)附属被保险人（3）InsuredPerson(3)*姓名Name性别Gender*身份证/护照号码Passport/IDNo.*出生日期

3、（日/月/年）DateofBirth(DD/MM/YYYY)国籍Nationality职业Occupation*与投保人关系RelationshiptoProposer本人Self保险费(人民币:元)Premium(RMB:Yuan)总保险费(人民币:元)TotalPremium(RMB:Yuan):____________________如被保险人为未成年人，请回答下列问题Pleaseanswerbelowquestionsifanyinsuredisunder18yearsold:是否在本公司或

4、者其他公司投保以死亡为给付保险金条件人身保险HaveyoupurchasedanypersonalinsurancewithdeathbenefitsfromAXATianpingProperty&CasualtyInsuranceCompanyLimitedorotherinsurers?是Yes  否No如有，请分别列明投保金额IfYes,pleasespecifytheSumInsuredofdeathbenefitsofeachpolicyseparatelywithInsurer(s)’n

5、ame(s)__身故保险金受益人(DeathBeneficiary)（若身故受益人资料为空白，身故保险金将作为被保险人之遗产；若未填写受益份额，身故保险金受益人将按照相等份额享有身故保险金。ThedeathbenefitsshallbepaidtotheestateoftheInsuredifNameofBeneficiaryleavesblank.Iftheshareofbenefitsarenotstated,thebeneficiariesshallbeentitledtoequalshare

6、ofthedeathbenefits）被保险人姓名Name oftheInsuredPerson身故保险金受益人姓名NameofBeneficiary身故保险金受益人证件号码IDcard/passportNo.ofBeneficiary受益份额(%)ShareofBenefits(%)与被保险人关系RelationshiptotheInsuredPerson(1)(2)(3)(4)投保计划TypeofPlan单次旅程SingleJourney*旅游目的地TravelDestination:*保险期间

7、InsurancePeriod:天days（包括首尾两日startdateandduedateinclusive）*旅行开始日期InsurancePeriodFrom:年(YYYY)月(MM)日(DD)（北京时间BeijingTime）*旅行结束日期InsurancePeriodTo:年(YYYY)月(MM)日(DD)（北京时间BeijingTime）全年旅程AnnualJourney*保单生效日期InsurancePeriodFrom:年(YYYY)月(MM)日(DD)（北京时间BeijingTi

8、me）年度保单每次旅行的保障期限最长为30天Themaximumdurationofeachinsuredtripis30days.*保单满期日InsurancePeriodTo:年(YYYY)月(MM)日(DD)（北京时间BeijingTime）保险费表PremiumTable（币种Currency：人民币RMB）保险期间InsurancePeriod经典计划Classic尊贵计划VIP1天day5122天days10203天days12254–5天days1430