卓越商务行标准保险计划投保单2017版

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1、卓越商务行标准保险计划投保单(2017版)SmartBIZTripInsuranceStandardPlanProposalForm（2017）投保人资料ProposerDetails*投保人姓名/投保单位NameofProposer:联系人ContactPerson:*联系电话Tel.No.:通讯地址CorrespondenceAddress:邮政编码PostCode:*组织机构代码CompanyRegistrationCode:传真FaxNo.:被保险人资料DetailsoftheInsuredPerson*

2、姓名Name性别Gender*出生日期DateofBirth*身份证/护照号码ID/PassportNo.国籍Nationality职业Occupation保险费(人民币:元)Premium(RMB:Yuan)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。ThedeathbenefitsshallbepaidtotheestateoftheInsuredifNameoftheBenefi

3、ciaryleavesblank.Ifthebenefitssharesarenotstated,thebeneficiariesshallbeentitledtoequalshareofthedeathbenefits）被保险人姓名NameoftheInsuredPerson身故保险金受益人姓名NameofBeneficiary身故保险金受益人证件号码D/PassportNo.ofBeneficiary受益份额(%)ShareofBenefits(%)与被保险人关系RelationshiptotheInsure

4、dPerson(1)(2)(3)(4)投保计划TypeofPlan单次旅程SingleJourney*旅游目的地TravelDestination:*保险期间InsurancePeriod:天days每次商务旅行最长承保期间最长为90天Themaximumdurationofeachinsuredtripis90days.*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

5、)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BeijingTime）*保单满期日InsurancePeriodTo:年(yyyy)月(mm)日(dd)（北京时间BeijingTime）保险费率表PremiumTable（币种Currency：人民币RMB）保险期间InsurancePeriod保费Premium典雅计划Classic保费Premium尊贵计划VIP全年保障Annua

6、lPremium1,2302,1501–4天days901955–8天days1402759–12天days19036513–16天days24045017–20天days28553521–24天days33562525–28天390715每增加一周（不满一周按一周计算）Eachadditionalweek(lessthan1weekshallbedeemedas1week)x100元/周weeksx145元/周weeks保障利益明细ScheduleofBenefits承保项目Coverage各被保险人保险金额（

7、人民币RMB）MaximumLimitperInsured(RMB:Yuan)典雅计划Classic尊贵计划VIP1.人身意外伤害PersonalAccident-意外事故身故、烧伤及残疾保险金AccidentalDeath,Burns&Dismemberment250,000600,000-意外抚恤金CompassionateDeathCashBenefit5,00020,0002.意外事故及疾病医疗费用补偿Accidental&SicknessMedicalReimbursement(含门急诊及住院医疗Inc

8、l.OutpatientandInpatient)350,000800,000*其中中草药医生和接骨师费用每天每次最高不超过RMB100,累计赔偿总额ChineseherbalistsandbonesettersfeesaresubjecttoamaximumofRMB100pervisitperday,uptoamaximumof*其中境内旅行的疾病医药费用Limito