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ID:29948201
大小:138.50 KB
页数:4页
时间:2018-12-25
《团体保险个人健康告知书》由会员上传分享,免费在线阅读,更多相关内容在学术论文-天天文库。
1、泰康人寿保险股份有限公司厦门分公司厦门市莲岳路1号磐基中心12层团体保险个人健康告知书HealthStatementforGroupInsuranceInsurants填写须知Notice1.在填写健康告知前,请详细阅读本公司相关保险产品条款,特别是保险责任和责任免除条款事项;PleasereadallthetermsandconditionsofthispolicycarefullybeforefillinginthisStatementofHealth,especiallyarticlesconcerningthebenefitsandexclusions.2.请您完整填
2、写本告知书内的相关部分。请您准确填写、如实告知,这对于您的投保申请十分重要;Pleasefilloutallrelevantsectionscompletely.PleasebenotedthatitisveryimportancethatallrelevantquestionsonthisStatementofHealthareansweredaccuratelyandtruthfully.3.本告知书只有被保险人本人亲笔签名后生效。如有修改,需在修改处加签字;TheStatementofHealthwillnotbevaliduntilbeingsignedbythein
3、suredhim/herself.Incaseofanycorrection,additionalsignatureshallbeaddednexttothecorrection.4.本告知书为投保人与保险公司所订立保险合同的组成部分。与本告知书各事项相违背的任何口头承诺均属无效。TheStatementofHealthshallbetreatedasapartoftheentireinsurancecontractbetweenpolicyholderandinsurer.Anyinformaloralagreementwhichisinconsistentwiththec
4、ontentoftheStatementofHealthshallbedeemedasinvalid.A、被保险人资料(InformationofInsurant)投保人/Company:厦门大学XiamenUniversity被保险人姓名/Name:被保险人与员工的关系:□配偶□子女N/ATheinsuredpersonandemployeerelations:□Spouse□child附属被保险人姓名:N/ANameofthesubsidiaryinsured:N/A身份证号码:ID:性别/Gender:年龄/Age:B、个人健康问卷(IndividualHealthQu
5、estionnaire)请您完整填写您的相关信息。假如您有连带保险人一同投保,请另外填写告知书。Pleasecompleteallthenecessaryinformation.Ifyouhavedependents,pleasefillinadditionalStatementofHealthformsforthem.请对本部分的问题做出“是”或“否”的回答。对回答“是”的问题,请在随后的空白处填写详细的相关信息,所有提供的信息均会被严格保密。申请人必须对相关问题的重要事实如实告知,否则将有可能影响本保单的有效性。“重要事实”是指任何有可能影响本次投保的结果的信息;若你对某
6、些事实是否属“重要事实”有所疑问,请您就这些事实一并如实告知。Thequestionsinthefollowingsectionshallbeansweredwith“YES”or“NO”.Ifyes,pleasespecifydetailsinthespaceprovided.Allinformationprovidedherewillbekeptconfidential.Allmaterialfactspertinenttothesequestionsshallbedisclosedcorrectlyandtruthfully.Anymisstatementinthequ
7、estionnairemayinfluencethevalidationofthepolicy.“Materialfact”referstoanyinformationthatwouldbelikelytoinfluencetheinsurer’sassessmentandacceptanceofthisapplication.Ifyouhaveanydoubtaboutwhetherafactshallbetreatedasmaterial,pleasediscloseitatthesametime.
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