全球医疗保险个人投保申请书医疗问卷

《全球医疗保险个人投保申请书医疗问卷》由会员上传分享，免费在线阅读，更多相关内容在工程资料-天天文库。

1、国寿康优全球团体医疗保险(B型)ChinaLifeGoodhealthInternationalHealthcarePlan(TypeB)a中国人寿保险股份有p艮公旬ChinaLifeInsuranceCompanyLimited全球医疗保险个人投保申请书/医疗问卷InternationalHealthcarePlanIndividualApplicationForm/MedicalQuestionnaire代理公司/经纪公nj名称并盖章Agent/BrokerNameandStamp您所提供的所冇信息都将被严格保密

2、。所冇重耍事实必须如实告知，否则将影响此保险合同的冇效性。重要事实是指可能会影响木次投保申请结果的信息。如果您遇到您无法判断其重要与否的事实，亦请一并告知。Allinformationsuppliedwillbetreatedinstrictconfidential.Youmustdiscloseallmaterialfacts・FailuretodosomayinvalidatethePolicy.Amaterialfactisonewhichislikelytoinfluencetheassessmentanda

3、cceptanceofthisapplication.Ifyouareinanydoubtwhetherafactismaterial,itshouldbedisclosed.中请投保时，请回答所有的问题并代表此中请书下的所有人签署声明。Astheapplicantyoushouldanswerallthequestionsandsignthedeclarationonbehalfofallpersonsincludedinthisapplication.1.投保资料（主被保险人）DetailsofInsured(F

4、irstPerson)姓：FamilyName:名：FirstName(s):称谓：Title:性别：身高：体重：Sex:Height:Weight:出生日期（日/月/年）：婚姻状况：国籍：DateofBirth(Day/Month/Year):MaritalStatus:Nationality:护照签发国家：留学国家：身份证号/护照号码：CountryofPassport:CountryofStudy:ID/PassportNumber:团体保单持有人名称：中国国际教育信息网（赛恩网）PolicyholderNam

5、e:ChinaInternationalEducationInformationNet通讯地址居住地址CorrespondenceAddress:ResidentialAddress:路/弄/号/室路/弄/号/室StreetAddress:StreetAddress:区/县区/县TownCity:TownCity:国家/省市国家/省市Country/State:Country/State:邮政编码邮政编码PostCode:PostCode:固定电话固定电话HomeTelephone:HomeTelephone:手机手

6、机Mobile:Mobile:电子邮箱电子邮箱EmailAddress:EmailAddress:1.附带被保险人信息SupplementaryInsured'sDetails请注意：本保险计划下的子女附带被保险人必须在18周岁以下，在全n制学校就学并依赖被保睑人供养者放宽至23周岁以下。Pleasenotechildrentobeincludedunderthisplanmustbeunder18yearsofageorunder23yearsofageiftheyareinfulltimeeducationand

7、arefullydependantuponyou.姓名Name关系Relationship出生日期(日/月/年)DateofBirth(Day/Month/Year)性别Sex职业Occ叩ation身爲Height体重Weight国籍Nationality身份证/护照号码ID/PassportNo.配偶Spouse子女DependantChild(女DependantChild子女DependantChild子女DependantChild若您还冇其他附带被保险人，请用另外的纸捉供详细资料。Ifyouhaveanyf

8、urtherSupplementaryInsured,pleaseprovidedetailsonaseparatesheet.3、医疗问题调查MedicalQuestionnaire请对卜•列问题片的“是”或"否”打勾，若回答为“是”，请提供详细资料。（必要时请用另外的纸提供详细资料。）请在相应选项上打勾“7”。Pleasereplytoth