Professional Documents
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个人意外保险投保书
个人意外保险投保书
个人意外保险投保书
个人意外保险投保申请书
PERSONAL ACCIDENT INSURANCE PROPOSAL FORM
依据《中华人民共和国保险法》第十七条之规定,被保险人必须如实、详尽地填写本投保申请书。否则,由此签署的保单无效。
Statement pursuant the seventeenth Article of The Insurance law of the People’s Republic of China (or any subsequent amendments thereof) -You are to disclose
in this Proposal Form fully and faithfully all facts which you know, otherwise the Policy issued hereunder may be void.
请被保险人如实填写以下内容,并在适当的位置打;确认
Please write and tick ; clearly where applicable
工作单位Company:
职业/工种Occupation:
a 在工作中您是否In the nature of your work do you:
(i) 从事车间工人管理工作Superintend manual work?
是YES
否NO
(ii) 从事手工劳作do manual work?
是YES
否NO
(iii)使用某种机器设备use any machinery?
是YES
否NO
b 您是否参与任何危险运动或活动Do you engage in any hazardous sports or activities?
是YES
否NO
如果是,请详细说明if yes, please give details
c 您是否平均一个月内有一次或多次空中旅行Do you travel by air more than once a month on
是YES
否NO
average?
如果是,请详细说明if yes, please give details
d 您是否平均每三个月内有一次或多次到其它国家的旅行Do you travel to other countries more
是YES
否NO
than once every three months?
如果是,请详细说明到访国家及频率if yes, please give details
e 您是否长期派驻其它国家工作Do you take long-term business execution in other countries?
是YES
否NO
如果是,请详细说明到访国家及频率if yes, please give details
f 您是否拥有自己的汽车或经常驾驶汽车?Do you have your own car or drive frequently?
是YES
否NO
III. 健康Health
a. 您是否因曾遭遇意外而在过去五年中必需接受医学治疗
是YES
否NO
Have you sustained any accidents necessitating medical attention during the last five
years?
如果是,请详细说明if yes, please give details
b. 您是否存在任何身体上的缺陷或衰弱现象,或具有某种患病的倾向?
是YES
否NO
声明 DECLARATION
本人在此声明并保证以上回答及各项信息均真实无误。本人无隐瞒任何影响保险公司承保的信息,并同意本投保申请书及声明
作为本人与保险公司合同的基础。本人在此一并同意接受保险公司相关保险合同所载的保险条款、除外责任以及保险条件。
WE/I DO HEREBY DECLARE AND WARRANT the answers/information given above in every respect are true and correct and I have not withheld any information likely to
affect the acceptance of this Proposal, and I agree that this Proposal & Declaration shall be the basis of the Contract between the Company and myself and I further agree to
accept the Company's Policy subject to the terms, exclusions and conditions to be expressed therein, endorsed thereon or attached thereto.