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| Family Package Insurance Application accepted! Application No.：EB123456 |
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| Name of Insured: |
Mr. Tom, Ren
(Surname, Given Name) |
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| Correspondence Address: |
18A, The World Finance Center |
| Luohu District, Shenzhen |
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| E-mail Address: |
tomren@cmbwinglungbank.com |
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| Occupation: |
IT |
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| Telephone No.: |
88888888 (Home) |
| 66666666 (Office) |
| 18988888888 (Mobile) |
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| Collection of Policy: |
to be mailed to correspondence address |
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| Premium Payment Account: |
CHAN TAI MAN, Current A/C 601-003-0000-0 |
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| Premium: |
29,279.02 |
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| Particulars of Insurance |
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Insured Address:
(if different from correspondence address) |
18A, The World Finance Center |
| Luohu District, Shenzhen |
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| Period of Insurance: |
From 2009/01/20 (yyyy/mm/dd) |
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| Insured Items & Sum Insured |
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1. Contents |
HKD500,000 |
| Gross Floor Area |
5,000 sq.ft |
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2. Personal and Occupier Liability |
HKD5,000,000 |
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3. House |
HKD5,000 |
| Mortgagee |
2323 |
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4. Personal Accident (Age Limit 16 - 65) |
a.
Accidental Death & Permanent
Disablement |
HKD5,000 |
| b.Temporary Disablement |
HKD1,000
(per week) |
| c.
Medical Expenses |
HKD1,000
(per event) |
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5.
Worldwide All Risk (Please provide receipt copy) |
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Item name |
Sum Insured In HKD |
| a. |
item1 |
1000 |
| b. |
item2 |
1000 |
| c. |
item3 |
1000 |
| d. |
item4 |
1000 |
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6. Domestic Servants (Age Limit 65) |
| Cover A |
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| Name of Servant: |
Hua Li |
| Sex: |
M |
| Nationality: |
China |
| Date of Birth: |
1977/12/28 (yyyy/mm/dd) |
| HKID / Passport No.: |
C387979(A) |
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| Please complete the following if Section 4 above is selected : |
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| a) |
Name of Insured: |
Hua Li |
| Sex: |
M |
| Date of Birth: |
1977/12/28 (yyyy/mm/dd) |
| HKID No.: |
C387979(A) |
| Occupation: |
Professional, administrative & office duties without manual work. |
| Beneficiary: |
Hua Li |
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| b) |
Name of Insured: |
Hua Li |
| Sex: |
M |
| Date of Birth: |
1977/12/28 (yyyy/mm/dd) |
| HKID No.: |
C387979(A) |
| Occupation: |
Professional, administrative & office duties without manual work. |
| Beneficiary: |
Hua Li |
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| c) |
Name of Insured: |
Hua Li |
| Sex: |
M |
| Date of Birth: |
1977/12/28 (yyyy/mm/dd) |
| HKID No.: |
C387979(A) |
| Occupation: |
Other non-manual occupations. |
| Beneficiary: |
Hua Li |
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| Declaration |
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| I/We hereby apply for insurance as set out in the Company's Family Package Policy, and I/we hereby warrant that the above particulars are true and agree that this proposal shall be the basis of the contract between
myself/ourselves and the Company. |
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| This application is subject to final approval of CMB Wing Lung Insurance Co. Ltd. Our Staff will contact you on the next working day. |
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| Thank you for using Family Package
Insurance Application Service. |
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Customer Service Hotline: 2952 6666
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