Professional, administrative & office duties without manual work
Date of Birth:
1977/12/18 (yyyy/mm/dd)
Policy Commencement Date:
2009/01(yyyy/mm)
Name of Beneficiary:
Hua Li
Relationship with Insured Person:
Brother
Cover Type :
Cover 1
Collection of Policy:
to be mailed to correspondence address
Premium Payment Account:
Credit Card
I hereby authorize CMB Wing Lung Insurance Co. Ltd to debit from my Credit Card account the premium of the cover type selected.
VISA
4003-5820-0000-0000
Card Expiry Date:
2020/12 (yyyy/mm)
Name of Credit Card Holder:
Hua Li
Premium (HKD):
33.00
Declaration
1.
I/We hereby apply for insurance as set out in the Company's Credit Protect 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.
2.
I have read, understand and agree with the terms & conditions related to this insurance. I also agree to provide personal information to the Company for application of insurance.
3.
I agree to be abided by the Credit Protect Terms to be sent to me later.
4.
I also agree that:
This offer is for holders of valid CMB Wing Lung Bank Credit Card (including affinity card) only.
Acceptance of application is subjected to the customer's financial situation, available balance, and approval of the Company and CMB Wing Lung Bank.
Premium will be debited to the credit card account. The policy will be sent out by mail on the second next working day.
Thank you for using NET Banking Credit Protect Insurance Application Service.
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