Place of Employment
(if different from correspondence address)
Collection of Policy:
to be mailed to correspondence address
to be collected at
branch
Premium Payment Account:
Primary Account:
EXCELMASKEDMASKED MASKED
Current A/C
601-003-0000-0
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 MasterCard:
-
-
-
Card Expiry Date:
(yyyy/mm)
Name of Credit Card Holder:
Particulars of Helper
Name of Helper:
Date of Birth:
(yyyy/mm/dd)
Sex:
M
F
Passport No./HKID No.:
Nationality:
Annual Total Earnings (HKD):
Please "select" the applicable one.
One Year
Two Years
Plan A - Section I only
HK$400
HK$720
Plan B - All Sections
HK$600
HK$1080
Declaration
I/We hereby apply for insurance as set out in the Company's Domestic Helper 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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