From 2012/01/20 (yyyy/mm/dd) To 2014/01/19 (yyyy/mm/dd)
Place of Employment
(if different from correspondence address)
18A, The World Finance Center
Luohu District, Shenzhen
Collection of Policy:
to be mailed to correspondence address
Premium Payment Account:
Primary Account:
EXCELMASKEDMASKED MASKED
Current A/C
601-003-0000-0
Premium (HKD):
1,080.00
Particulars of Helper
Name of Helper:
Hua Li
Date of Birth:
1977/12/18
(yyyy/mm/dd)
Sex:
M
Passport No./HKID No.:
C387979(A)
Nationality:
China
Annual Total Earnings (HKD):
100,000
Select Plan
Plan A - Section I only:
HK$400
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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