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:
1977/12/19
(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.
The policy will be sent out by mail on the second next working day.
Premium will be debited to the credit card account.
Thank you for using Internet Domestic Helper Package Insurance Application Service.
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