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Name of Insured: Mr. Tom, Ren (Surname, Given Name)
Correspondence Address: 18A, The World Finance Center
Luohu District, Shenzhen
E-mail Address: tomren@cmbwinglungbank.com
Occupation: IT
Telephone No.: 88888888 (Home)
66666666 (Office)
18988888888 (Mobile)
Collection of Policy: to be mailed to correspondence address
Premium Payment Account: EXCELMASKEDMASKED MASKED, Current A/C 601-003-0000-0
Premium: 29,279.02
 
Particulars of Insurance  
Insured  Address:
(if different from correspondence address)
18A, The World Finance Center
Luohu District, Shenzhen
Period of Insurance: From 2009/01/20 (yyyy/mm/dd)
 
Insured Items & Sum Insured  
1. Contents HKD500,000
Gross Floor Area 5,000 sq.ft
2. Personal and Occupier Liability HKD5,000,000
3. House HKD5,000
Mortgagee 2323
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)
5. Worldwide All Risk (Please provide receipt copy)
  Item name Sum Insured In HKD
a. item1 1000
b. item2 1000
c. item3 1000
d. item4 1000
6. Domestic Servants (Age Limit 65)
Cover A  
Name of Servant: Hua Li
Sex: M
Nationality: China
Date of Birth: 1977/12/28 (yyyy/mm/dd)
HKID / Passport No.: C387979(A)
   
Please complete the following if Section 4 above is selected :
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
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
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
   
Declaration  
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.
 

 
  Customer Service Hotline: 2952 6666