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Please click here to view the product details
 
Name of Proposer: (Surname, Given Name)
Correspondence Address:
Email Address:
Telephone No.: (Home)
(Office)
(Mobile)
Person Insured:
HKID No.:
Sex: M    F
Occupation:
Date of Birth: (yyyy/mm/dd)
One year Insurance Period: From (yyyy/mm/dd)
Collection of Policy: to be mailed to correspondence address
to be collected at branch
 
Premium Payment Account:  
Primary Account: HING MASKEDMASKED MASKED, Current A/C 601-000-0000-0
  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:
 
Occupation Classification  
i. Professional, administrative and office duties without manual work
ii. Other non-manual occupations
iii. Occupations involving slight manual work
iv. Occupations involving manual work excluding construction workers
 
Benefit Sum Insured
Accidental Death & Permanent Disablement: HK$
Temporary Disablement: HK$ (per week) 
Medical Expenses: HK$ (per event) 
Note : Accidental Death and Permanent Disablement are compulsory. Temporary Disablement's sum insured should not exceed the average weekly income of proposer. 
Beneficiary Name of Beneficiary : Relationship with proposer :
a.
b.
 
Please answer the following questions
1.Do you have any existing accident insurance ? Yes    No 
2.Has any of your application for life or accident insurance been declined ? Yes    No 
3.Is your hearing or sight in anyway impaired, or do you have any physical defect or infirmity ? Yes    No 
4.Have you ever made a claim against any insurer in respect of any accident bodily injury ? Yes    No 
Please give details if the answer to any of the above is "Yes" :-  
   
Declaration  
I/We hereby apply for insurance as set out in the Company's Personal Accident 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