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Travel Insurance Application accepted! Application No.：EB123456
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| Plan: |
Diamond |
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| Type: |
Family |
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| Hong Kong Resident(s): |
Yes |
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| Type of Travel: |
One way |
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| Destination(s): |
Paris |
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| Inception Date: |
2009/01/21 (yyyy/mm/dd) |
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| Expiry Date: |
2009/04/26 (yyyy/mm/dd) |
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| Total No. of Days: |
96 |
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Section 1 |
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| Name of Insured Person 1: |
Mr. HING |
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| Date of Birth: |
1980/01/19 (yyyy/mm/dd) |
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| HKID / Passport No.: |
C387979(A) |
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| Address: |
18A, The World Finance Center |
| Luohu District, Shenzhen |
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| Telephone No.: |
88888888(Home) |
| 66666666(Office) |
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Section 2 |
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| No. of Children Accompanying Insured Person 1: |
1 |
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Section 3 |
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| Name of Insured Person 2: |
Mr.Hua Li |
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| Date of Birth: |
1985/01/19 (yyyy/mm/dd) |
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| HKID / Passport No.: |
C387979(A) |
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| Premium (HKD): |
3,319.00 |
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| Discount: |
25.00% |
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| Net Premium (HKD): |
2,489.30 |
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| Premium Payment Account: |
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| Primary Account: |
EXCELMASKEDMASKED MASKED, Current A/C 601-003-0000-0 |
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| Collection of Policy: |
to be mailed to correspondence address |
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| Medical History: |
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| Are you and your accompanying applicant(s) in good health, free from physical impairment or deformity and not travelling to receive medical treatment? (For Insured Person aged from 65 to 80, doctor's certificate of good health is required. Please apply at our office or branches.) |
No |
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| If No, please provide full details. |
detail info |
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 Declaration |
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| 1. |
I/we understand that this Policy excludes all pre-existing conditions for which I/we received medical treatment, diagnosis, consultation or prescription during the 180 days preceding my/our trip. |
| 2. |
I/we further declare that to the best of my/our knowledge, there is no reason why the proposed travel should have to be altered or cancelled, I/we agree to accept the terms, exclusions and conditions as set out in the Policy. |
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Premium has been debited to premium payment account. The policy will be sent out by mail on the second next working day.
Thank you for using Travel Package Insurance Application Service. |
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Customer Service Hotline: 2952 6666
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