HT华泰环球健康个人保险产品ApplicationForm(DOC可编).docVIP

华泰环球健康个人保险产品 申请表 Huatai Worldwide Health Individual Insurance Product – Application Form 由Aetna Global Benefits( 管理 Administered by Aetna Global Benefits( 在填写本申请表前，请仔细阅读以下内容，并以大写字母填写本申请表。 Please read through the following before completing this application and complete in BLOCK CAPITALS. 我们会严格必威体育官网网址您所提供的信息。您所提供的信息须为事实，失实的信息将会导致保单无效。失实及信息的错漏可能会影响保单的审核及是否承保的最后决定（如：既往病史、从事有危险性的活动等）。若您遇到您无法判断该事实，请一并告知。 All information supplied will be treated in strict confidence. You must disclose all material facts. Failure to do so may invalidate the Policy. A material fact is one which is likely to influence the assessment and acceptance of this application (e.g. a pre-existing health condition or involvement in hazardous activities). If You are in any doubt whether a fact is material, it should be disclosed. 作为申请人，您必须回答申请表中所有问题，并代表申请表中所有申请人在申请表上签字。请您保留一份提供给我们的信息资料（包含信件的副本）便于本保险合同的签署。 As the applicant, You should answer all the questions and sign the declaration on behalf of all persons included in this application. You should keep a record of all information (including copies of all letters) supplied to Us for the purpose of entering into this contract. 在填写完本表后，请将其寄回至以下地址： Please return this completed form to Us. 华泰环球健康保险 电话: （86）400 881 1291 传真: （8621） 6326 8525 邮箱: HTPSSShanghai@18号港陆广场，1806单元 HuaTai Insurance Company of China Limited T: （86）400 881 1291C/O: Aetna (Shanghai) Enterprise Services Co.,Ltd F: （8621） 6326 8525Suite 1806 Harbour Ring Plaza E: HTPSSShanghai@ 18 Middle Xi Zang Rd., Shanghai   第一部分 – 投保人（即直接被保险人）信息 Section 1 – Applicant’s Details (First Person)