团体保险被保险人健康风险告知书.PDF

团体保险被保险人健康风险告知书 Group Life Assured Health Declaration 投保团体: 保单号码： Company Name: Policy Number: 姓名： 性别：□男 □女 出生日期： 身高： 米 体重： 公斤 d Name: Sex: □Male □Female Date of Birth ： Height: m Weight: kg e 人 r u 证件类型： 身份证 护照 其它_____________ 证件号码: 险 s 保 s A 被 e Document Type: □ID card □Passport □Others_________ ID/Passport Number: f i L 婚姻状况： 已婚 未婚 离婚 丧偶 行业类型： 具体工作： Marital status: □Married □Single □Divorced □Widowed Type of industry: Occupation: 请提供“是”或“否”的答案，若被保险人为未成年人，则请被保险人的父母代为回答： 有 无 Please tick ‘Yes’or ‘No ’to the questions below. If the Life Assured is below 18 years old, all the questions should be duly Yes No answered by his/her parents: 1、您是否曾在投保医疗、意外或人寿保险时被拒绝、延期或附加条件承保？   Have you ever been refused insurance or been offered insurance with restricted benefits or other than standard rates? 被 2 、目前尚在住院或病假中？   Are you now hospitalised or on sick leave? 保 3、最近一年内有无超过10 天的病假？   During the past one year, have you ever been absent from work due to sickness for more than 10 days? 险 4 、近两年内有无因患病而减轻劳动量？   During the past t