指定受益人声明书.doc

指定受益人声明书 Statement of the Beneficiary Designation 被保险人姓名： 性别： Name of the Insured: Gender: 证件号码： 联系电话： Document No.: Contact Phone: 本人是-----------------------------------------的员工，现我公司为本人购买了平安的福利保障保险。为保障被保险人及受益人的权益，根据相关法律之规定，本人现声明如下： I am employed by , and the company buys for me the Employee Benefit Plan provided by Ping An Life Insurance of China, Ltd. In order to protect the rights and benefits of the Insured and beneficiaries, I hereby affirm according to related laws that: 受益人：Beneficiary: 1.该保单的生存受益人为被保险人本人； 1. The survival beneficiary of this policy is myself. 2.身故受益人本人指定为 ：----------，此身故受益人与被保险人本人是--------关系。 2. I designate as my beneficiary upon my death, who is of mine. 以上声明均是本人的真实意思表示。 The above statement is the presentation of my true meaning. 声明人签章： Signature of the person who makes the statement: 年 月 日 Year Month Day备注：对中、英文文义的理解存在分歧的，以中文为准。