丰泰保险（亚洲）有限公司上海分公司-AXAChina.docVIP

卓 越 家 居 综 合 保 险 投 保 书 HOME MULTICOVER INSURANCE PROPOSAL FORM 投保人/被保险人详细资料Proposer Details 最低保费: RMB800 Minimum Premium：RMB800.00 投保人/被保险人姓名Name of Proposer： 国籍Nationality： 身份证或护照号码No. of ID Card/Passport： 出生日期（日/月/年）Date of Birth (dd/mm/yyyy): 通讯地址Postal Address： 邮政编码Post Code： 联系电话Phone No.： 邮箱地址E-mail： 就职公司名称Company Name: 职业Occupation: 投保住宅资料 Home Details 投保住宅地址（如与上述通讯地址不同）Address of home to be insured (Please complete if different from correspondence address)： 投保住宅的用途Home to be insured for 自住Self-occupied 出租 Rental 租用 Tenant 投保住宅楼龄Age of the Building： 如楼龄超过25年，请提交至安盛保险有限公司核准 If the age of building is 25 years, please to AXA Tianping Property Casualty Insurance Company Limited. 投保住宅建筑总面积（平方米）Gross Floor Area (in square meter): 楼宇结构Construction of the Building： 钢筋混合结构Reinforced Concrete 混凝土结构Concrete 砖石结构Brick and stone 其他，请说明Other, please specify： 请提交至安盛保险有限公司核准 Please to AXA Tianping Property Casualty Insurance Company Limited 如果有其它任何利益方（如按揭银行），请详细列明银行名称、地址及相关信息If there is any other interested party (for example a Mortgagee), please detail the name, address and reference information as below: 保险期间Insured Period：本保单由Policy to commence on //（日dd/月mm/年yyyy）起一年有效for one year. 问卷 Questionnaire 投保住宅是否会在保险期间内连续空置多于30天？Will the dwelling be left unoccupied for more than 30 consecutive days? 是Yes 否No 对于本投保书内任何投保项目,您或其他与您长期居住之人士In respect of any of the risks to be insured, have you, or any other person permanently residing with you： 在过去三年内是否由于任何投保之风险而蒙受损失？Sustain a loss during the past three years under any of the classes of insurance now proposed? 是Yes 否No 是否曾被保险公司拒绝投保或续保？Ever had a proposal for insurance declined, renewal refused, or cover terminated? 是Yes 否No 若以上问题回答为“是”，请提供详细资料, 并提交至安盛保险有限公司核准：Please provide full details as belowAXA Tianping Property Casualty Insurance Company Limited if questions above are answered “Yes” 详细资料Details : 保障计划Coverage 基本保障BASIC COVER 第一部分SECTION 1: 楼宇及/或房屋硬装修保险责任BUILD