雇员赔偿保险投保书.PDFVIP

僱員賠償保險投保書 EMPLOYEES’ COMPENSATION INSURANCE PROPOSAL FORM 公司名稱 Full Company Name 通訊地址 Corresponding address 營業性質 工作詳情 Business Nature Particulars of work 保險生效日期 由 至 區域 香港 香港及 Period of Insurance From To Area covered H.K. only H.K. and ____________ 固定工作地址 電話號碼 Location of Employment Tel no. 投保僱員資料 Employees to be Insured 所有屬於僱員賠償條例下之員工均須包括在內 All employees within the scope of the employees’ compensation ordinance must be included 保險公司專用 僱員工作類別 僱員人數估計 年薪 / 工資及其它收入估計 For Office Use Only Description of Employees’ Occupation Estimated no. Estimated Annual Salaries / 費率 保費 編號 條款 of Employees Wages other Earnings Rate Percent Premium Class No. Clause 總計 Total 請回答下列各題，如答 “是” 請在下面提供詳情 Please answer the following questions and give details below if your answer is “Yes” 您是否需要依據僱員補償條例投保承包商之責任? Do you wish to insure your liability under Employees’ Compensation Laws to employees of sub-contractors? 您是否有僱用行業外之臨時工人，外工或與您同住之家眷，並需要為該等僱員投保? Do you employ and wish to insure casual workers, out workers or family members residing with you? 您和您的僱員是否需要操作重型或危險的機器? Do you and your employees need to operate large and/or dangerous machinery? 您是否會使用液酸、有霉氣體燃料、化學原料或炸藥? Do you use any acids, toxic gases, chemicals or