团体保险个人健康告知书幻灯片.doc

团体保险个人健康告知书 Health Statement for Group Insurance Insurants Notice 1. 在填写健康告知前，请详细阅读本公司相关保险产品条款，特别是保险责任和责任免除条款事项； Please read all the terms and conditions of this policy carefully before filling in this Statement of Health, especially articles concerning the benefits and exclusions. 2. 请您完整填写本告知书内的相关部分。请您准确填写、如实告知，这对于您的投保申请十分重要； Please fill out all relevant sections completely. Please be noted that it is very importance that all relevant questions on this Statement of Health are answered accurately and truthfully. 3. 本告知书只有被保险人本人亲笔签名后生效。如有修改，需在修改处加签字； The Statement of Health will not be valid until being signed by the insured him/herself. In case of any correction, additional signature shall be added next to the correction. 4. 本告知书为投保人与保险公司所订立保险合同的组成部分。与本告知书各事项相违背的任何口头承诺均属无效。 The Statement of Health shall be treated as a part of the entire insurance contract between policyholder and insurer. Any informal oral agreementwhich is inconsistent with the content of the Statement of Health shall be deemed as invalid. A、被保险人资料（Information of Insurant） 投保人/ Company： 被保险人姓名/ Name： □配偶 □子女 N/A The insured person and employee relations：□Spouse □child 附属被保险人姓名： N/A Name of the subsidiary insured：N/A 身份证号码： ID： 性别/ Gender： 年龄/Age： B、个人健康问卷（）Please complete all the necessary information .If you have dependents, please fill in additional Statement of Health forms for them. 请对本部分的问题做出“是”或“否”的回答。对回答“是”的问题，请在随后的空白处填写详细的相关信息，所有提供的信息均会被严格保密。申请人必须对相关问题的重要事实如实告知，否则将有可能影响本保单的有效性。“重要事实”是指任何有可能影响本次投保的结果的信息；若你对某些事实是否属“重要事实”有所疑问，请您就这些事实一并如实告知。 The questions in the following section shall be answered with “YES” or “NO”. If yes, please specify details in the space provided. All information provided here will be kept confidential. All material facts pertinent to these questions shall be disclosed correctly and truthfully. Any misstatement in the questionnaire may influence the validation of the policy. “Material fact” refers to any information that would be likely to influence the insure