卓越优游乐投保申请书316k.docVIP

卓越优游乐保险计划投保单 Smart Traveler Insurance Plan(A) Proposal Form 投保人资料 Proposer Details 投保人姓名 Name of Proposer: 国籍 Nationality: 职业 Occupation: 联系电话 Tel. No.: 出生日期（日/月/年） Date of Birth ( DD / MM / YY) 投保人身份证/护照号码 ID card/passport No. of Proposer: 通讯地址Correspondence Address: 邮政编码 Post Code: 被保险人资料 Details of The Insured Person(s) （附属被保险人须为主被保险人的配偶或子女 The Insured persons should be the spouse or child(ren) of the Main Insured） 主被保险人 Main Insured 附属被保险人（1） Insured Person (1) 附属被保险人（2） Insured Person (2) 附属被保险人（3） Insured Person (3) 姓名 Name 性别 Gender 身份证/护照号码 Passport / ID No. 出生日期（日/月/年） Date of Birth (DD /MM/ YY) 国籍Nationality 职业Occupation 与投保人关系 Relationship to Proposer 保险费(人民币:元) Premium(RMB: Yuan) 总保险费 (人民币:元) Total Premium (RMB: Yuan):____________________ 如被保险人为未成年人，请回答下列问题 Please answer below questions if any insured is under 18 years old: 是否在本公司或者其他公司投保以死亡为给付保险金条件人身保险 Have you purchased any personal insurance with death benefits from Winterthur Insurance (Asia) Ltd. SH branch or other insurers? 是Yes?? 否No 如有，请分别列明投保金额 If Yes, please specify the Sum Insured of death benefits of each policy separately with Insurer(s)’name(s)__ 身故保险金受益人 (Death Beneficiary)（若身故受益人资料为空白，身故保险金将作为被保险人之遗产；若未填写受益份额，身故保险金受益人将按照相等份额享有身故保险金。The death benefits shall be paid to the estate of the Insured if Name of Beneficiary leaves blank. If the share of benefits are not stated, the beneficiaries shall be entitled to equal share of the death benefits）Name of the Insured Person 身故保险金受益人姓名 Name of Beneficiary 身故保险金受益人出生日期 Date of Birth of Beneficiary 受益份额(%) Share of Benefits (%) 与被保险人关系 Relationship to the Insured Person (1) (2) (3) (4) 投保计划 Type of Plan 单次旅程 Single Journey 旅游目的地 Travel Destination: 保险期间Insurance Period: 天 days （包括首尾两日 start date and due date inclusive） 旅行开始日期Insurance Period From: 年(YYYY) 月(MM) 日(DD) （北京时间 Beijing Time） 旅行结束日期Insurance Period To: 年(YYYY) 月(MM) 日(DD) （北京时间 Beijing Time） 全年旅程 Annual J