投保表格-浙商保险.docVIP

“卓越”环球个人医疗保障计划SMARTCARE EXCLUSIVE Health Insurance Application Form 重要注释Important Notes：especially for policy exclusions, annual limit, deductible, free-look period, cancellation/termination of cover, and the others which are all highlighted in bold. You can enquire of your consultant if need any clarification before fill in this application form, otherwise you are deemed to fully understand the clause and have no objection. 2.请如实填写本表内容并确定所填写的内容全部正确无误，根据保险法和相关规定，如您未履行如实告知义务，则可能会导致保险合同被解除或者本公司不承担相关保险责任。Under Insurance Law or any subsequent amendment, you are to disclose in the Application form, fully and faithfully, all the facts which you know or ought to know, otherwise the policy issued may be void. 3.投保人对被保险人应当具有保险利益，否则依据保险法合同无效。 A policyholder shall own the insurable interest in the objects of insurance, otherwise the insurance contract shall be invalid. 4.本投保单为保险合同的重要组成部分。请中文或英文正楷填写，Please fill in it in Chinese or English block letters with blue or black ink, and shall not alter. There must be handwritten signature of the policyholder and the insured person(s) (or legal guardian). 5.请填写下列所有并在适当的空格内填上“X”如有遗漏，则该问题被视为回答“否”Please complete this form by answering carefully all questions and “X” the boxes where appropriate. Any question not answered on this form will be taken as an answer in the negative. 6.退保时，若保险期间内无理赔记录，则按条款列明的退费比例退还保费。若已有理赔记录，则退还保费为零。 For cancellation, premium will be refund according to “premium refund table” stated in the clause provided that no claims have been made during the insurance period. No premium refund if any claim has been made. 7.对于直接付费服务，如有任何计算错误或不属保障范围的项目，您有义务接受理赔款的最终调整。 For direct billing service, you are obligated to accept the final adjustment in charges and actions if there is any miscalculation or uncovered item according to the terms and conditions of the Policy. 8.若任何被保险人停止在中国居住超过连续三个月的话，请及时通知本公司。本公司保留改变保费或拒绝承保的权利。 Please inform us immediately if any of the insureds leave China for a period of three consecutive months. We