死亡赔偿申请书.PDFVIP

HSBCDEA Claimant’s Statement for Death Claim Form 死亡賠償申請書 Policy No. 保單號碼: Date 日期: PICS 2017Feb (CRS) Notes 注意： Documents required to be submitted with this form: 以下文件請連同此表格一併交回： 1. Original Death Certificate of Life Insured. 受保人死亡證書正本。 2. ID Card / Passport / Birth Certificate copy of Life Insured. 受保人身分證╱護照╱出生證明書副本。 3. ID Card / Passport / Birth Certificate copy of Beneficiary(ies) / Claimant(s) 受益人╱索償人身份證╱護照╱出生證明書副本。 4. Photocopy of proof of Relationship between Life Insured and Beneficiary(ies) / Claimant(s). 受益人╱索償人與受保人之關係證明文件副本。 5. Original Policy Document. 保單正本。 ’ 6. Attending Physician s Report completed by Physician in attendance during the last illness of the Life Insured (To be obtained by the Claimant). 最後為受 保人治病醫生之報告（此報告需由申請人負責索取）。 7. Photocopy of proof of present residential address of the Beneficiary(ies) / Claimant(s) which is issued not more than 3 months from now (eg water/ electricity/gas/mobile phone bill or bank correspondence) 受益人╱索償人現時住址證明副本（例如水╱電╱煤氣╱手提電話費單或銀行信件等），而該住址證 明需距今不超過三個月。 8. This form must be completed together with applicable “Tax Residency Self-Certification Form(s)” signed by Beneficiary. These forms are available at .hk/personal/form-centre.html. For minor beneficiary of age below 18, legal parent or authorised guardian of the beneficiary should complete and submit the applicable “Tax Residency Self-Certification Form(s)“ on behalf of the beneficiary. .hk/zh-hk/personal/form-centre.html If “Standing Instruction”* has been set up for pr