团体人身保险契约变更申请书-平安保险.PDFVIP

团体人身保险契约变更申请书 Application for Alteration of Group Insurance Policy A ．基本申请信息/General information 保单号/Policy number 投保单位全称/Policyholder B．申请项目/Items to be altered 申请下述标记有 *”的项目时，请根据本公司要求填写相关人员信息及健康告知。 It you select items marked with a *” below, please fill out the relevant personal information and health declaration according to the applicable requirements. *□增加被保险人 申请人数合计/Total number of new additional Insureds:_________________________ Addition of Insured 申请原因 □新入职/New hires Reasons for application □其他/Other:___________________________________ □减少被保险人 申请人数合计/Total number of Insureds to be removed:_________________________ Removal of an 申请原因 □离职/People leaving Insured Reasons for application □退休/Retirement □丧失参保资格/Disqualification □整单退保 □其他/Other:___________________________________ Full policy 投保人声明：投保人已知晓自退保申请之日起相关保险责任终止并已经告知所有相 Cancellation 应被保险人。 □犹豫期退保 Applicant s declaration: we (I) have understood that related insurance liabilities will be terminated upon the date of insurance cancellation application and have notified all the Cancellation during Insureds involved. cooling-off period *□保障计划变更 申请项目 □新增保障计划/Adding a rider Alteration of Policy selection to be □减少保障计划/Removing a rider policy selection altered □层级变更/Grade change 变更人数/Alteration of number of Insured:____________________________________ □续期交费 申请人数合计Total number of Insureds:_____________________________________