意外健康险索赔申请表.PDFVIP

意外健 康 险 索赔 申 请表 Accidental and Health Claim Form 索赔申请人应正确详细填写此申请表，并将附件所列索赔所需的文件于索偿事由发生３０天内交回保单签发机构 Please complete this form accurately and return with the supporting documents within 30 days after the occurrence of the claimed condition to the insurance company. 视索赔性质及金额，保险公司有权要求进一步资料。每份申请表仅限一位索赔申请人填写。 Further documents may be requested depending on the nature and extent of the claim. Separate forms must be used for different claimants. 被保险人/索赔申请人资料Insured / claimant 保险单号码Policy Number