第三者付款指示表格（只适用於续期保费及保费徵费）.PDF

第三者付款指示表格 (只適用於續期保費及保費徵費) Third Party Payment Instruction Form (For Renewal Premium and Premium Levy Only) POS-TPP 保單號碼 Policy No. 保險中介人資料 Insurance Intermediary’s Information 保險中介人姓名 1 分行/ 中介人編號/註冊編號 1 流動電話號碼 1 Insurance Intermediary ’s Branch/Intermediary’s Code/ Mobile No. Name 2 Registration Code 2 2 本表格中所用之「本公司」或「貴公司」之表述指中國人壽保險（海外）股份有限公司，「本人/我們」之表述指保單持有人/ 申請人及第三者付款人。 The expression “the Companyi used in this form refers to China Life Insurance (Overseas) Company Limited, and the expression I/We refers to the Policyholder/Applicant and the Third Party Payor. 1. 款項由保單持有人/ 申請人之直系親屬繳交。 The payment is made by an immediate family member of the Policyholder/Applicant. 2. 為處理閣下的申請，閣下必須填妥本表格內欄中所有資料，並簽署本表格。 In order to process your request, you must complete all fields in this form and sign on it. 3. 本公司保留索取付款及/或關係及/或身份證明文件之權利。在收到本表格及所需文件（如有）前，本公司不會處理所收到的任何款項及任何相關指示(包 括投資指示或償還貸款) 。 The Company reserves the right to obtain documentary proof of payment and/or relationship and/or identity. The Company will not process any payment received and any related instruction (including investment instructions or loan repayment) until this form and the required documents (if any) have been received by the Company. 第一部份 保單資料 Part 1 Policy Information 受保人姓名 Name of Insured (若受保人並非保單持有人/ 申請人，請填寫此部份) (Please complete this part if the Insured is different from the Policyholder/Applicant) 姓 Last name 名 First name 保單持有人/ 申請人姓名Name of Policyholder/Applicant 姓 Last name 名 First name 第二部份 付款詳情 Part 2 Paym