家庭佣工保障索偿表格.PDFVIP

Prudential General Insurance Hong Kong Limited 保誠財險有限公司 (A member of Prudential plc group) (英國保誠集團成員) 25 3/F, Berkshire House, 25 Westlands Road 香港魚涌華蘭路 號 3 克大廈 樓 Quarry Bay, Hong Kong Tel : (852) 2977 3888 電話：(852) 2977 3888 Fax : (852) 2164 8445 傳真：(852) 2164 8445 Domestic Helper Insurance Claim Form 家庭傭工保障索償表格 Please complete this claim form in full carefully. The forwarding of this claim form for completion is not an admission of liability upon the part of Prudential General Insurance Hong Kong Limited (“the Company”). For queries, please contact your Financial Consultant or us by email at gi.claims@.hk. If it is a claim for Section VII-Clinical Benefits, completion of this claim form is waived. Please submit the original medical receipt(s) with diagnosis directly to us within 31 days counting from the issue date of the receipt(s). Please also indicate the corresponding policy number on the back of the receipt(s). 請小心填妥本索償表格。發出本索償表格予以填寫，並不能視作保誠財險有限公司（“本公司”）已承認有賠償的責任。如有查詢，請聯絡你的理 財顧問或電郵至gi.claims@.hk 。 如屬項目VII- 門診費用保障的索償，則可免填寫本索償表格；請將列明診斷的醫療收據正本，在有關發出日起計31天內遞交。請於收據背面註明 閣下正索償的保單編號。 Please complete in BLOCK LETTERS 請以正楷填寫 PART I 第一部份 Name of Policyholder Policy number 投保人姓名