复星联合和睦医疗保险投保单.pdf

复星联合健康保险股份有限公司 FOSUN UNITED HEALTH INSURANCE Co.,Ltd. 和睦医疗保险个人投保单 INDIVIDUAL UNITY HEALTH PLAN APPLICATION FORM 尊敬的客户； Dear member, 1.为使您充分了解投保内容并维护您的权益，投保前请向业务代表索要保险条款，并要求业务代表详细解释保险条款，特别是保险责任、 责任免除等重要内容。请在业务代表已解释保险条款，您已仔细阅读本保险相关内容和条款，确认已充分理解保险责任、责任免除、如实 告知、合同解除等重要事项后做出投保决定。 In order for you to fully understand the insurance applied for and so as to protect your rights and interests, please ask sales representative/broker for the policy wording and detailed explanations of the policy wording, particularly in terms of important contents such as benefits and exclusions before apply. Please make your application decision only when sales representative has explained the policy wording; you have carefully read relevant insurance contents and policy wording; and you have fully understood important issues like benefits, exclusions, honest disclosure and contract cancellation. 2.本保险为和睦家专属医疗保险产品，致力于为您提供国际标准的高品质医疗保障。原则上被保险人应当前往和睦家诊所和医疗院接受治 疗，您前往其他诊所接受治疗的，不一定能够获得保障，具体见保险条款。 The insurance is United Family Healthcare devoted health insurance, aiming to provide high quality medical services of international standards for you. In general, the Insured shall make a visit to United Family clinics or hospitals (hereinafter short for UFH) for treatments. Any treatments in other clinics or hospitals may not be covered. Please refer to the policy wording. 3.投保单及其它保险人认为有必要的资料（以下简称“投保资料” ）是本公司签发保险单的依据，将成为保险合同的重要组成部分。请您保 留一份提供给我们的信息资料（包含信件的附件）便于本保险合同的签署。 The Application Form, and other files deemed necessary by the Insurer (hereinafter application files) are basis for the Insurer to issue the Insurance Contract and will be an important part of the Insurance Contract. You should keep a record of all information (including copies of all letters) supplied to Us for the purpose of entering into this contract. 对于本公司提出的各项询问，投保