保费缴付特别安排申请书模板.pdfVIP

Special Arrangement of Premium Payment Application Form 保費繳付特別安排申請書保費繳付特別安排申請書 保費繳付特別安排申請書保費繳付特別安排申請書 Being the Policyowner of the following policy(ies), I understand that policy premiums should be paid by myself or the life insured (if different from me). However, I would like to propose the following designated third-party (the “Payor”) to pay for my policy(ies) on my behalf. Below are the details: 作為以下保單之權益人 ，本人明白保費應由本人或被保人 （如非本人）繳交 。唯本人現申請由下述之第三者（簡稱 “繳款人”）代本人繳付本 人之保單 ，詳情如下： Policy No(s) 保單編號 : Payor 繳款人 : Reason 原因 : ______________________________________________________________________________________ I confirm the following relationship between the Payor and me (Policyowner): 本人 （保單權益人）確認與繳款人之關係如下: □ Spouse 配偶 □ Parent / Child / Grandparent / Grandchild* 父母 / 子女 / 祖父毋 / 孫子女* □ Parent-in-law / Son-in-law / Daughter-in-law* 配偶之父或母 / 女婿 / 媳婦* □ Employer-Employee 僱主-僱員 □ Sole Proprietor / Partner of the Partnership / Director of the Limited Company *1 獨資業務東主 / 合夥公司之合夥人 / 有限公司之董事* # *Please delete where inappropriate 請刪除不適用者 1For Payor that is a body corporate or unincorporated, please contact your adviser or customer service centre about the documents required. 如繳款人屬法人團體或非法人團體，請向閣下之理財顧問或客户服務部查詢所需文件 。 I understand that the above application is subject to FWD’s approval. FWD reserves the rights to (i) request the relevant supporting documents (such as address proof, relationship proof, etc.), and/or (ii) decline any application or withdraw approval at any subsequent time without giving reason. 本人明白上述申請需交由富衛審批 。富衛保留以下權利 ：(i) 索取相關證明文件(如:地址證明 、關係證明等)及 / 或(ii) 拒絕任何申請或於其後任 何時間取消批准而毋須給予理由 。 Signature 簽署: Policyowner 保單權益人 Witness (Full Name) 見證人(全名) Date 日期: Declaration