团体保险个人健康告知书

《团体保险个人健康告知书》由会员上传分享，免费在线阅读，更多相关内容在应用文档-天天文库。

1、泰康人寿保险股份有限公司厦门分公司厦门市莲岳路1号磐基中心12层团体保险个人健康告知书HealthStatementforGroupInsuranceInsurants填写须知Notice1.在填写健康告知前，请详细阅读本公司相关保险产品条款，特别是保险责任和责任免除条款事项；PleasereadallthetermsandconditionsofthispolicycarefullybeforefillinginthisStatementofHealth,especiallyarticlesconcer

2、ningthebenefitsandexclusions.2.请您完整填写本告知书内的相关部分。请您准确填写、如实告知，这对于您的投保申请十分重要；Pleasefilloutallrelevantsectionscompletely.PleasebenotedthatitisveryimportancethatallrelevantquestionsonthisStatementofHealthareansweredaccuratelyandtruthfully.3.本告知书只有被保险人本人亲笔签名后生效

3、。如有修改，需在修改处加签字；TheStatementofHealthwillnotbevaliduntilbeingsignedbytheinsuredhim/herself.Incaseofanycorrection,additionalsignatureshallbeaddednexttothecorrection.4.本告知书为投保人与保险公司所订立保险合同的组成部分。与本告知书各事项相违背的任何口头承诺均属无效。TheStatementofHealthshallbetreatedasaparto

4、ftheentireinsurancecontractbetweenpolicyholderandinsurer.AnyinformaloralagreementwhichisinconsistentwiththecontentoftheStatementofHealthshallbedeemedasinvalid.A、被保险人资料（InformationofInsurant）投保人/Company：厦门大学XiamenUniversity被保险人姓名/Name：被保险人与员工的关系：□配偶□子女N/AT

5、heinsuredpersonandemployeerelations：□Spouse□child附属被保险人姓名：N/ANameofthesubsidiaryinsured：N/A身份证号码：ID：性别/Gender：年龄/Age：B、个人健康问卷（IndividualHealthQuestionnaire）请您完整填写您的相关信息。假如您有连带保险人一同投保，请另外填写告知书。Pleasecompleteallthenecessaryinformation.Ifyouhavedependents,pl

6、easefillinadditionalStatementofHealthformsforthem.请对本部分的问题做出“是”或“否”的回答。对回答“是”的问题，请在随后的空白处填写详细的相关信息，所有提供的信息均会被严格保密。申请人必须对相关问题的重要事实如实告知，否则将有可能影响本保单的有效性。“重要事实”是指任何有可能影响本次投保的结果的信息；若你对某些事实是否属“重要事实”有所疑问，请您就这些事实一并如实告知。Thequestionsinthefollowingsectionshallbeansw

7、eredwith“YES”or“NO”.Ifyes,pleasespecifydetailsinthespaceprovided.Allinformationprovidedherewillbekeptconfidential.Allmaterialfactspertinenttothesequestionsshallbedisclosedcorrectlyandtruthfully.Anymisstatementinthequestionnairemayinfluencethevalidationoft

8、hepolicy.“Materialfact”referstoanyinformationthatwouldbelikelytoinfluencetheinsurer’sassessmentandacceptanceofthisapplication.Ifyouhaveanydoubtaboutwhetherafactshallbetreatedasmaterial,pleasediscloseitatthesametime.