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GPS Plan Application Form / 導航版申請表

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Please select user type 請選擇用戶身份
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Insured Company Details

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Company Name / 公司名稱
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Other than Hong Kong
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for 1 year cover

Sections Cover

I. Personal Accident 人身意外保障
Annual premium for Personal Accident (per person) 人身意外全年保費(每位)
 

If more than 10 items, please send details via email to cs.hk@aig.com 如選擇多於10個項目,請電郵傳送詳細給客戶服務 cs.hk@aig.com 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Personal Accident Premium 人身意外保障保費


II. Business Travel 商務旅遊 

Annual Premium for Business Travel (Per Group) 團體商務旅遊保障之全年保費(每個團體)

Select the number of trips 請選擇旅程次數
 
Select your plan 請選擇計劃
 
Select your plan 請選擇計劃
 
Select your plan 請選擇計劃
 
Select your plan 請選擇計劃
 
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Business Travel Premium


Loss History (Past 3 years) 索償記錄(過往3年)
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Declaration 聲明

Agent Declaration 保險代理聲明
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a. The applicant has expressly authorised me to submit this application to AIG insurance Hong Kong Limited (the “Company”) on his/her/their behalf. 申請人已明確授權本人代表其向美亞保險香港有限公司(「本公司」)遞交本申請。
b. I/We have obtained relevant information from the applicant to ascertain that the above sign up criteria apply. 本人/吾等已向申請人獲取相關資料,以確定上述申請條件適用。
c. I/We have explained to the applicant and the applicant understands that: i) the statements in this application and the information received by the Company as to the employee’s subsequent changes shall form a part of this application, and shall be the basis for underwriting thereof; ii) all individuals, for whom an application for insurance is submitted, or may be submitted during the continuance of the policy, shall be the full-time salaried employees working for the applicant; and iii) the arrangement for emergency cash transfer is subject to Travel Guard first securing payment from us. The applicant also undertakes to settle any medical expenses that is not payable or not covered by this insurance or any amount in excess of the insurance limit within 14 days after receiving the written notification from the Company. The credit facility will be suspended if the applicant fails to reimburse the Company within the above the time limit. Upon suspension, the applicant has to return all CHINA Assist Cards to the Company and will remain liable to the Company for any outstanding payment in arrears. In the event of loss of CHINA Assist Card, the covered employee should advise the Company within 48 hours and pay HK$30 for each replacement card. 本人/吾等已向申請人說明且申請人亦明白:i) 本申請內陳述及本公司所接獲關於僱員後續變動之資料,均構成本申請一部分,並為承保之依據;ii) 已提交投保申請或可能在保單有效期間提交投保申請之所有人士,必須為申請人僱用之全職受薪僱員;及iii) 享受緊急現金匯款安排須申請人支付Travel Guard先行保證金。申請人亦承諾,對所有保障範圍以外之醫療費用或所有超出所定限額之醫療費用,於收到本公司通知書 14 天內支付。如申請人未能於限期內向本公司付清款項,預繳服務將被終止,同時申請人須將「中國支援卡」歸還本公司,但對所有上述債項仍須負責。如遺失「中國支援卡」,受保僱員須於 48 小時內向本公司報失並繳付HK$30作補領費用。
d. The applicant has confirmed to me/us that he/she/they have disclosed, fully and faithfully all the facts which they ought to know in respect of the risk being proposed. 申請人已向本人/吾等確認,彼∕彼等已完全及如實披露其所知關於所提出風險的全部事實。
e. I/We have explained to the applicant that if there is any inaccurate, incomplete or incorrect information (including the loss history of the applicant) provided in this application, the Company may have the right to reject all claims under any insurance issued and to treat any insurance issued as void from inception and that this insurance application will not be in force until the application has been accepted by the Company. 本人/吾等已向申請人說明,本申請中如有任何不準確、不完整或不正確資料(包括申請人之索償紀錄),本公司可能有權拒絕賠付任何有關保險之索償,並對其予以自保單生效起即屬無效處理,以及本投保須在獲得本公司接納後方可生效。
f. I/We have explained to the applicant that in the event of differences between the English and Chinese version of this application for insurance, the English version shall prevail and that the insurance policy the Company will issue will only be in English. 本人╱吾等已向申請人說明,如以上投保申請之中文本於意義上有任何爭議,一概以英文本為準,本公司亦僅提供英文保單。
g. I/We have explained to the applicant that, and the applicant has consented to any personal data and other information relating to his/her/their policies contained in this application or collected, obtained, compiled or held by the Company by any means, may be used, processed or transferred by the Company for the purposes stated in the Company’s Data Privacy Policy which can be found on the Company’s website, www.aig.com.hk. These purposes include implementing and administering in the insurance which is the subject of this application and all purposes related thereto. Further if the applicant wishes to gain access to or request correction of any personal data we hold in him/her, they may contact the Company as per the contact details in the Company’s Data Privacy Policy and the applicant has confirmed that its employees have been informed and have agreed that their personal data will be released to the Company in accordance with the personal information collection statement set out in this paragraph (g). 本人/吾等已向申請人說明而且申請人亦已同意,本申請內所載、或經本公司透過任何途徑所收集、獲得、整理或持有的有關申請人保單之任何個人資料及其他資料,均可由本公司根據其私隱政策(載於本公司網站www.aig.com.hk)所載用途進行使用、處理或轉交。該等用途包括執行及管理保險(亦即是項申請之內容)以及與之相關的所有用途。另外,申請人如欲查閱或要求改正其由吾等持有之任何個人資料,可按本公司私隱政策內之聯絡方式聯絡本公司。申請人亦已確認,其轄下僱員已知悉並同意根據本(g)段所載之個人資料收集聲明,向本公司提供其個人資料。
Broker Declaration 中介人聲明
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a.The applicant has expressly authorised me to submit this application to AIG insurance Hong Kong Limited (the “Company”) on his/her/their behalf. 申請人已明確授權本人代表其向美亞保險香港有限公司(「本公司」)遞交本申請。
b. I/We have explained to the applicant that by instructing and authorising me/us (as an insurance broker) to proceed with this application, the applicant agrees to the Company paying me/us commission as remuneration for arranging and/or renewing the insurance policy. 本人/吾等已向申請人說明,經申請人指示及授權本人/吾等(作為保險經紀)處理本申請,即表示申請人同意公司向本人/吾等支付佣金,作為安排保單及/或續保之報酬。
c. I/We have obtained relevant information from the applicant to ascertain that the above sign up criteria apply. 本人/吾等已向申請人獲取相關資料,以確定上述申請條件適用。
d. I/We have explained to the applicant and the applicant understands that: i) the statements in this application and the information received by the Company as to the employee’s subsequent changes shall form a part of this application, and shall be the basis for underwriting thereof; ii) all individuals, for whom an application for insurance is submitted, or may be submitted during the continuance of the policy, shall be the full-time salaried employees working for the applicant; and iii) the arrangement for emergency cash transfer is subject to Travel Guard first securing payment from us. The applicant also undertakes to settle any medical expenses that is not payable or not covered by this insurance or any amount in excess of the insurance limit within 14 days after receiving the written notification from the Company. The credit facility will be suspended if the applicant fails to reimburse the Company within the above the time limit. Upon suspension, the applicant has to return all CHINA Assist Cards to the Company and will remain liable to the Company for any outstanding payment in arrears. In the event of loss of CHINA Assist Card, the covered employee should advise the Company within 48 hours and pay HK$30 for each replacement card. 本人/吾等已向申請人說明且申請人亦明白:i) 本申請內陳述及本公司所接獲關於僱員後續變動之資料,均構成本申請一部分,並為承保之依據;ii) 已提交投保申請或可能在保單有效期間提交投保申請之所有人士,必須為申請人僱用之全職受薪僱員;及iii) 享受緊急現金匯款安排申請人須支付Travel Guard先行保證金。申請人亦承諾,對所有保障範圍以外之醫療費用或所有超出所定限額之醫療費用,於收到本公司通知書 14 天內支付。如申請人未能於限期內向本公司付清款項,預繳服務將被終止,同時申請人須將「中國支援卡」歸還本公司,但對所有上述債項仍須負責。如遺失「中國支援卡」,受保僱員須於 48 小時內向本公司報失並繳付HK$30作補領費用。
e. The applicant has confirmed to me/us that he/she/they have disclosed, fully and faithfully all the facts which they ought to know in respect of the risk being proposed. 申請人已向本人/吾等確認,彼∕彼等已完全及如實披露其所知關於所提出風險的全部事實。
f. I/We have explained to the applicant that if there is any inaccurate, incomplete or incorrect information (including the loss history of the applicant) provided in this application, the Company may have the right to reject all claims under any insurance issued and to treat any insurance issued as void from inception and that this insurance application will not be in force until the application has been accepted by the Company. 本人/吾等已向申請人說明,本申請中如有任何不準確、不完整或不正確資料(包括申請人之索償紀錄),本公司可能有權拒絕賠付任何有關保險之索償,並對其予以自保單生效起即屬無效處理,以及本投保須在獲得本公司接納後方可生效。
g. I/We have explained to the applicant that in the event of differences between the English and Chinese version of this application for insurance, the English version shall prevail and that the insurance policy the Company will issue will only be in English. 本人╱吾等已向申請人說明,如以上投保申請之中文本於意義上有任何爭議,一概以英文本為準,本公司亦僅提供英文保單。
h. I/We have explained to the applicant that, and the applicant has consented to any personal data and other information relating to his/her/their policies contained in this application or collected, obtained, compiled or held by the Company by any means, may be used, processed or transferred by the Company for the purposes stated in the Company’s Data Privacy Policy which can be found on the Company’s website, www.aig.com.hk. These purposes include implementing and administering in the insurance which is the subject of this application and all purposes related thereto. Further if the applicant wishes to gain access to or request correction of any personal data we hold in him/her, they may contact the Company as per the contact details in the Company’s Data Privacy Policy and the applicant has confirmed that its employees have been informed and have agreed that their personal data will be released to the Company in accordance with the personal information collection statement set out in this paragraph (g). 本人/吾等已向申請人說明而且申請人亦已同意,本申請內所載、或經本公司透過任何途徑所收集、獲得、整理或持有的有關申請人保單之任何個人資料及其他資料,均可由本公司根據其私隱政策(載於本公司網站www.aig.com.hk)所載用途進行使用、處理或轉交。該等用途包括執行及管理保險(亦即是項申請之內容)以及與之相關的所有用途。另外,申請人如欲查閱或要求改正其由吾等持有之任何個人資料,可按本公司私隱政策內之聯絡方式聯絡本公司。申請人亦已確認,其轄下僱員已知悉並同意根據本(h)段所載之個人資料收集聲明,向本公司提供其個人資料。

 


Please note that this insurance application will not be in force until it has been accepted by AIG Hong Kong and the premium has been paid. 此保險申請須待美亞保險覆核,接納投保書及繳付保費後才能生效。

Our Customer Service Team will get in touch with the contact person within 48 hours with next steps and details on how to pay premium. 我們的客戶服務團隊將於48小時內就接下來的步驟及支付保費方法聯絡聯絡人。

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