华泰财产保险有限公司华泰安怡健康团体医疗保险计划——.PDF

华泰财产保险有限公司 华泰安怡健康团体医疗保险计划—— 会员申请表 Administered by Huatai Property Casualty Insurance Co., Ltd. Aetna International Huatai Healthy AEssentials Insurance Plan - 由Aetna International管理 Member Application Form 注释：填写本申请表前，请阅读下列条款。请酌情使用正楷或复选框。 Explanatory Notes: Please read the following before completing this application. Please use BLOCK CAPITALS or check boxes as appropriate. 告知义务提示：所有可能影响我们对本申请表的评估和考虑的所有事实（例如：既往疾病或参与危险活动的情况），均应予以 告知，否则将影响该保险单的有效性。如果您遇到您无法判断其重要与否的事实，亦请一并告知。 Terms and Conditions: All material facts (e.g. a pre-existing health condition or involvement in a hazardous activity), which may affect Our assessment and consideration of this application, should be declared. Failure to do so may invalidate Your Cover under a Group plan. If You are in doubt as to whether a fact is material, then it should be disclosed. 若您之前有了类似的保险保障，请附上您现有保险凭证的副本以便投保人要求连续保险单转移申请。 If You were covered under a similar Policy immediately prior to Your application for inclusion under this Group plan, please include a copy of Your current Certificate of Insurance, as Your Plan Sponsor may have requested Continuous Transfer Terms. 若仍有其他的补充信息，请用另外的纸提供详细资料。您提供的所有信息都将严格保密。 If You run out of space please use a separate sheet of paper where necessary to provide full details. All information supplied will be treated in strict confidence. 申请投保时，请回答所有问题并代表此申请表下的所有人签署声明。您可以在提交申请的三个月内向我们提出索取本申请表 的副本。您应保存一份提供所有信息的记录。 As the applicant, You should answer all the questions and sign the declaration on