文档介绍：团体意外伤害保险索赔申请书
Group Personal Accident Insurance Claim Form
所有问题均须由被保险人/索赔申请人完全回答保单号码
All questions must be answered by Insured/ applicant Policy No. __________________
1. 保单持有人名称英文/中文
Name of Policy Holder in full (English/Chinese) _______________ __________________________ _______________ _ ____
事故人员姓名英文/中文年龄
Name of Person(s) involved in the accident in full (English/Chinese) ____________________________________ Age _______
事故人员地址
Address of Person(s) involved in the accident ______________________________ _________________________
联络电话(日间固定电话) 联络电话(手机)
Tel. no. (Daytime) _________ Mobile _______
职业(请详述) 身份证号码
Occupation (describe fully) __________________________________________________ Identity Card No. ___
2. 意外在何时何地发生
When and where did the accident occur?
(a) Date 日期______________________________________ (b) Time 时间___________________________________________________
(c) Place 地点______________________________________________________________________________________________ ____
3. 请详述意外事故发生经过
How did the accident occur? (Please state fully)____________ _________________________________________
__________________________________________________________________________________________________________ ____
__________________________________________________________________________________________________________ ____