旅行意外伤害保险索赔申请书.docx

文档介绍：旅行意外伤害保险索赔申请书ZURICH苏黎世保险
TravelAccidentInsuranceClaimForm
所有问题均须由被保险人/索赔申请人完全回答保单号码
AllquestionsmustbeansweredbyInsur旅行意外伤害保险索赔申请书ZURICH苏黎世保险
TravelAccidentInsuranceClaimForm
所有问题均须由被保险人/索赔申请人完全回答保单号码
AllquestionsmustbeansweredbyInsured/applicantPolicyNo.
Hotline:[phone]ClaimsDepartmentZurichGeneralInsuranceCompany(China)Limited,Room606,6thFloor,OfficeBuildingF,PhoenixPlace,Tower21,,Shuguangxili,ChaoyangDistrict,100028,Beijing/NameofInsuredinfull(English/Chinese)Age保单持有人英文/中文NameofPolicyHolderinfull(English/Chinese)被保险人地址邮政编码AddressofInsuredPostalcode联络电话(日间固机).(Daytime)Mobile职业(请详述)―身份证号码Occupation(describefully)IdentityCardNo.
(若索赔申请人为被保险人本人，无需填写此栏Iftheapplicantistheinsured,thispartcanbeignored)索赔申请人姓名英文/中文年龄Nameoftheapplicantinfull(English/Chinese)Age索赔申请人地址由SAddPostalcode联络电话(日间固定电话)机).(Daytime)Mobile与被保险人关系身份证号码RelationshiptotheinsuredIdentityCardNo.
保险期间由(Theinsuranceperiodisfrom)至(to)索赔类别1.□医疗费用2.□人身意外3.□行李/随身财物/证件遗失ClaimItemMedicalExpensesPersonalAccidentLossofPersonalBaggageandTravelDocument4.□旅程/行李延误5.□个人责任6.□行程取消/缩短
TravelandBaggageDelayPersonalLiabilityCancellationandCurtailmentofTrip7.□家居财物盗抢损失8.□其它LossofHomecontentduetoBurglaryOthers意夕卜在何时何地发生Whenandwheredidtheaccidentoccur?
(a)Date日期(b)Time时间(c)Place地点请详述意外事故发Howdidtheaccidentoccur?(Pleasestatefully)索赔金额Claimamount:
是否已向其它保险机构索赔？
Haveyousubmittedtheclaimtootherinsurer?
□否No
口是Ye