旅行意外伤害保险索赔申请书.doc

文档介绍：旅行意外伤害保险索赔申请书
Travel 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
Hotline: [phone]
Claims Department
Zurich General pany (China) Limited,
Room 606, 6th Floor, Office Building F, Phoenix Place,
Tower 21, , Shuguangxili, Chaoyang District,
100028, Beijing

被保险人姓名英文/中文年龄
Name of Insured in full (English/Chinese) Age________________
保单持有人英文/中文
Name of Policy Holder in full (English/Chinese)_____________________________________________________________________ 被保险人地址邮政编码 Address of Insured______________________________________________________________ Postal code_______________________
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


(若索赔申请人为被保险人本人,无需填写此栏 If the applicant is the insured, this part can be ignored )
索赔申请人姓名英文/中文年龄
Name of the applicant in full (English/Chinese)____________________________________________Age______________________
索赔申请人地址邮政编码
Add_________________________________________________________________________Postal code_________________________
联络电话(日间固定电话) 联络电话(