PDF《汽车保险投保书》

the vehicle is in a sound and roadworthy condition;

the vehicle has not been modified nor altered in any way to improve performance. 2. 本人/我们谨同意此车辆将不交由任何曾被拒受保险之驾驶人驾驶. I/We undertake that the vehicle to be insured shall not be driven by any person who to my/our knowledge has been refused insurance or continuance thereof. 3. 本人/我们同意本投保书本人/我们与贵公司订立此保险契约及以后续约之根,并愿接受保单上所刊载一切条款,并同意上文各项若非本 人/我们亲笔填写而由别人代笔均属已经得本人/我们认可及授权. I/We agree that this Proposal and Declaration shall be the basis of the contract between me/us and the Insurers and shall be deemed to be incorporated in such contract, and any renewal thereof which may be agreed, subject to the terms and conditions of the policy issued by the Insurers. If any answer has been written by anyone other than myself/ourselves, such person shall for that purpose be deemed to be my/our agent and not the agent of the Insurers. 4. 本人/我们授权中国太平洋保险(香港)有限公司及其代理收取本人的个人资料作为申请此保险之用. I/We authorize China Pacific Insurance Co.,(H.K.) Ltd. (CPIC) and its agent to collect and use my/our personal data for the purpose of application for this insurance. 收集个人资料声明 阁下提供的资料,本公司提供保险业务所需,并可能使用於下列目的: ? 任何与保险或财务有关的产品或服务或该等产品或服务的任何更改、变更、取消或续期 ? 任何索偿或索偿分析及可能转移予现存或不时成立的任何有关的公司或任何其他从事与保险或再保险业务有关的公司或与保险业务有关的 中介人或索偿或调查或其他服务提供者或任何保险公司的协会或联会. 阁下有权查阅及要求更正由中国太平洋保险(香港)有限公司持有有关阁下的个人资料,如有此项要求,可向本公司的个人资料(私隐)条例监察主任 提出.联络电话s(852)

2541 4338 或 电邮至 [email protected] Personal Data Collection Statement The information you provide to us is collected to enable us to carry on insurance business and may be used for the purpose of ? Any insurance or financial related product or service or any alternations, variations, cancellation or renewal of them. ? Any claim or analysis of it And may be transferred to any related business partners, companies carrying on insurance or reinsurance related business or an intermediary or a claims or investigation or other service provider providing services relevant to insurance business or any association or federation of insurance companies that exists or is formed from time to time. You have the right to obtain access to and to request correction of any personal information concerning yourself held by CPIC. Requests for such access can be made to our Personal Data (Privacy) Ordinance Compliance Officer accordingly. Telephone : (852)

2541 4338 or E-mail : [email protected] 本人/我们兹声明上述各项均属确实并同意本投保书作双方订立契约之根 I/We hereby declare that all the particulars of this proposal are true, and I/We agree that this proposal shall be the basis of Contract between myself/ourselves and China Pacific Insurance Co.,(H.K.) Ltd 投保人签署及公司盖章 日期 Proposer'

s Signature with Co. Chop (if Applicable)Date 注意:请阁下随投保书附上汽车登记文件及所有驾驶者执照副本. N.B. Please provide us with copies of the Vehicle Registration Document, the Driving Licenses of all Drivers Official Use only Ag........