SHKPI Householders' Comprehensive Insurance

Please complete the form in English. Shaded input fields must be completed.
請用英文完成表格。陰影部份必須填上。

Department
職員部門

Staff No
職員編號

Part I Insured's Personal Information 投保人個人資料

Title 稱謂

Surname
姓

Given Name
名

Email
電郵地址

Sex
性別

HKID (Please Provide First 4 Characters)
香港身份證號碼 (請提供首4位字元)
e.g. A123456(7) => A123
AA123456(7) => AA12

Insured's SHKP Club Membership No. (if applicable)* 投保人新地會會員編號 (如適用)*

Ordinary Member
普通會員

Star Member
星級會員

WIL Membership No.

WIL會員編號

Contact Telephone No. 聯絡電話

Mobile
手提電話

Home
住宅

Office
辦公室

Fax No
傳真

Correspondence Address 通訊地址

Room
單位

Floor
層

Block
座

Building/Estate Name
大廈/屋苑名稱

Street No.and Name
街道號數及名稱

District
地區

Territory
區域

Part II Insurance Particulars 投保事項

Insured Property Address(for Residential Only) 投保物業地址(只限住宅)

Same as above 同上

Yes 是No 否

(if not, please fill in below) 如答否，請填寫以下有關資料

Room
單位

Floor
層

Block
座

Building/Estate Name
大廈/屋苑名稱

Street No.and Name
街道號數及名稱

District
地區

Territory
區域

1) What is the building category of the Insured Property? 投保物業屬於那種樓宇類別?

Government Public Housing Estate 政府公共屋邨
Private Residential Development/Building 私人屋苑/樓宇
Home Ownership Scheme 居者有其屋計劃之屋苑

2) Is the age of the building over 25 years? 樓宇樓齡是否超過二十五年?

Yes 是No 否

3) Is the Insured Property a house/ Semi-detached House/ Village House? 投保物業是否獨立屋/ 半獨立屋/ 村屋 ?

Yes 是No 否

4) Is the Insured Property located on ground level? 投保物業是否位於地面層?

Yes 是No 否

5) Have you made any claims on Home Contents Insurance and the like within the past 3 years? 閣下是否於過去三年內就家居綜合保險或類似保險申請索償?

Yes 是No 否

6) Have you ever been declined for any new application, renewal or imposed special terms and conditions on Home Contents Insurance?
閣下是否曾經被拒絕接受投保同類之家居財物保險或於續保時需附加任何特別條件?

Yes 是No 否

Part III Sum Insured & Coverage 保額及承保範圍

Gross Floor Area (in sq. ft.)* 建築面積(平方呎)*

Saleable Area (in sq. ft.)** 實用面積(平方呎)**

Promotion Code 優惠編號 (if applicable, 如適用)

Period of Insurance 投保日期 (dd/mm/yyyy)

12 months start from
12個月由開始

Levy 保險徵費 (HK$)

Net Premium plus Levy
折實保費及保險徵費 (HK$)

* For gross floor area exceeds 2,500 sq. fts. or house/ semi-detached house/ village house,
or ground level flat of the building, please call Customer Services at 2828 7886.
如建築面積超過2,500平方呎或獨立屋/ 半獨立屋/ 村屋，或投保物業位於地面層，請致電2828 7886 客戶服務部。

** For saleable area exceeds 2,000 sq. fts. or house/ semi-detached house/ village house,
or ground level flat of the building, please call Customer Services at 2828 7886.
如實用面積超過2,000平方呎或獨立屋/ 半獨立屋/ 村屋，或投保物業位於地面層，請致電2828 7886 客戶服務部。

*** The minimum premium of the policy is HK$400. This sum is non-refundable even if
   the policy is subsequently cancelled.
   本保單最低收費為 HK$400。倘若投保人於保單屆滿前退保，此保費將不獲退還。
  The Insurance policy and official receipt will be transmitted to the Insured by email.
  保單及正式收據將以電郵方式傳送至投保人。


Use of Personal Data Circular 個人資料使用通告
Please click here to read 請按此詳閱
I have read and agreed with the Circular to Customers relating to the Personal Data (Privacy) Ordinance - Use of Personal Data. 我已閱讀並同意新鴻基地產保險有限公司就個人資料(私隱)條例致客戶有關個人資料的通告。