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。
15 digits card no. of SmarTone Prepaid Travel Data Card (Please refer to the back of your card)
SmarTone旅遊數據咭15位數字咭號 (請參閱卡背) Card no.
Each SmarTone Prepaid Travel Data Card is entitled to the privilege for one time only. 每個SmarTone旅遊數據咭咭號只享用此優惠一次。
Part I Insured's Personal Information 投保人個人資料
Title 稱謂
Surname 姓
Given Name 名
HKID 香港身份證號碼 例: A123456(3)
Sex 性別 Male 男Female 女
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 
Email 電郵地址
Contact Telephone No. 聯絡電話 Mobile 手提     
Home 住宅      
Office 辦公室   
Fax No 傳真    
Part II Insurance Particulars 投保事項
From Hong Kong to 由香港至
To 至 Day(s)
 
Role
關係
Names of Insured Persons
受保人姓名
Date of Birth
出生日期
(dd/mm/yyyy)
Sex
性別
香港身份證號碼
H.K.I.D. Card
例: A123456(3)
Plan
計劃
Premium
保費
(HK$)
Insured 受保人
Spouse 配偶
Child 1 子女(1)
Child 2 子女(2)
Child 3 子女(3)
   Total Premium 總保費
  Discount 保費優惠 % %
  Net Premium 折實保費(HK$)
  Levy 保險徵費 (HK$)
  Net Premium plus Levy 折實保費及 保險徵費 (HK$)

* Insurance Coverage is applicable to HONG KONG RESIDENTS at or below the age of 70.
* 此保險保障只適用於70歲或以下的香港永久居民。
* Insured Persons over the age of 65 or under the age of 16 are eligible for Silver Plan (no double indemnity benefits) and Cruise Plan only. For Cruise Plan, their Personal Accident and Medical Expenses Benefits will be up to HK$250,000 and HK$200,000 respectively.
* 在65 歲以上或16 歲以下的受保人士,只可選擇銀計劃 (不獲個人意外雙倍賠償)及郵輪計劃。而郵輪計劃中的個人意外及醫療費用保障最高賠 償額分別為港幣250,000 元 及200,000 元。
* Maximum 90 days per single trip. The journey must commence from Hong Kong.
* 每次旅程最長為90 天。旅程須由香港出發。
No refund of premium will be made once the insurance policy is issued.
保單發出後,保費將不獲退回。
DECLARATION 聲明
I warrant that no insured person is travelling contrary to the advice of a medical practitioner or for the purpose of obtaining medical treatment and that the insured person(s) understand(s) that treatement of any pre-existing, existing, recurring or congenital medical conditions are not insured. I further warrant that the insured person(s) is/are not aware of any condition, cause or circumstances that may necessitate the cancellation or curtailment of the journey as planned.
I declare that the above statements and information are true. I understand and agree that this Travel Insurance Application Form will form part of the insurance contract that will be issued by Sun Hung Kai Properites Insurance Ltd.
本人保證並據實相信各受保人絕不會違反醫生的囑咐或僅為獲得醫療而外出旅遊, 各受保人更清楚明白任何現已存在之疾病,現有, 不時復發或先天疾病皆不在承保之列。 各受保人保證對已安排而又必須取消或縮短旅程之絕不知情。 本人聲明在此申請書內填報的資料乃確實。本人明白及同意此申請書乃作為本人與新鴻基地產保險有限公司合約的基礎。
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。