How to Complete Application Form for Life Protection Plan (LifeReward)

Transcription

1 How to Complete Application Form for Life Protection Plan (LifeReward) Attention: 1. Use BLACK Ball Pen. 2. Write down all information in BLOCK LETTERS. 3. Any amendment should be countersigned by Main Applicant and Joint Applicant (if applicable). Don t use correction pen or fluid. 4. If the answer is NO, please don t state N/A, NIL or cross out the question. Otherwise, please use Supplementary Statement for Application Form to confirm the related information. Special Notes: 1. All forms must be submitted within 1 month from sign date. Requirements: 1. Application Form 2. Tailor Made Benefit Illustration 3. Customer Information Analysis Form 4. Identity Card or Passport Copy (Certified True Copy) 5. Address Proof (Certified True Copy) 6. Initial Premium 7. Source of Wealth form (if premium amount meets/exceeds Medium/High risk) Last updated on 12 April

2 Section 1 Personal Details *All questions in this part must be completed. The personal particulars including name and identity card number must be consistent with the information in the identity document of the Main Applicant / Joint Applicant. If the client has changed name which is different from our existing record, copy of legal document, such as deed poll, must be provided. CHAN TAI MAN 陳 大 文 CHINESE G765432(1) HONG KONG Checking the identity details of HKID / travel document of the applicant is a significant process to confirm these information Last updated on 12 April

3 Industry and Job Position is compulsory to be completed. Job Position is equivalent to the job title of the client under his/her employment contract. For example: customer service officer, human resource manager, electrical engineer. Job Nature means job description of the client under his/her employment contract. For example: clerical duties, teaching, repair household air conditioning without height work. Please avoid using ambiguous terms, such as production or operation ; so as to minimize any need for further clarification of job duties at a later stage. IBM 22/F DECON HSE, QUARRY BAY. HONG KONG COMPUTER COMPUTER ENGINEER PROGRAMMING aviva@aviva.com 4 14 E GREENLEAVES GARDEN 11 TAI KOK STREET Last updated on 12 April

4 Section 2 Plan Information 1,000,000 93,270 1) For Aviva LifeReward, Terminal Illness Benefit is not available for: i) age next birthday 65 or above; ii) nationals and / or residents of Mainland China. Last updated on 12 April

5 Not applicable for LifeReward application Last updated on 12 April

6 Please complete A/C info below if Option 3 is/are chosen CHAN TAI MAN HONGKONG BANK CAUSEWAY BAY ) The name of A/C holder MUST be the same as the policy holder. 2) If no option is selected under Annual Dividends and/or Guaranteed Cash Coupons, the default payout option will be option 1. 3) If option 3 are chosen on both Annual Dividends and/or Guaranteed Cash Coupons, both dividend and coupon will be direct credited to the same bank A/C. Last updated on 12 April

7 Not applicable for LifeReward application Last updated on 12 April

8 Section 3 Assurance Details Aviva Life Insurance Company Ltd 01 Sep ,000,000 Scuba Diving For Question1), please give details in Part (a) if client s answer is Yes. For Question2), please give details in Part (b) if client s answer is Yes. *Applicant who has been declined by Aviva before will be declined for application Last updated on 12 April

9 Section 4 Health Details Not applicable for LifeReward application Last updated on 12 April

10 Not applicable for LifeReward application Last updated on 12 April

11 Not applicable for LifeReward application Last updated on 12 April

12 Section 5 Beneficial Interest/ Source of Wealth Client needs to state where their source came from. And extra Source of Wealth form may be needed, depending on premium amount. Yes : Example 1 A client wishes to have a financial growth by investment. He therefore applies for a LifeReward under his own name. In this situation, as he is acting solely on his own behalf in making the application, he should answer Yes in Application Form - Beneficial Interest/Source of Fund Q3 Example 2 A client wishes to have an investment for his own children education expense. He therefore applies for a LifeReward with himself as the Proposed Policyholder and his child as the Proposed Life Assured. In this situation, he is still acting solely on his own behalf in making the application, he should answer Yes in Application Form - Beneficial Interest/Source of Fund Q3 No : 4) A client was asked to have an investment on behalf of a third party. He therefore applies for a LifeReward but solely under his own name as both the Policyholder and Life Assured. In this situation, as he is in fact acting on behalf of that third party, he should answer No in Application Form - Beneficial Interest/Source of Fund Q3. He should provide written authority for our verification that the individual purporting to represent the customer is authorised to do so. Further, he should also provide the details of that third party including name, date of birth, identity number, nationality, residential address (with proof for high risk cases), contact number, occupation and the relationship by supplementary statement together with that third party s identity document copy for further consideration. Last updated on 12 April

13 Section 6 Beneficiary Information WONG LAI KUEN 黃 麗 娟 K (7) SPOUSE 100 Notes to Beneficiary Section: 1. Accept the following beneficiary relationship only: parent, children or spouse. For all other relationships, insurable interest must be given for consideration. 2. ID or passport number of each beneficiary must be completed. 3. Total Share of all beneficiaries must be equal to 100%. 4. Section 8& 9 Initial Payment Method and Subsequent Premium Payment HSBC For Aviva LifeReward, client can use credit card for initial payment if the Premium Mode is monthly ONLY. Last updated on 12 April

14 HONGKONG BANK CAUSEWAY BAY CHAN TAI MAN G765432(1) Notes to Premium Payment 1. Third party payment is not allowed. 2. Client ID no. and bank a/c information must exactly match with bank record. Otherwise, the DDA application will be rejected. 3. For joint bank a/c, please provide both joint a/c holder names, ID, and signatures. 4. Credit card is not available for subsequent payment for Aviva LifeLink and Aviva LifeReward. Last updated on 12 April

15 Section 10 Replacement Declaration Customer Protection Declaration form is required if Yes is chosen for any question(s) in policy replacement section of the application form. 1 Apr 2012 Last updated on 12 April

16 Section 11 Declaration and Authorisation 1 Apr 2012 Agent must have relevant license. Signature must be consistent among all submitted forms. Application sign date must be on or after Benefit Illustration sign date. Last updated on 12 April