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在线保险 Insurance Online

谢谢点击, 收到你的要求后, 我们会很快联系你. We will contact you once your order received.

选择保险类别 Insurance Plan 你的要求 Your Need


从上框选入或任意输入:
从上框选入或任意输入:
起报日期 Start From: (点击日历, 选择起报日期 Start Date)  
保险结束日 End Date: (点击日历, 选择保险结束日期 End Date)
如果在读书, 请输入学校名称 Name of School Attending
如果在工作, 请写入工作性质 If working, please write nature of employment
公司名称 Name of Company (if known)

Medical Questions

To be completed by Policyholder or Parent/Guardian
1. Are you, or any of the insured persons, suffering from a medical condition, illness or
    injury, inlcuding sports-related injuries?
2. Have you, or any of the insured persons, been hospitalised in the past 12 months?
3. Are you, or any of the insured persons, currently taking any medication?
4. Have any of the insured persons ever received treatment for any type of heart
    ailment, circulatory condition, cancer, or back or spinal problems?

My answer to the above is:
If your answer is Yes to any of the questions above, you must write a full description of medical condition(s) and treatment/medication below. In the case of a ‘family’ application please specify which ‘family’ member the medical condition(s) apply to.
Medical conditions that you already suffer from are not automatically covered under the policy. You will be advised in writing by us whether or not we are able to provide cover for your existing condition.

Declaration

I (the Policyholder or Parent/Guardian) declare that:
1.        I am authorized by each person to complete this from and to sign it on his or her behalf.
2.        I am authorized by the credit cardholder to charge their credit card (if this is the payment method I have selected)
3.        All answer given above is complete, true and accurate. I have not withheld any information likely to affect the terms of acceptance of this application for cover. If I have not complete, true and accurate information, Southern Cross Benefits Limited may cancel my policy and refuse any claim I may make.
4.        My police contract is made up of my policy wording and my Certificate of Insurance. It is my responsibility to read and familiar with the policy wording. I acknowledge that my policy contains conditions and exclusions.
5.        I am not traveling with the intention of receiving medical treatment.
6.        I authorize Southern Cross Benefits Limited (which includes its representative, consultants and international assistance agent, Southern Cross Worldwide Assistance and re-insurer) to collect, hold and use information about the insured persons for the purposes of deciding to issue a policy, specific terms applying, investigating and verify claims and otherwise relating to matters covered by the policy terms. I authorize any doctor, hospital, clinic or other person to give Southern Cross Benefits Limited any and all information concerning my current and past medical history. A photocopy of this authorization shall be valid as the original. Each of the issued persons has the right to access and correct health and personal information held about them.
7.        Regarding the International Student Insurance policy, I understand that I may cancel this policy within 10 days of purchase provided that no claim have been submitted, and receive a full refund of the premium paid. I understand that after this period the policy will be non-refundable (except to the extent that your may be entitled to a refund under the Consumer Guarantees Act 1993)
8.        Regarding the Visiting New Zealand Insurance policy, I understand that I may cancel this policy within 3 days of the start date provided that no claim have been submitted, and receive a full refund of the premium paid. I understand that after this period the policy will be non-refundable
9.        I understand that I must inform Southern Cross Benefits Limited of any change of address, and that is my responsibility to ensure I renew my insurance without any lapse in cover.
10.    I understand that, if I have selected StudenEssentials as my plan then I have no cover under Section 8 – Baggage & Personal Items.
11.    I understand that the International Student Insurance policy is underwritten by Southern Cross Benefits Limited.
12.    I understand that the Visiting New Zealand Insurance policy is underwritten by Southern Cross Benefits Limited.
I confirm that all persons named on this application agree to be bound by the international student insurance policy wording and the terms & conditions.
关于你 Your Details:
姓 Family Name
名 First Name
中文名 Ethnic
生日 Birthday
手机 Mobile
电话 Phone
传真Fax
邮件Email
其他 others
你也可以将你的要求, Email, Fax, 或邮寄给我们, 具体号码及地址见本页下方 You may email, fax or post us your request, see address below.

 


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