Employees' (Domestic Helper) Insurance Proposal - 藍十字(亞太 ...

Blue Cross (Asia-Pacific) Insurance Limited
Blue Cross (Asia-Pacific) Insurance Limited (‘Blue Cross’) is a member
of the Bank of East Asia Group. With more than 35 years of experience
in the insurance industry, Blue Cross provides a comprehensive range
of products including life, travel, medical and general insurance, which
caters to the needs of both individual and corporate customers.
Blue Cross has a strong track record in the development of new
products and tailor-made services. As a pioneer in the development of
managed care, Blue Cross is the first insurer to develop a ‘Preferred
Provider Organization’ in Hong Kong and introduce preventive health
check-up programs for its customers.
Blue Cross has received major awards in recognition of its
contribution to the fields of insurance and customer services, such as
the Hong Kong Award for Services – Innovation Award of the Year, the
Superbrands Award and the Asia Pacific Customer Relationship
Excellence Award – Innovative Technology of the Year.
Employees' (Domestic
Helper) Insurance Proposal
29/F, BEA Tower, Millennium City 5, 418 Kwun Tong Road,
Kwun Tong, Kowloon, Hong Kong
418529
Tel3608 2888Fax3608 2938
www.bluecross.com.hk
CUSTOMER SERVICE HOTLINE
3608 2988
E-mailcs@bluecross.com.hk
MD021/05.2005

Employees' Compensation
Cover the employee who shall sustain bodily injury by accident
or disease caused and arising out of and in the course of
employment by the Insured in the business. It indemnifies the
Insured against liability at Law (including liability under
Legislation set out below) to pay compensation in respect of
such injury.
Legislation:
Employees' Compensation Ordinance
Repatriation/Burial Expenses
In the event of the death of the employee, the company will
pay the actual expenses incurred for burial or the conveyance
of body or ashes of the deceased to the place of interment up
to but not exceeding HK$10,000.
Age Limit:
65 years old
Minimum Annual Premium:
HK$556.50 includes 2% ECIIB, 6.3% ECIL & 3% G.T.F. Charge
for each employee. (There will be no refund for cancellation of the
policy.)

Note: The Liability of the Company does not commence until this proposal has been accepted
by the Company and the premium paid in full. (Proposal must be accompanied with
payment and there will be no refund for cancellation of the policy.)
(
)
1. I have not withheld any material information and I accept that this
application and declaration shall be the basis of and incorporated in the
contract between I and the Company.
2. I understand that the liability of the Company does not commence until this
proposal has been accepted by the Company and the premium has been paid.
3. I hereby declare that, to the best of my knowledge, the insured premises have
never had any fire or other loss.
4. I / We understand and agree that any personal information is collected or held
by Blue Cross (Asia-Pacific) Insurance Limited ( he Company to enable the
Company to carry on insurance business and may be used, stored, disclosed
and transferred (within or outside of Hong Kong) to any individuals /
organizations associated with the Company or any selected third party as the
Company may consider necessary for the purposes of: (1) any insurance or
financial related product or service or any addition, alteration, variations,
cancellation or renewal or reinstatement of them; (2) any scope of insurance
coverage, claim processing/investigation, any analysis of it and data matching;
(3) promotion of financial products or services by the Company and its
affiliated companies; and (4) communicating with me/us/the insured or any
relevant organization/person as the Company may consider necessary . I / We
have the right to obtain thePrivacy Policy Statementaccess to and to request
correction of any personal information concerning myself/ourselves held by the
Company. Such request could be made to the Company's Corporate Data
Protection Officer at 29th Floor, BEA Tower, Millennium City 5, 418 Kwun Tong
Road, Kwun Tong, Kowloon, Hong Kong.
1.
2.
3.
4.
If you have any enquiry, please feel free to contact
our Customer Service Hotline: 3608 2988.
Details of benefits, conditions and exclusions will be as per policy wordings.
Member of the Accident Insurance Association

EMPLOYEES' (DOMESTIC HELPER) INSURANCE PROPOSAL
Particulars of Employer
Name of Applicant (Employer)
a. Has your Domestic Helper suffered from any physical defect, infirmity or ill
health of any description? If yes, please give details.
?
Occupation
Correspondence Address
b. Does your Domestic Helper engage in any hazardous activities? If yes, please give
details.
?
Contact Telephone No.
Policy Effective Date (dd/mm/yy)
- For 1 year
(Policy effective date subject to Company's underwriting acceptance
(I) Particulars of Domestic Helper
Name of Domestic Helper
Sex
Nationality
Annual Salary
Date of Birth (dd/mm/yy)
(//)
H.K.I.D.Card No.
Passport No.
Place of Employment (if different from the above)
(2) Particulars of Domestic Helper
Name of Domestic Helper
Sex
Nationality
Annual Salary
Date of Birth (dd/mm/yy)
I/We warrant that the particulars given above are true and agree that the statements
made in this proposal shall be the basis of any contract made between myself/ourselves
and Blue Cross (Asia-Pacific) Insurance Limited.
Signature of Applicant (Employer)
Date (dd/mm/yy)
(//)
Name of Intermediary
Intermediary's Code
Please Tick the Payment Mode
Cash
Cheque - payable to "Blue Cross (Asia-Pacific) Insurance Limited"
Credit Card(s) VISA Master Card
VISA
I hereby authorize Blue Cross (Asia-Pacific) Insurance Limited to debit the annual
premium from my credit card account for the insurance policy.
Credit Card Account No.
Expiry Date
Cardholder's Name
Cardholder's Signature
H.K.I.D.Card No.
Passport No.
Place of Employment (if different from the above)