Guarantee Slip No.
投保人姓名
Name of Policy Holder
被保险人姓名 Name of Insurant
护照号码 Passport No.
身份证号 ID Card No.
通讯地址及电话 Address & Tel No.
旅行路线 Itinerary
出发地 Departure
目的地 Destination
航班号 Flight No.
头等舱 First Class
商务舱
Business Class
经济舱
Economy Class
保险金额
Amount of Insurance
意外身故、残疾¥200万元
Accidental Death and Disability ¥2,000,000 Yuan
意外医疗 ¥20万元
Accidental Medical Treatment ¥200,000 Yuan
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意外住院津贴¥200元/日
Accidental Hospitalization Benefit ¥200 Yuan/day
保险费
Insurance Premium
保险期间:壹年内一次往返有效。
Insurance Period: It is valid for one trip within one year.
特别约定:乘客以有效行程单上列明的出境航程改期或签转航班继续有效(最长有效期一年),非因乘客本人原因造成的机票签转或转乘下一航班时继续有效。Special Stipulation: Emigration flight modified date or flight signed for extension listed on effective trip sheet by passenger goes on taking effect (maximum effective period is one year).
Ticket signed for extension or transfer to take the next flight due to no reason of passenger goes on taking effect.
保险责任:自踏入出发地航班舱门时起,至踏出目的地航班舱门时止,被保险人在乘坐本保单上列明的民航班机时,因意外伤害事故导致180日内身故,或下落不明、经人民法院宣告死亡的,本公司按保险金额给付身故保险金。Insurance Liability: From the time for stepping into the flight gate of departure to the time for stepping out of the flight gate of destination,in case the Insurant takes civil aviation airliner listed on this Guarantee Slip and dies within 180 days or is whereabouts unknown or is declared to dieby People’s Court caused by accidental injury, this company pays death insurance benefit according to amount of insurance.
投保人签名:
Signature of Policy Holder: 被保险人签名: Signature of Insurant:
投保单填写日期:
Date of Guarantee Slip Filling:
出单单位: Issuing Unit:
出单人:
Issuing Person: