旅行保险合同变更解除申请书供自营官网平台使用.docx

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1、旅行保险合同变更/解除申请书(供自营官网平台使用)ApplicationforEndOrSement/CancellationOfTravelInsurancePolicy(forAIGwebsite)申请日期ApplicationDale保险单号码PolicyNo.投保人姓名NameofthePolicyholder被保险人姓名NameoftheInsuredPerson联系电话ContactTelNo.邮箱EmailAddress保险期间PolicyPeriod年(YYYY)月(MM)日(DD)至To年(YYYY)月(MM)H(DD)其他需要提供的信息OtherInformation变更/

2、解除内容Endorsement/CancellationContent口更正被保险人资料CorrectionOfInformationoftheInsuredPerson(仅限于姓名或证件号码的非实质性修改Onlyfornon-materialchangestothenameorIDdocumentno.请提供身份证或护照复印件等有效证明文件PleaseprovidevalidIDdocumentsuchascopyofIDorpassport)姓名Name性别Gender口男Male口女Female证件号码No.ofDocument口身份证ID口护照Passport出生日期DateofBir

3、th年(YYYY)月(MM)B(DD)口变更身故保险金受益人ChangeoftheDeathBeneficiaryZBeneficiaries(须投保人与被保险人同时签署NeedtobesingedsimultaneouslybythePolicyholderandInsuredPerson)受益人一Beneficiarj-One身份证号码IDNo.与被保险人关系ReIationShiPtotheInSUredPerSOn受益份额PerCentage%受益人二BeneficiarjTwo身份证号码IDNo.与被保险人关系RelationshiptotheInsuredPerson受益份额Per

4、centage%口退保(合同解除)Cancellation(请提供投保人/被保人亲笔签名的申请书原件、保单/发票原件、投保人身份证及其银行卡/存折复印件Pleaseprovidesignedapplication,policySChedUle/invoiceinoriginal,copyofIDandbankcardofthePolicyholder)因下列原因，申请解除保险合同：Applyforcancellationduetobelowreasons:使领馆拒签(请另附使领馆拒答证明和被保险人未出行证明)Visaapplicationrejected(pleaseattachtheproo

5、foftheEmbassyZConsuIateandtheproofofnodeparture)口旅行取消仅限境外旅行，请另附被保险人未出行证明).Tripcancelled(Foroverseastravelonly.Pleaseattachtheproofofnodeparture)口其他(请详述。如为全弟旅行保障计划退保，请选此项，并注明申请的合同终止日)Others(Pleaseprovidedetails.Pleasechoosethisifcancellinganannualpolicyandfillinpolicyterminationdate.)合同终止时间PoIiCyIenn

6、inaliOnlime弟(YYYY)月(MM)H(DD)24:00时(HrS)其他变更(清详述)OtherChanges(Pleaseprovidedetails)申请人声明DeclarationoftheApplicant1 .上述申请内容均真实无讹，申请按此变更或解除保险合同。所述申请经美亚财产保险限公司审核同意后方可生效.Allapplicationcontentaboveistrue.I/Weherebyapplytoendorse/cancelthepolicy.TheapplicationshalltakeforceafterbeingreviewedandagreedbyAIGI

7、nsuranceCompanyChina1.imited(lheCompany)-2 .本人同意并明白，若保险合同是获得“申根协定”缔约国签证的必要条件，根据与相关使领馆的协议，贵公司在同意:退保申请并签署批单后，Itr权将退保情况通知相关使领馆，告知该保险合同已失效。I/WeherebyunderstandthatifthepolicyisrequiredfortheSchengenvisa,accordingtotheagreementwiththerelevantEinbassyZConsu1ate,theCompanyisauthorizedtoinformtherelevantEmb

8、assyZConsuIatetheterminationofthepolicyaftertheCompanyhasagreedtoandcompletedcancellationofthepolicy.3 .如本人申请退保的为单次旅行保障计划，本人特此确认并同意：截至本人退保前，保险合同项下未发生过任何保险事故或可能导致贵公司承担保险贡任的任何事故：任何情形下，费公司于所解除保险合同项下对任何被保险人均不承担任何责任。同时，本人知悉，如前述单次旅行保隙计划退保申请经贵公司审核同意，本人将收到该保障计划已交保费的全额退还。Intheeventofapplicationforcancellatio

9、nofsingletripinsuranceplan,I/weherebyconfirmandagreethatuptomy/ourcancellation,therehasbeennoinsuranceincidentarisingunderthePolicynoranyeventthatmayresultintheCompanysliability;undernocircumstanceshalltheCompanybeliableforanyinsuredpersonunderthepolicywhichistobecancelled.1am/Weareawarethatafterthe

10、cancellationapplicationisreviewedandagreedbytheCompany.I/wewillreceivefullrefundofthepremiumpaidunderthesaidinsuranceplan.投保人/被保险人签名：/SignatureofPolicyhoIderZInsuredPerson退保银行账号/账户信息和资料邮寄地址见第2页PleasefindBankAccountforCancellationRefundandMailingAddressibrSupportingMaterialsonPage2退保银行账号/账户BankAccoun

11、tforCancellationRefund收款人姓名NameofPayee收款账号AccountNo.收款银行全称FullNameofReceivingBank温馨提示Notes:1 .以转账方式退还保险费,款项将转入投保人账户，请提供详细银行账号，账户信息。RefundwillbemadeviabanktransfertothebankaccountofthePolicyholder.Pleaseprovidedetailsofbankaccount.2 .信用卡账号及邮政储蓄账户均不能作为退还保险费时之收款账号储户。CreditCardorPostalSavingsAccountisno

12、tacceptableforthepremiumrefund.3 .请提供详细的收款银行名称，如XX银行XX分行XX支行/办事处/分理处/储蓄所。如有福要，我司将可能要求客户提供有关复印件.Pleaseprovidedetailednameofreceivingbank,forexample:xxsub-branch,xxbranchofxxbank.Wemayrequirecopyofbankaccountifnecessary.资料邮寄地址MailingAddressforSupportingMaterials公司名称：美亚财产保险有限公司CompanyName:AIGInsuranceCompanyChina1.imited邮寄地址MailingAddress:中国上海市浦东新区陆家嘴环路IOOo号恒生银行大厦31楼041室，邮编200120Unit31F/041,HangSengBankTower,10001.ujiazuiRingRoad,PudongNewArea,Shanghai200120,P.R.China电话Tel:400820-8858邮件地址EmailAddress: