BusinessTravelPackageInsurancePlanApplicationForm
投保单位资料InformationofApplicant
投保人NameofApplicant:
办公地址BusinessAddress:邮政编码Postcode:
营业范围BusinessScope:联络人ContactPerson:手机MP:
保险单资料PolicyInformation
(详细的保障计划以投保人最后确认的报价单为准
BenefitsdetailsshallrefertothequotationacceptedbytheApplicant.)
保险期间ProposedPolicyPeriod由From:00:00时hrs.
(年/月/日YYYY/MM/DD)至To:24:00时hrs.
(年/月/日YYY/MM/DD)
说明：保险期间最早开始于投保人签署本投保单的次日零时零分。
Remark:ThePolicyPeriodshallstartnotearlierthanthetimeof00:00onthenextdayofthedatethisApplicationFormissignedbytheApplicant.
保障计划内容InsuranceCoverageofthePackage:
保障项目Coverage
保险责任LimitofLiability(RMB：yuan)
一、商务旅行公众责任保险PublicLiabilityDuringBusinessTravel
二、监管行动及诉讼保障保险RegulatoryActionProtector
三、团体旅行意外综合保险GroupTravelAccident
保险金额/人(人民币：元)SumInsured/Limit(RMB：yuan)
每次差旅/PerTrip
黄金计划Gold铂金计划Platinum钻石计划Diamond至尊计划Privilege
1.意外身故、烧伤及残疾保障AccidentalDeath,BurnsandDismemberment
2.双倍给付意外伤害(仅适用境外)DoubleIndemnity(onlyforoutbound)
3.紧急医疗费用EmergencyMedicalExpenses-Accident&Sickness
*其中境内旅行的疾病医药赔偿限额
LimitofSicknessMedicalReimbursementforDomesticTravel
4.每日住院津贴(境内仅包含意外住院)HospitalCash（domesticforaccidentonly）
5.紧急医疗运送及医疗遣返MedicalEvacuation&Repatriation
6.遗体遣返和丧葬费用BodyRepatriation（funeralfee）
7.家属紧急旅行费用EmergencyTravelExpensesforFamilyMember
8.个人钱财LossofMoney
9.随身财产及旅行证件遗失LossofBaggage&PersonalDocuments
*每件手提电脑赔偿限额Limitperlaptopcomputer
*每件或每套物品赔偿限额Limitperitemorsetofitems
*证件遗失赔偿限额LimitforPersonalDocuments
10.已交运行李损失CheckedBaggageLoss
*每件或每套行李赔偿限额Limitperitemorsetofitems
11.家居保障HomeGuard(每件或每套物品赔偿限额:RMB)
12.行程延误TravelDelay(每四小时延误赔偿额:RMB;
RMBforevery4hoursofdelay)
13.行李延误BaggageDelay(每八小时延误赔偿额：；
RMBforevery8hoursofdelay)
14.个人责任PersonalLiability
保险费率表PremiumTable
保障项目Coverage保险费（人民币：元）Premium(RMB：Yuan)
1.商务旅行公众责任保险PublicLiabilityDuringBusinessTravel/每张保单全年
2.监管行动及诉讼保障保险RegulatoryActionProtection/每张保单全年
3.团体旅行意外综合保险GroupTravelAccident
黄金计划铂金计划钻石计划至尊计划
GoldPlatinumDiamondPrivilege
预估投保人数Numberofinsuredperson
保险单全年预估总保费Totalpremiumperpolicy
投保须知ImportantInformation:
请仔细阅读以下划线标注免除或减低本公司给付或赔偿责任的项目
PleasereadcarefullytheitemsespeciallytheunderlinedpartswhichreducetheCompany’sliabilityorexemptingtheCompanyfromliabilityundertheinsurance.
1.团体旅行意外综合保险承保的被保险个人年龄最高为18周岁至80周岁。71至80周岁的被保险人,其“意外身故、烧伤及残疾保障”和“双倍给付意外伤害”的保险金额为本计划既定保险金额的一半。
TheGroupTravelInsurancecoversInsuredPersonsbetween18to80yearsofage.ForanyInsuredPersonsattheagebetween71-80,onlyhalfoftheinsuredamountsdesignatedintherespectivetravelinsuranceplansunderitemsofAccidentalDeath,Burns&DismemberBenefit,DoubleIndemnityBenefitshallbeprovided.
2.商务旅行公众责任保险及团体旅行意外综合保险均仅适用于投保人为業務需要派遣其已投保本综合保障计划的董事、监事、董事会秘书、合伙人及员工等前往其日常工作所在的直辖市或省的市级行政区域之外的目的地，执行下列任务的商务旅行：
TheinsuranceForPublicLiabilityDuringBusinessTravelandtheGroupTravelAccidentInsuranceshallapplyonlytoaBusinessTravelthatanyInsuredPersonundertakestoperformthefollowingbusinessassignedbytheApplicantinadestinationawayfromtheprovinceormunicipalitywheretheInsuredPersonordinarilyworks:
拜访客户或供应商；tovisitcustomersorsuppliers;
参观或参加商品交易会；tovisitorparticipateinatradefair;
参加会议或研讨会；toparticipateinmeetingsorseminars;or
接受在职培训安排或或进行市场研究的旅行。
foron-the-jobtrainingprogramormarketresearch.
前述商务旅行应在出发前依内部管理程序获得核准，其中每次境外（指中国大陆以外的国家和地区，包括台湾、香港和澳门）承保旅程最长期限为从旅程开始（在保险期间内）起算的连续90天，但境内承保旅程最长期限为从旅程开始（在保险期间内）起算的连续30天，最迟均不超过承保明细表记载的保险期间。
AnapprovalforanysuchBusinessTravelmusthavebeengrantedinaccordancewiththeinternalmanagementprocedurespriortothecommencementofsuchtravel.Themaximumperiodofonetripcoveredisaconsecutive90-dayperiodforanoverseastrip(includingtripstoTaiwan,HongKongandMacaoareas)；oraconsecutive30-dayperiodforadomestictrip,bothshallcommenceandendwithinthePeriodofInsuranceshownintheScheduletothePackagePolicy.
3.本保障计划不承保任何直接或间接由于前往或途经阿富汗、缅甸、古巴、刚果民主共和国、伊朗、伊拉克、利比里亚、苏丹、叙利亚、以色列、索马里、也门、利比亚或及其它处于战争状态或已宣布为紧急状态的国家或地区，或在上述国家旅行期间发生的保险事故。Thispackagepolicywillnotcoveranyloss,injury,damageorlegalliabilityarisingdirectlyorindirectlyfrom:Travelin,to,orthroughAfghanistan,Burma(Myanmar),Cuba,DemocraticRepublicofCongo,Iran,Iraq,Liberia,Sudan,Syria,Israel,Somalia,Yemen,Libya,orothercountriesorareasinwarordeclaredtobeinthestateofemergency.
4.如果由于贸易或经济制裁或其它类似法律禁止本公司、本公司的母公司或最终控股公司提供本保障计划的承保范围，在禁止范围内本保障计划即不适用。
ThispackagepolicydoesnotapplytotheextentthattradeoreconomicsanctionsorothersimilarlawsorregulationsprohibittheCompany,theCompany’sparentcompanyorultimatecontrollingentityfromprovidingcoverageprovidedbythispackagepolicy.
5.本保障计划不承保任何国家或国际组织认定的恐怖分子或恐怖组织成员，或非法从事毒品、核武器、生物或化学武器交易人员。
Thispackagepolicywillnotcoveranyterroristormemberofaterroristorganization,narcoticstrafficker,orillegalpurveyorofnuclear,chemicalorbiologicalweaponsdefinedbyanycountryorinternationalorganization.
FailuretodiscloseamaterialfactknowntotheApplicantmaycausetheInsurertodeclineliabilityunderthePolicy.AmaterialfactreferstothefactthatmayinfluencethedecisionoftheInsureronwhethertoaccepttheriskorincreasethepremium.Incaseofdoubtastowhetherafactismaterial,pleasediscloseit.
7.投保人目前是否在上海或深圳证券交易所以外的任何证券交易所上市？
DoestheApplicantcurrentlylistinanystockexchangeotherthanShanghaiorShenzhenStockExchange
如回答否,投保人是否計劃近期在上海或深圳证券交易所以外的任何证券交易所上市？
Iftheansweris"No",whethertheApplicantisplanningforlistinginthenearfutureinanystockexchangeotherthanShanghaiorShenzhenStockExchange
请注意监管行动及诉讼保障不适用于任何目前在上海或深圳证券交易所以外的任何证券交易所上市的投保人。
PleasenotetheRAPCoverageisnotapplicabletoanyApplicantlistinginanystockexchangeotherthanShanghaiorShenzhenStockExchange.
8.1/目前是否有正针对投保的被保险个人进行中的监管行动或诉讼？如有，请详细说明：
IsthereanyexistingActionbroughtormaintainedagainstanypersonproposedforcoverageIfyes,pleaseprovidedetails:
2/投保人或投保的被保险个人目前是否认知任何将导致或可能导致未来监管行动或诉讼的事实或情况？如有，请详细说明：
IstheApplicantoranypersonproposedforcoveragecognizantofanyfactsorcircumstanceswhichtheApplicantorsuchpersonhasreasontosupposemightaffordvalidgroundsforanyfutureActionorindicatetheprobabilityofanysuchActionIfyes,pleaseprovidedetails:
ItisagreedthatanActionbasedupon,arisingfrom,orinconsequenceofanyexistingActionsagainstapersonproposedforcoverage,orknowledgebytheApplicantorthepersonproposedforcoverageofapotentialAction,priortothestartdateofthePolicyPeriodagreedisexcludedfromtheproposedcoverage.
WeherebyapplytoChubbInsurance(China)CompanyLimited(the“Insurer”)for"Business"BusinessTravelPackageInsurancePlananddeclarethatthestatementsandinformationgiveninthisapplicationare,tothebestofourknowledgeandbelief,trueandcomplete.FailuretodiscloseamaterialfactknownmaycauseInsurertodeclineliabilityunderthePolicy.AmaterialfactreferstothefactthatmayinfluencethedecisionoftheInsureronwhethertoaccepttheriskorincreasethepremium.WeherebyagreethatthisapplicationwillformapartofthebasisofthepolicywiththeInsurer.WeunderstandandagreethattheinsurancecontractcomesintoeffectiveastheeffectivedateoftheinsurancespecifiedintheScheduleandassumingliabilitybytheInsurerissubjecttotheapprovaloftheInsurerandcollectionofpremium.
2.投保人确认已经认真阅读保险合同规定，尤其是免除保险人责任的规定，并对保险人就保险合同的内容说明和提示完全理解，没有异议，申请投保。投保人知晓所有保险责任均以本保险合同所载为准。
Weacknowledgethatbeforeapplyingfortheinsurance,wehavereadcarefullythetermsandconditionsofthisPolicy,especiallytheexclusions,andfullyunderstandtheInsurer’sexplanationsandreminder.WeunderstandthatallinsurancecoverageissubjecttothetermsandconditionsofthisPolicy.
3.投保人同意现申请投保或在保险期间内可能提出申请投保的人员，都必须为投保单位的员工/成员。凡提供的参保人员资料或之后的变更，均视为本投保单的部分，也是保险人核保的基础。
WeherebyagreethattheInsuredPersonsmustbeouremployees/members.ThestatementsandinformationgivenortobegivenregardingtheInsuredPerson(s)ortheirchangeslaterwillformapartofthebasisofthePolicy,andshallformapartofthebasisforunderwritingthepolicy.
Weherebydeclareandagree,andwillinformtherelevantinsuredpersonsandobtaintheirconsent,thatourinformationandanypersonalinformationregardingtheinsuredpersonscollectedorheldbytheInsurer(containedinthisapplicationformorotherwiseobtained)maybeheld,usedanddisclosedbytheInsurertoindividualsororganizationsassociatedwiththeInsurer(withinoroutsideChina)forthepurposesof(i)processingthisapplicationandotherinsurancerelatedmatters,(ii)providinginsuranceservices&(iii)communicationwithusortheinsuredpersons.
5.于订立本保险合同时或因履行本保险合同发生争议时，投保人/被保险人选择以下第种方式解决:
Regardinganydisputearisingfromperformanceofthisinsurancecontract,weselectofthefollowingitsresolution:
（1）被告所在地法院诉讼；litigationatthecourtwherethedefendantisdomiciled;
（2）国际经济贸易仲裁委员会上海分会仲裁arbitrationatInternationalEconomicandTradeArbitrationCommissionShanghaiSub-commission.
重要提示ImportantNotice
1.本投保单、保险条款、保险单、批单或批注（如有）及其它约定书均为保险合同的构成部分。
ThisApplicationForm,policywording,Schedule,anyendorsementattachedheretoormarkedthereon(ifany)andanyotherwrittenagreementshallformintegratedpartsofthisPolicy.
Pleasesignonthispageafteryoureadthroughthis"Business"BusinessTravelPackageInsurancePlanApplicationFormcarefully,especiallyRemarkandDeclarationandfullyunderstandandagreethetermsandconditionsincludingexclusions.