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 E Self-Service and Form Library

Policy Servicing

E Self-Service  

Form Application

  • HK-CS-CHG-01
    Change of Owner Address / Telephone Numbers / Email Address

    Download Change of Contact Information User Guide

  • HK-CS-CHG-11
    Request for Change of Owner & Insured Information / Occupation/ Signature
  • HK-CS-CHG-02
    Request for Policy Ownership Transfer
  • HK-CS-CHG-03
    Request for Change of Payment Mode

    Download Change Payment Mode User Guide

  • HK-CS-CHG-05
    Policy Assignment/Release of Policy Assignment Form
  • HK-CS-CHG-06
    Policy Donation and Beneficiary Appointment Form

    Download Change Beneficiary User Guide

  • HK-CS-CHG-07
    Request for Change of Policy Coverage
  • HK-CS-CHG-08
    Request for policy Reinstatement
  • HK-CS-CHG-12_202106-01
    Policy Assignment Declaration(For Designated Broker Channel Only)
  • HK-CS-CHG-13
    Request for Designation / Change / Termination of Contingent Insured
  • HK-CS-CHG-14
    Request for Change of Insured Form
  • HK-CS-CHG-15
    Request for Appointment / Change / Termination of Contingent Policyholder
  • HK-CS-SUP-1
    Supplemental To Change of Policy Information – General Information
  • HK-CS-CHG-04
    Policy Lost Declaration
  • HK-CS-PICSE
    Personal Information Collection Statement
  • HK-PCSWD
    WITNESS DECLARATION FORM (Customer Service As Witness)
  • HK-PSWD
    WITNESS DECLARATION FORM (For Policy Service Use)
  • HK-CSCRS-CP
    Self-Certification Form – Controlling Person (Applicable for existing client)
  • HK-CSCRS-EN
    Self-Certification Form – Entity (Applicable for existing client)
  • HK-CSCRS-IN
    Self-Certification Form – Individual (Applicable for existing client)

    Download Self-Certification (“CRS”) User Guide

Payment & Collection

E Self-Service  

Form Application

  • AFDD
    Authorization For Demand Draft
  • HK-CS-FIN-01
    Request For Financial Services Form
  • HK-CS-FIN-02
    Request For Policy Maturity Benefit Form
  • HK-CS-FIN-03
    Policy Payment Application Guidance Notes (Applicable to Entity Policyholder)
  • HK-CS-FIN-07
    Request For Change of Payment Options and Information Form

    Download Change Payment Option User Guide

  • HK-CS-FIN-08
    Special Payment Arrangement Request Form
  • HK-CS-ATP-01
    Direct Debit Authorization

    Download Application for Autopay User Guide

  • HK-CS-ATP-02
    Direct Debit Authorization (Applicable to Cross Border Long Card Direct Debit Authorization)
  • HK-CS-CHG-09
    Request for Cancel Autopay Instruction

    Download Reactivate or Cancel Autopay Instruction User Guide

  • HK-CS-CHG-10
    Request for Reactivate Autopay Instruction

    Download Reactivate or Cancel Autopay Instruction User Guide

  • HK-CS-PDF
    Payment Declaration Form - For Bank Draft
  • HK-CS-TPP
    Third Party Payment Instruction Form (For Renewal Premium and Premium Levy Only)
  • NB-TPP
    Third Party Payment Instruction Form(For Initial Premium and Premium Levy Only)

New Application

E Self-Service  

Form Application

  • HK-UWCRS-CP
    Self-Certification Form – Controlling Person (For New Business Use)
  • HK-UWCRS-Entity
    Self-Certification Form – Entity (For New Business Use)
  • HK-UWCRS-Individual
    Self-Certification Form – Individual (For New Business Use)
  • HK-UW-BrokerGFNA-Entity
    Financial Needs Analysis Form of Broker Channel - (Applicable To Company/Entity As (Proposed) Policyholder)(for Broker Channel only)
  • HK-UW-BrokerGFNA-IND
    Financial Needs Analysis Form of Broker Channel (Applicable To Individual As (Proposed) Policyholder)(for Broker Channel only)
  • HK-UW-FIN-REIPF
    Risk Evaluation Information of Premium Financing
  • HK-UW-FNA-Entity
    Financial Needs Analysis Form (Applicable To Company/Entity As (Proposed) Policyholder)
  • HK-UW-FNA-IND
    Financial Needs Analysis Form (Applicable To Individual As (Proposed) Policyholder)
  • HK-UW-FNA-SAQ
    Suitability Assessment Questionnaire for Medical Insurance Product (Applicable To Medical And Critical Illness Coverage – FNA Exempted Product)
  • HK-UW-FNA-SAQ_FNA
    Suitability Assessment Questionnaire for Medical Insurance Product (Applicable To Medical And Critical Illness Coverage Submit With FNA)
  • BFQ
    Supplementary Financial Statement for Business Covers
  • LAQ
    Large Amount Questionnaire
  • HK-UW-CN
    Health Declaration For Voluntary Health Insurance Scheme Policy 「Guard Your Health / Healthy Life Medical Insurance Plan 」
  • HK-UW-DC
    Disclaimer for Application
  • HK-UW-IFSPR
    Important Facts Statement – Policy Replacement
  • HK-UW-QNR-JI
    Questionnaire For The Junior Insured
  • HK-UW-QNR-TQ
    Travel Questionnaire
  • HK-UW-SUPP-ENTITY
    Supplementary Information Form - Applicable to Entity (Proposed)
  • HK-UW-SUPP-SHAREHOLDER
    Supplementary Information Form (Applicable to Individual Shareholder)
  • HK-UW-SUPP-SP
    Supplementary Information Form
  • HK-UW-WD
    Witness Declaration Form (For New Business Use)
  • HK-UWDECLRATION
    Declaration For Using Signature Stamp
  • HK-UWIFS-MP
    Important Facts Statement for Mainland Policyholder (IFS-MP) (Chinese Only)

Individual Claim

E Self-Service  

Form Application

  • HK-CL-ICLA18
    Claim Direct Payment Application Form
  • HK-CL-ICLA24
    Claims Cross Border Remittance Service Application Form (Only Applicable For Greater Bay Area CGB’S Account Holder)
  • HK-CS-FIN-08
    Special Payment Arrangement Request Form
  • HK-CL-ICLA25
    Hospitalization Direct Billing Pre-Approval Form (Applicable For Non Mastercare Medical Plan)
  • CRS-CP(Claims)
    Self-Certification Form – Controlling Person (For Claims Use)
  • HK-CLCRS-Entity
    Self-Certification Form – Entity (For Claims Use)
  • HK-CLCRS-Individual
    Self-Certification Form – Individual (For Claims Use)
  • HK-CL-ICLA05
    Critical Illness Claim Form - Cancer

  • HK-CL-ICLA06
    Critical Illness Claim Form - Stroke

  • HK-CL-ICLA07
    Critical Illness Claim Form - Heart Attack

  • HK-CL-ICLA08
    Critical Illness Claim Form - Heart Valve Replacement

  • HK-CL-ICLA09
    Critical Illness Claim Form - Others

  • HK-CL-ICLA11
    Terminal Illness Claim Form

  • HK-CL-ICLA12
    Long Term Sick Leave Claim Form
  • HK-CL-ICLA13
    Waiver of Premium / Payor Benefit Claim Form

  • HK-CL-ICLA04
    Time Lady Insurance Claim Form

  • HK-CL-ICLA19
    LadyVital Female Protection Claim Form

  • HK-CL-ICLA22
    Beneficiary Withdraw Annuity Benefit Form
  • HK-CL-ICLA23
    Application for Share Happiness Reward
  • Novel_Coronavirus_Vaccine_Side_Effects
    Declaration Form for Coverage against "Novel Coronavirus Vaccine Side Effects" Claim Application
  • PLD
    Policy Lost Declaration
  • HK-CL-CLA21
    MasterCare Medical Plan Direct Billing Pre-approval Form
  • HK-CL-ICLA02
    Hospitalization Claim Form

  • HK-CL-ICLA10
    Individual Out-Patient Claim Form

  • HK-CL-ICLA03
    Accident Claim Form

  • HK-CL-ICLA01
    Death Claim Form

Group Claim

E Self-Service  

Form Application

  • CRS-CP(Claims)
    Self-Certification Form – Controlling Person (For Claims Use)
  • HK-CLCRS-Entity
    Self-Certification Form – Entity (For Claims Use)
  • HK-CLCRS-Individual
    Self-Certification Form – Individual (For Claims Use)
  • HK-CL-GCLA-04
    Group Life Insurance Claim Form
  • HK-CL-GCLA-02
    Group Outpatient Claim Form
  • HK-CL-GCLA-03
    Group Hospitalization Claim Form
  • HK-CL-GCLA-01
    Group Accident Claim Form

Investment-Linked Insurance Plan

E Self-Service  

Form Application

  • HK-CS-ILAS-020210713
    Investment Options Information
  • HK-CS-ILAS-04
    Request for Investment-Linked Assurance Scheme Policy Services
  • HK-CS-ILAS-RPQFD-01
    Risk Profile Questionnaire for Individuals_Investment-Linked Assurance Scheme Policy <ILAS> (For Wealth Builder Investment-Linked Plan only)
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