Domestic Helper InsuranceApplication Form| Insurance Services

Important Notes:

Information sent through our Online Application pages are secure and use Secure Socket Layer (SSL). SSL technology secretly encodes information that is being sent over the Internet between your computer and China Construction Bank (Asia), helping to ensure that the information remains confidential.

The insurance applies to domestic helpers aged 18 to 60 inclusive. Please read the geographic limit, general exclusions and specific exclusions of this insurance and Terms of Use and Privacy Statement before completing the application form.

The policy will only be effective if the application is accepted by QBE Hongkong & Shanghai Insurance Limited and the premium is successfully debited to your credit card account.

If the Applicant is not an existing customer of China Construction Bank (Asia), the Bank's representative will contact the Applicant for a copy of his/her identification document.

The Applicant should disclose all the material facts affecting the assessment of this application. Inaccuracy or non-disclosure of any requested information or other material facts in the proposal form would preclude recovery of any claim under the policy.

The policy's terms and conditions are governed by and shall be construed in accordance with the laws of Hong Kong Special Administrative Region of the People's Republic of China.

Applicant Details (Please complete in English)

* Mandatory fields

* Name of Proposer (Employer) :

* HKID :

(Bracket not required)

* Gender :

Male

Female

* Date of Birth :

Address :

* Area:

Hong Kong

Kowloon

N.T.

* Contact Number :

E-mail address :

* Occupation :

* Existing China Construction Bank (Asia) customer :

Yes

Insured Person (Domestic Helper)

* Insured Person (Domestic Helper)

* Gender :

Male

Female

* Passport Number :

* Date of Birth :

* First Date of Arrival :

* Nationality :

* Contract Period:

* Commencing Date of
Insurance :

* Cover Required :

One year basic cover : HK$600
(Original: HK$750, Exclusive online discount: 20% off)

Two years basic cover : HK$1,080
(Original: HK$1,350, Exclusive online discount: 20% off)

One year basic cover PLUS Cancer & Heart Disease Extension : HK$800
(Original: HK$1,000, Exclusive online discount: 20% off)

Two years basic cover PLUS Cancer & Heart Disease Extension : HK$1,440
(Original: HK$1,800, Exclusive online discount: 20% off)

IA levy collected by the Insurance Authority has been imposed on relevant policy (except for certain exempted insurance classes) at the applicable rate and would be remitted in accordance with the prescribed arrangements. Policy holders / customers should pay the levy in accordance with the law. For further information, please visit www.qbe.com/hk or www.ia.org.hk.

The above premium is not inclusive of IA levy.

Note: Please ensure that the information in this form is accurate and complete as inaccuracy or non-disclosure of the requested information or other material facts could preclude recovery of any claim under the Policy.

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Important Notes:

Applicant Details (Please complete in English)

Insured Person (Domestic Helper)

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