HomeSafe Protection Insurance - Application Form
This insurance is underwritten by: Blue Cross (Asia-Pacific) Insurance Limited
Hints on use of online transaction procedure:
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Do not use the [BACK] button of the browser.
Please call Tel. 25987660 for technical support if required.
Some Important Matters To Observe :
Construction of Insured Building = Class I (i.e. cement & concrete throughout with reinforced steel bar ceiling).
Use of Insured Building must be residential use.
The Insured Building is less than 30 years.
The Optional Benefits in Section 3 of "HomeSafe Protection Insurance" are not applicable to this online insurance application.
Only Visa or MasterCard will be accepted to be settlement for the purpose of online credit card payment under this online insurance application.
If discrepancy exists between the English version and the Chinese version, the English version shall prevail.
Applicant must be 18 years old or above.
The policy must commence within 30 days from the date of application.
Agent Code: A-4803
* Fields must be filled in.
(This form must be filled in English.)
1. Construction of Insured Building = Class I (i.e. cement & concrete throughout with reinforced steel bar ceiling)? *
Yes
No
2. Use of Insured Building = residential use? *
Yes
No
3. Is the Insured Building of less than 30 years? *
Yes
No
PLEASE DECLARE: Age of Insured Premises
year(s)*
If the building age exceeds 30 years, the application will be subject to the Company's approval and rating.
NOTE: This online insurance application is not applicable to premises where the age of insured premises are not declared, and also not applicable to premises with building age exceeding 30 years.
Coverage
Type of Insured Premises
Non-Low Rise House
Low Rise House
Plan Selected - Annual Premium
Plan I HK$ 680
Plan II HK$ 980
Plan III HK$1,480
Plan I HK$1,280
Plan II HK$1,880
Plan III HK$2,680
Declaration
I/WE,HEREBY DECLARE AND AGREE THAT:
The answers to all the above questions including all information and particulars given herein are accurate, true and complete and are given to the best of my/our knowledge and belief. I/We have not withheld any material information and accept that this application and declaration shall form the basis of the contract between Blue Cross (Asia-Pacific) Insurance Limited ("the Company") and me/us. I/We hereby acknowledge that failure to supply true and accurate answers to this application or inform the Company of all material information about my/our application may render the Company unable to accept or process this application or the insurance policy void.
The insurance coverage applied for shall only take effect when this application has been accepted by and the first premium has been paid to the Company.
To the best of my/our knowledge, the insured premises have never suffered any fire damage or other loss in the past two years.
I/We have never had any new application/renewal declined, nor have special terms and conditions been imposed on such application or renewal for household insurance.
Personal Information Collection Statement
I/We understand and agree that any personal information collected or held by the Company (whether contained herein or otherwise obtained) may be used, stored, disclosed or transferred (within or outside of Hong Kong) to any individuals/organizations associated with the Company or any third party the Company may consider necessary including any other company carrying on insurance or reinsurance related business, any intermediary, claims investigator, medical facilities, other service providers relevant to insurance business, professional advisor, government authority or industry association/federation for the purposes of: (1) processing of this application/request and provision of insurance or financial related product or service or any addition, alteration, variations, cancellation or renewal or reinstatement of them; (2) any scope of insurance coverage, claim processing or investigation or analysis and data matching; (3) promotion of financial products or services by the Company and its affiliated companies; (4) communicating with me/us/the insured or any relevant organization/person as the Company considers appropriate; and (5) meeting any disclosure requirements imposed by law or court orders or pursuant to guidelines issued by regulatory or other relevant authorities. I/We have the right to obtain access to and to request correction of any personal information concerning myself/ourselves held by the Company. I/We understand that if I/we do not want my/our personal information to be used for purpose (3) above, I/we may notify the Company at any time. Such request(s) or notice(s) can be made in writing to the Company's Corporate Data Protection Officer at 29th Floor, BEA Tower, Millennium City 5, 418 Kwun Tong Road, Kwun Tong, Kowloon, Hong Kong.
I Agree to the Terms and Conditions.
Note:
This "HomeSafe Protection" Insurance Certificate is delivered electronically.
According to normal operation, an electronic HomeSafe Protection Insurance Certificate will show up
in your browser by clicking the button "HomeSafe Protection E-Cert" after your payment
has been successfully processed. You must print out your HomeSafe Protection Insurance Certificate
for your own records. The transaction information is transmitted through SSL 128-bit
encryption keys.
All insurance transactions must be arranged within the territory of the Hong Kong Special Administrative Region.
AuspharmTrading (H.K.) Limited (Insurance Agent Reg 96903619)
[ Insurance Agent for Blue Cross(Asia Pacific) Insurance Limited &
American Home Assurance Company ]
Disclaimer
Rm. 902 Yue Xiu Building, 160-174 Lockhart Road, Wanchai, Hong Kong.
Email:tls@tiglion.net Tel.
No.852-25987660 852-25117189 Fax. No. 852-25197296
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(H.K.) Limited . All rights reserved.