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张 方 ZHANG FANG √ 中国 上海 √

1. 每项都必须完整填写. 张 方 ZHANG FANG √ 中国 上海 √ 1986 2 1 180 75 √ 2032 2 5 2 2 7 5 2 1 9 8 60 2 0 1 1 0 0 0 平安健康保险股份有限公司

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张 方 ZHANG FANG √ 中国 上海 √

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  1. 1 每项都必须完整填写 张 方 ZHANG FANG √ 中国 上海 √ 1986 2 1 180 75 √ 2032 2 5 2 2 7 5 2 1 9 8 60 2 0 1 1 0 0 0 平安健康保险股份有限公司 保险推销员 2 0 7 0 2 0 2 1 3 8 1 5 5 5 0 0 0 0 021 12345678 021 23456789 123 √ zhangfang 126.com 上海 上海 浦东新 上丰路1288号 2 0 1 2 0 1 50 ①⑤ 张方 若地址同上 此处必须勾选 投被保险人关系必须勾选 √ √

  2. 无须填写

  3. 险种名称 计划可自行选择确定 尊优人生 一 8422 捌肆贰 贰零 零 8422 √ √ √ √ 张方 √ 招商 上海 6 2 2 2 1 0 0 0 1 2 3 4 5 6 7 8 须填写分行信息 可转账银行： 借记卡、存折均支持： 农业银行、招商银行、中国银行、邮政储蓄银行、工商银行、建设银行、兴业银行、光大银行、广发银行、交通银行 借记卡支持： 民生银行、平安银行

  4. √ 5 2 √ √ √ √ √ √ √ √ √ √ √ √

  5. √ √ √ √ √ √ √ √ √ 仅18岁以上女性需要告知 仅2岁以下儿童需要告知

  6. √ √ √ √ C √ 50 ①⑤ √ √

  7. 张方 张方 2012.7.24 被保险人未成年时 由法定监护人签名 投保日期为填写投保单当日

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