The following Forms and Samples for your reference ONLY.
• 於2023年12月1日或之後簽署之所有表格(包括後補文件) 必須為「安達人壽保險香港有限公司」之版本 (即新版本表格)#
• 於2024年1月1日起，將不再接受舊版本﹝安達人壽保險有限公司﹞之表格﹝以本公司收到表格日期為準﹞
New Business Forms
Form [A1] Agent's Questionnaire-PRC Policy (NB212)(Updated: 10 May 2016)
Form [A2] Amendment of Application (Updated: 06 Jan 2026)
Form [A4] Application Supplement For Critical Illness/ Cancer/ Hospital Personal Accident Plan (Updated: 05 Jul 2023)
Form [A5] Application For Life Insurance (Updated: 6 Jan 2026)
Form [A6] Application Supplement For“The ONE” Accident Protector Free Family Accidental Protection（Family Accident Protection Registration Form） (Updated: 26 Aug 2021)
Form [A7] Authorization (Updated: 05 Jul 2023)
Form [C2] Chinese Resident Questionnaire (NB165) (Updated: 10 May 2016)
Form [F1] Financial Questionnaire (NB007) (Updated: 05 Jul 2023)
Form [F2] Financial Needs Analysis (Updated: 24 Mar 2026) Guideline [English] [Chinese] (Updated: 29 Mar 2021)
- Financial Need Analysis update "Memo" The new Financial Needs Analysis (FNA) form is effective immediately. The original form can still be used until April 30, 2026 (Based on the date of form
signing). However, for forms signed between March 31, 2026 and April 30, 2026, the original form must be accompanied by the supplementary form
“Amendment Of Application” (NB001_0125_Supplement of FNA) to answer the new questions.
Form [H1] HSBC Credit Card Instalment Application Form [Sample] (Updated: 4 Mar 2020)
Form [I1] Important Facts Statement for Mainland Policyholder (IFS-MP) (Updated: 05 Jul 2023)
Form [I2] Important Upfront Disclosures - Chubb VHIS - Standard/Flexi Plan [Eng] (Updated: 28 Feb 2020) [Chi](Updated: 1Apr 2020)
Form [I5] Important Upfront Disclosures-Multi-Select Term Form [Eng] [Chi] (Updated: 30 Mar 2020)
Form [I7] Important Upfront Disclosures-Hospital & Surgical Benefit Form [Eng ][Chi] (Updated: 30 Mar 2020)
Form [I8] Important Facts Statement - Policy Replacement (Updated: 23 Nov 2023)
Form [M1] Medical Examination Request Form (For Blue care Medical Centre) (Updated: 16 Jan 2025)
Form [M2] Medical Examination Request Form (For MediFast(HK)) (Updated: 16 Jan 2025)
Form [O1] One Off Payment-Credit Card Payment Authorization Form (Updated: 21 Feb 2025) [Sample] (Updated: 20 Dec 2018)
Form [P1] Premium Payment Declaration Form (Updated: 25 Jul 2024)
Form [R5] Request for Conversion Form (Updated: 16 Jan 2025)
Form [R7] Registration Of Family Members For Embrace Care Critical Illness Protector (Updated: 31 Oct 2018)
Form [R8] Request To Certify The True Copy Of Passport/Proof Of Identity Document(Proposed Insured/Applicant/Owner Without HK ID Card) (Updated: 6 Nov 2018)
Form [S1] Supplementary Form of Beneficial Owner / Controlling Person/Successor Owner (NB222) (Updated: 16 Jan 2025) (For Corporate Application)
Form [S2] Self-Certification Form – Entity (For company) (Updated: 17 Jan 2025)
Form [S3] Self-Certification Form – Individual (For individual) (Updated: 16 Jan 2025)
Form [S4] Self-Certification Form – Controlling Person (For applicant being a passive non-financial entity) (Updated: 16 Jan 2025)
Form [S6] Supplement of New Application for Policy (Simply Underwriting) (Updated: 12 Feb 2026)
Form [V1] Voluntary Health Insurance Scheme (VHIS) Specified Relative Declaration Form (Updated: 05 Dec 2023)
POS Forms
Form [C9] Credit Card Direct Debit Authorization(POS043) (Updated: 25 Jul 2024)
Form [D1] Direct Debit Authorization (Updated: 04 Feb 2025) [sample] (Updated: 16 Aug 2023)
Form [O1] One Off Payment-Credit Card Payment Authorization Form (administration fee of 1.8% would be charged) (Updated: 21 Feb 2025) [Sample] (Updated: 16 Aug 2023)
Form [R1] Request for Change In Policy Form (POS069) (Updated: 04 Feb 2025) [sample] (Updated: 16 Aug 2023) [Change of Automatic Premium Holiday Notification for Golden Touch Series] (Updated: 30 May 2019) [Sample for premium holiday] (Updated: 16 Aug 2023)
Form [R2] Request of Surrender Form (POS001) (Updated: 16 May 2025) [sample] (For Surrender) (Updated: 16 Aug 2023)
Form [R3] Request for Financial Transaction Form (For Golden Touch Series Plan) (POS073) (Updated: 04 Feb 2025) [sample] (Updated: 16 Aug 2023)
Form [R4] Request for Change of Policyowner / Beneficiary Form (POS067) (Updated: 04 Feb 2025)
Form [R6] Request for Financial Transaction Form (For Investment-Linked Plan) (POS070) (Updated: 04 Feb 2025)
Form [R9] Request for Change of Personal Information Form (POS086) [Eng] [Chi] (Updated: 19 May 2025) (User Guide) (Updated: 2 Jul 2020)
* Please fill in page 1 part 4 and stated change of residential address only If client willing to update the residential address
* No address proof is needed for address change request (Updated: 16 Aug 2023)
Form [R10] Request for Financial Services Form (POS020) (Updated: 04 Feb 2025)
Form [S5] Statement of Insurability (POS071) (Updated: 04 Feb 2025) [sample] (Updated: 16 Aug 2023)
Claim Forms
Form [A3] Attending Physician’s Statement For Death Claim (Updated: 02 Mar 2026)
Form [C3] Claim Form-Death (Updated: 02 Mar 2026)
Form [C7] Claim Form-Disability (Updated: 02 Mar 2026)
Form [C8] Claim Form - Living Benefit Critical Illness Benefit (Updated: 02 Mar 2026)
Form [C9] Claim Form - Medical Benefit / Accident Benefit (Updated: 02 Mar 2026)
Form [C10] Claim Form - Lady’s Partners (Updated: 02 Mar 2026)
Form [D2] Disability Claim-Attending Physicians Statement (Updated: 02 Mar 2026)
Chubb Life (ACE) Customer Hotline：28949833