Forms - ILAS - Zurich

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Forms - Zurich International Life Limited

- You may download the latest forms from Zurich International Online (ZIO) > Resources > Downloads.

- The form sample is for reference only.

New Business Forms

Form [C5] Customer Protection Declaration Form (HK00103) (Updated: 18 Sep 2020)

Form [C7] OnePlatform Consultant Supplementary Form (Updated: 7 Sep 2014)

Form [D2] Declaration for intermediaries in relation to business conducted with residents of mainland China (HK00095) (Updated: 10 Jul 2020)  [Sample]

Form [D3] Declaration for residents of mainland China (HK00094) (Updated: 10 Jul 2020) [Sample] (Updated: 7 Sep 2015)

Form [F1] Financial Needs Analysis Form (HK00434) (Updated: 15 Mar 2021)

Form [F4] Foreign Account Tax Compliance Act (FATCA) (MSP13283)  (Updated: 5 May 2014)

Form [H2] Health and lifestyle questionnaire (HK00093) (Updated: 8 May 2018)

Form [I4]  International Term Assurance Application form (HK00037) [Sample] (Updated: 17 Apr 2019)

Form [I15] Important facts statement for Mainland Policyholder (IFS-MP) (HK00142SCH) (Updated: 10 Jul 2020)

Form [I16] Important facts statement – policy replacement (HK00435) (Updated: 9 Mar 2021)

Form [L2] Lives / Additional lives insured Application Form (HK00092) (For ILAS) (Updated: 06 Oct 2020)

Form [O1] Origin of wealth guidelines and questionnaire (HK00143) (For Assignment; New Application) (Updated: 15 Oct 2025)

Form [P5] Pre underwriting declaration (MSP13191)

Form [P6] Preferred Choice Application Form [Single Life(HK00003)] [Sample] or [Joint Life(HK00004)] (Updated: 17 Apr 2019)

Form [S3] Supplementary Application Form for Corporate & Trustee Policies (HK00023) (For ITA & Corporate Application) (Updated: 14 Apr 2021)

Form [S4] Subject access request - Medical details (HK00104)  (For ITA)  (Updated: 8 May 2018)

Form [S5] Supplemental Document - Declaration for Data Protection for Zurich International Life Limited (HK00274) (Updated: 3 Jul 2020) [Sample] (Updated: 5 Jun 2018)

POS Forms

Form [A1] Additional single contribution (HK00016) (For IWA & Vista Lump Sum Top-up)(Updated: 15 Oct 2025)

Form [A5] Appointment of Beneficiary form (For Beneficiary)(HK00112) (Updated: 24 Oct 2025)

Form [C3] Contribution Decrease Request Form (HK00101) (For Decrease Premium) (Updated: 09 Nov 2022) [Sample]

Form [C6] Certifying Signature Form (HK00096) (For change of client's signature) (Updated: 17 Oct 2022)

Form [D1] Deed of Assignment (HK00005)(Updated: 18 Sep 2020)

Form [D4] Declaration for resident of mainland China (for top up application) [Sample] (Updated: 7 Sep 2015)

Form [E1] Elite International Bond Cash Withdrawal Plan (HK00021) (For EIB Regular Cash Withdrawal) (Updated: 15 Oct 2025)

Form [E2] Encashment Surrender Form For Regular Premium(HK00025) (For Futura & Vista Encashment; Partial Surrender; Withdrawal; Surrender) (Updated: 13 Oct 2025)

Form [E3] Encashment Surrender Form For Single Premium(HK00019) (For EIB & IWA Encashment; Partial Surrender; Withdrawal; Surrender) (Updated: 13 Oct 2025)

Form [I3] IWA Request to Make Regular Withdrawals (HK00028) (For IWA Regular Cash Withdrawal) (Updated: 15 Oct 2025)

Important facts statement and applicant's declarations for new application and top up application (Updated: 19 Aug 2016)

Form [L1] Lost Policy Declaration and indemnity form (HK00100) (For Lost of Policy) (Updated: 8 May 2018)

Form [L3] Letter of Transfer In Servicing Agent (For Transfer in Servicing Agent)

Form [M1] Maturity and Reinvestment Form (HK00024) (For Policy Maturity) (Updated: 14 Oct 2025)

Form [M2] Method of Payment Form (HK00035) (Updated: 09 Nov 2021) [Sample for DDA] / [Sample for Credit card]  (Updated: 10 May 2016)

Form [P1] Contribution / Premium Holiday Request form (HK00099)  (For Vista 2 Contribution Holiday) (Updated: 17 Nov 2022)[Sample]

Form [P2] International Policy Loan Application (HK00102) (For Loan Option) (Updated: 19 Aug 2016)

Form [P4] Personal details update (HK00006) (Update Personal Details) (Updated: 10 Jul 2020) [Sample] (Updated: 07 Nov 2022)

Form [R1] Premium change / reinstatement form (HK00017) (Updated: 15 Oct 2025) [Sample for Reinstatement] [Sample for Decrease] [Sample for Top Up] (Updated: 8 Aug 2018)

Form [R3] Risk Profile Questionnaire  (HK00432) (Updated: 11 Sep 2020)

Form [S2] Switch and redirection form (HK00038) (For Fund Switching/Redirection) (Updated: 17 Sep 2020)

Form [S5] Supplemental Document - Declaration for Data Protection for Zurich International Life Limited (HK00274) (Updated: 3 Jul 2020) [Sample] (Updated: 5 Jun 2018)

Form [T1] Third Party Payment Form (HK00111) (Updated: 15 Oct 2025)

Remarks

Important facts statement for Mainland Policyholder Requirement:

In comply with OCI requirement, all Mainland policyholder are required to complete and submit IFS-MP Form [I15] with effect from 1 September 2016. The summary of the requirement are listed below:

  • applicable to all new applications, policy assignment and top up where the policy owners / assignees are holders of Resident Identity Card (PRC);
  • IFS-MP needs be conducted once for one policy;
  • the customer needs to sign on every page of the form and the one signed by the Mainland customers must be in Simplified Chinese which the font size must not be smaller than 12;
  • policy applications from Mainland customers to insurers must be within 7 working days of the signing of the policy application (including the declaration signed by policyholder confirming that the selling process is conducted in Hong Kong);
  • for ILAS product, Mainland customers have to sign both IFS-MP and IFS-ILAS; sign date of both IFS must be on or before the application sign date.

Zurich Customer Hotline: +852 3405 7150

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