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: 16 Jan 2025) Updated: 23 Nov 2023) Guideline [English] [Chinese] (Updated: 29 Mar 2021)
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