To get a quotation, you may supply your information with the following form. If you have the renewal notice and claim record, you may also fax to us for a better rate.
TYPE
：
問與答
Provide you with hospital and outpatient covers. In addition to these, optional group life and income protection schemes may also be included.
APPLICATION FOR QUOTATION
A.
Contact Information
Company Name
：
Contact Person
：
Mr.
Ms.
Email
：
Tel No.
：
Mobile
：
Fax
：
Co. Address
：
B.
Group details
Age <2
0
20-29
30-39
40-49
50-59
>
60
Sex of staff
：
No. of Male
No. of Female
No. of staff kids
（
Male
）
No. of staff kids
（
Female
）
Type of Medical protection wanted
:
ordinary
fair
excellent
Budget of medical cover of the year :
Nature of co. business
：
Starting Date
：
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
d
1
2
3
4
5
6
7
8
9
10
11
12
m
2002
2003
2004
2005
2006
2007
2008
2009
2010
y
Never covered before
？
Yes
（
Name of insurance co.
：
）
（
Amount claimed
：
）
No
You may use the following to give us further information such as the address or claim record of past three years, etc
：
可否陳述醫療保險的保障範圍？
醫療保險限制及除外責任？
意外保險中醫療保險與一般的醫療保險？
