Client Needs Analysis 客戶需要分析

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Strictly Private and Confidential

絕對私人及機密資料 PRPRUIPRIVATE AND

Client Needs Analysis 客戶需要分析

Name of Client(s): 客戶姓名：

Date of Completion: 填寫日期：

Name of Financial Adviser Firm: 財務顧問公司名稱：

Name of Financial Adviser: 財務顧問名稱：

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Important Notes: 重要提示：

YOU MUST COMPLETE EVERY PART OF THIS FORM. 你必須填寫此表格的每個部分。

IF YOU CHOOSE BOX B OR BOX C IN SECTION II OF PART 5 – APPLICANT’S DECLARATIONS, YOU SHOULD INTITAL AT THE BOTTOM OF EVERY PAGE OF THIS DOCUMENT. 若你在「第 5部分 - 申請人聲明」的乙部中選擇「B」項或「C」項，你應在本文件每一

頁的底部草簽。

In order for your Financial Adviser to make a sound financial recommendation, your Financial Adviser must conduct an appropriate investigation of your investment objectives, personal needs and financial situation. 你的財務顧問必須就你的投資目的、個人需要及財務狀況進行合適的調查，方可作出合

適的理財建議。

The information requested in this form is necessary to enable your Financial Adviser to make a recommendation on a reasonable basis. If you provide the Financial Adviser with incomplete or inaccurate information, your Financial Adviser may not be able to provide you with products or services you are seeking. 你的財務顧問必須得到此表格要求的資料以作出合理的理財建議。若你向財務顧問提供

不完整或不實資料，你的財務顧問或會未能向你提供你所尋求的產品或服務。

If there is any substantial change of information upon completion of this form, you must inform your Financial Adviser or the relevant insurance company of those changes as soon as possible. 填妥此表格後如有任何重要資料更改，你必須儘快通知你的財務顧問或有關保險公司。

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Part 1 – Basic Personal Information

第一部分第一部分第一部分第一部分 - 個人基本資料個人基本資料個人基本資料個人基本資料

A. FIRST (OR ONLY) APPLICANT 第一第一第一第一(或唯一或唯一或唯一或唯一)申請申請申請申請人人人人

Name

(As shown in HKID card/ passport) 姓名

(與香港身份證/ 護照相同)

Gender 性別

Date of Birth 出生日期

Nationality 國籍

Occupation 職業

Marital Status 婚姻狀況 Single 單身/ Married 已婚/ Divorced 離婚/ Widowed 喪偶

Highest education level achieved 最高學歷

No schooling 從無就學/ Primary 小學/ Secondary 中學/ Tertiary or above 大專或以上

No. of Dependants 受供養者人數

Contact Number 聯絡電話

Correspondence Address 通訊地址

B. SECOND APPLICANT 第二第二第二第二申請申請申請申請人人人人

Name

(As shown in HKID card/ passport) 姓名

(與香港身份證/ 護照相同)

Gender 性別

Date of Birth 出生日期

Nationality 國籍

Occupation 職業

Marital Status 婚姻狀況 Single 單身/ Married 已婚/ Divorced 離婚/ Widowed 喪偶

Highest education level achieved 最高學歷

No schooling 從無就學/ Primary 小學/ Secondary 中學/ Tertiary or above 大專或以上

No. of Dependants 受供養者人數

Contact Number 聯絡電話

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Correspondence Address 通訊地址

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Part 2 – Financial Needs Analysis

第二部分第二部分第二部分第二部分 - 財務需要分析財務需要分析財務需要分析財務需要分析

Currency used 所用貨幣所用貨幣所用貨幣所用貨幣: ________________________

A. EXPENSES 支出支出支出支出

Living Expenses (such as transportation, mobile phone, personal goods, entertainment expenses) 生活支出 (例如交通、手提電話、個人物品、娛樂消費)

(a)

/month 每月

Household Expenses (such as rental, utilities, food, education, dependent expenses) 家庭支出 (例如租金、水、電、煤、食物、教育、受供養者的開支)

(b)

/month 每月

Mortgage Payment 按揭付款

(c) /month 每月

Regular Payments (such as MPF contributions, insurance premiums, savings, investments, loans) 定期的付款 (例如強積金供款、保費、儲蓄、投資、貸款)

(d)

/month 每月

Others 其他

(e) /month 每月

Total Monthly Expenses (a) + (b) + (c) + (d) + (e) 每月總支出 (a) + (b) + (c) + (d) + (e)

(f) /month 每月

Annual Expenses (f) x 12 months 每年支出 (f) x 12 個月

Number of years required to support the family 支持家庭所需年期

(g)

Funds Required to support the family x (g) 支持家庭所需的金額 x (g)

B. LIABILITIES 負債負債負債負債

Outstanding Mortgage Loan 未償還按揭貸款

Loans/ Debts (such as credit cards, car loans, etc) 貸款/ 債務 (例如信用卡、汽車貸款等)

Final Expenses (such as estate duties, funeral and associated expenses) 最後的支出 (例如遺產稅、葬禮及有關支出)

Emergency Fund 應急款項

Others 其他

Total Liabilities 總負債

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C. INCOME 收入收入收入收入

Earned Income: Salary and Bonuses: 賺取的收入：薪金及花紅 /month 每月

Unearned Income (such as rental, dividend, etc) 非賺取的收入(例如租金、股息等) /month 每月

Total Monthly Income 每月總收入

(h) /month 每月

Annual Income (h) x 12 months 每年收入 (h) x 12 個月

D. USABLE ASSETS 可用資產可用資產可用資產可用資產

Existing Life Insurance Coverage 現有人壽保障保額

Savings 儲蓄

Stock/ Securities/ Mutual Funds/ Bonds 股票/ 證券/ 共同基金/ 債券

Company Benefits (including ORSO, MPF) 公司福利 (包括職業退休計劃、強積金)

Others 其他

Total Usable Assets 總可用資產

E. FINANCIAL NEEDS OVERVIEW 財務需要概覽財務需要概覽財務需要概覽財務需要概覽

� A) Life Protection 人壽保障

� B) Savings 儲蓄

� C) Investment 投資

� D) Accident 意外

� E) Retirement 退休

� F) Education 教育

1. What are your purposes of buying an insurance policy/ investment linked assurance policy? (you may tick more than one) 你選購一份保險保單／投資相連壽險計劃的目的為何 ? (可選多於一項 )

� G) Health Protection 醫療保障

� H) Capital Investment Entrant Scheme (“CIES”) 資本投資者入境計劃

�I) Others 其他

(Please specify ) (請詳述 )

� A) < 1 year

1 年以下

� B) 1 – 5 years

1- 5 年

� C) 6 – 10 years

6 – 10 年

2. What is your target horizon for insurance policy/ investment linked assurance policy? (please tick one) 你的保險保單／投資相連壽險計劃的目標年期為 (只可選其中一項)： � D) 11 – 20 years

11 - 20 年

� E) > 20 years

20 年以上

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3. Your capacity to pay premiums for insurance or to contribute to investments: 你繳付保費或支付投資項目的負擔能力 :

� A) Specific Amount: 請註明金額：

Not less than HK$ per month 每月不少於港幣$ -

OR 或或或或

� B) In the following range: 在以下範圍內：

� i) Less than HK$4,000 少於港幣$4,000 � ii) HK$4,001 –

HK$9,999 港幣$4,001 - 港幣$9,999 � iii) HK$10,000 – HK$19,999 港幣$10,000 - 港幣$19,999

a. What is your average monthly income from all sources in the past 2 years? (you may tick more than one) 在過去兩年裡，你由所有收入來源所得的每月平均收入為(可選多於一項)：

� iv) HK$20,000 – HK$49,999 港幣$20,000 - 港幣$49,999

� v) HK$50,000 – HK$100,000 港幣$50,000 - 港幣$100,000

� vi) Over HK$100,000 多於港幣$100,000

b. What is the approximate current accumulative amount of liquid assets? 你現時累積的流動資產約有多少 ?

Please specify type and amount: 請註明類型及金額： Type: ______________________________ 類型: : ______________________________ HK$ - 港幣$ pe

r Note: 註註註註：：：：

Liquid assets are assets which may be easily turned into cash, for example, cash, money in bank accounts, money market accounts, actively traded stocks, bonds and mutual funds and US Treasury bills. However, real estate, coin collection and artwork are not considered to be liquid assets. 流動資產指可以容易變現為現金的資產，例如現金、銀行存款、貨幣市場戶口、交投活躍的股票、債券、共同基金及美國國庫券等。然而，房地產、錢幣收集及藝術品均不屬於流動資產。

� A) < 1 year

1 年以下

� B) 1 – 5 years

1- 5 年

� C) 6 – 10 years

6 – 10 年

c. For how long are you able to contribute to an insurance policy and/ or investment linked assurance policy? (please tick one) 你可支付保單及／或投資相連壽險計劃的年期為(請選其中一項)：

� D) 11 – 20 years

11 - 20 年

� E) > 20 years

20 年以上

� A) < 10%

� B) 10% – 20% � C) 21% - 30% d. Approximately what percentage of your income would you be able to use to pay your monthly premium for the entire term of the insurance policy/ investment linked assurance policy in c above? (please tick one) 就你在 c 所選擇的保險保單／投資相連壽險計劃之整段年期內，你每月可承擔的保費佔你個人收入的比率為 (請選其中一項)： � D) 31% - 50% � E) > 50%

� A) Salary 薪金

� B) Income 收入

� C) Savings 儲蓄

� D) Sale of Assets 出售資產

� E) Income from other investments (i.e. rental, dividends) 其他投資的收入(如租金及股息)

� F) Accumulative savings & investments 累積儲蓄及投資

e. In considering your ability to make payments, what are your sources of wealth? (you may tick more than one) 你考慮繳付能力時，請註明資金來源 (可選多於一項)：

� G) Others (please specify:_________________________________) 其他 (請詳述_________________________________________)

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4. If you choose to deviate in any respect from the Financial Needs Analysis process, you must indicate your reason(s) in writing. 如你選擇不填報上述財務需要分析，你必須書面詳述有關原因。

(Applicant(s) must complete explanation in own handwriting in this box)

(申請人必須在此親筆填寫解釋 )

Date 日期

Name of the First (or only) Applicant 第一(或唯一)申請人姓名

Signature of the First (or only) Applicant 第一(或唯一)申請人簽署

Date 日期

Name of the Second Applicant 第二申請人姓名

Signature of the Second Applicant 第二申請人簽署

Note: You are required to inform your Financial Adviser or the relevant insurance company if there is any substantial change of information provided in the form before the policy is issued. 註註註註：：：：若本表格上填報的資料有重大改變，你須在保單未簽發前通知你的財務顧問或有關保險公司。

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Part 3 – Risk Profile Questionnaire

第第第第三三三三部分部分部分部分 - 風險承擔能力問卷風險承擔能力問卷風險承擔能力問卷風險承擔能力問卷

A. Risk Profile Questionnaire風險承擔能力問卷

This questionnaire is designed to help assess your attitude towards investment risks. This is an important process in assisting to identify an appropriate investment strategy and make recommendations that suit your specific requirements. By completing the questionnaire below, you will be provided with some indication of your overall attitude towards risk of a particular type of investor and investment characteristics. Please note that this evaluation is for reference only which may not accurately reflect your actual attitude towards risks-taking and risk tolerance level. 此問卷是為協助評估你對投資風險的取向而設。進行此問卷乃一重要步驟，以協助得出一套合適的投資策略以及作出切合你個人要求的建議。完成以下問卷後，你會得悉一些你對投資風險的取向，屬於那一類投資者及擁有那一種投資特性。請注意，此評估只供參考之用，或會未能準確地反映你接受風險的真正取向和風險承受能力。

For Joint Application 有關聯合申請有關聯合申請有關聯合申請有關聯合申請

People who hold assets jointly often have differing views regarding the level of risk they are prepared to accept. If you have different views to your partner, please complete a separate questionnaire. 共同持有資產的人士對願意接受的風險水平的見解往往不同，若你和你的夥伴持有不同見解，請填寫另一份問卷。

Strongly Agree 非常同意

Somewhat Agree 頗為同意

Somewhat Disagree 頗為不同意

Strongly Disagree 非常不同意

1. I would feel comfortable if my investments could easily rise and fall by a quarter or more in a year. 即使我的投資在一年內會急速升跌 25%或以上，我也會處之泰然。

�

� � �

2. If my investments fell significantly in value I might see this as an opportunity to buy more at cheaper prices. 若我的投資的價值大幅下跌，我會視之為低價買入的機會。

� � � �

3. I would feel uncomfortable if my investments could fall in value at all. 若我的投資的價值下跌，我會感到不安。

� � � �

4. I prefer the security of bank accounts to stock market related investments. 我寧取較安穩的銀行戶口而不選擇與股市有關的投資。

� � � �

5. I can sleep at night knowing that my investments might rise and fall quite rapidly in the short term. 若我得知我的投資在短時期內急速升跌，我仍可安然入睡。

� � � �

6. If you choose to deviate in any respect from the Risk Profile Analysis process, you must indicate your reason(s) in writing. 如你選擇不填報上述風險承擔能力問卷，你必須書面詳述有關原因。

(Applicant(s) must complete explanation in own handwriting in this box)

(申請人必須在此親筆填寫解釋 )

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What is your scoring of the Risk Profile Questionnaire? 你的風險取向問卷得分你的風險取向問卷得分你的風險取向問卷得分你的風險取向問卷得分

Strongly Agree 非常同意

Somewhat Agree 頗為同意

Somewhat Disagree 頗為不同意

Strongly Disagree 非常不同意

Your score 你的得分你的得分你的得分你的得分

Question 問題 1 7 5 2 1





Your total score is: 你的總得分是你的總得分是你的總得分是你的總得分是：：：：

What type of investor are you? 你屬於哪一類投資者你屬於哪一類投資者你屬於哪一類投資者你屬於哪一類投資者？？？？

Score 得分得分得分得分 Risk Profile Description 風險取向描述風險取向描述風險取向描述風險取向描述

5 – 10

Risk Level 1: Very Defensive

As a very defensive investor you are looking for the security of a deposit-based type of investment. Protecting the value of your investment in money terms is more important than the protection against the long term erosion of its spending value by inflation.

1級風險級風險級風險級風險 –––– 非常防守型的投資者非常防守型的投資者非常防守型的投資者非常防守型的投資者作為非常防守型的投資者，你會選擇以存款為主的一類投資。對你來說，保障投資本金的價值較保障資金的消費價值長期被通脹蠶食更為重要。

11 – 15

Risk Level 2: Defensive

As a defensive investor you are seeking security of your investment but are prepared to consider a portfolio of low risk assets that can offer the potential to provide better returns than deposits over the longer term. You understand that there may be short periods when the value of your investments could fall, but these are expected to be of limited impact due to the highly diversified asset mix.

2級風險級風險級風險級風險 –––– 防守型的投資者防守型的投資者防守型的投資者防守型的投資者作為防守型的投資者，你會尋找穩健的投資，但亦願意考慮長期比存款可帶來更高潛在回報的低風險投資組合。你明白你的投資價值在短時期內可能下跌，但因資產種類高度分散，預期跌幅只會產生有限度的影響。

16 – 19

Risk Level 3: Cautious

As a cautious investor you are looking to preserve the value of your investment against the erosion of inflation and are therefore prepared to consider a combination of low risk alternatives to deposits to help generate a steady return over the long-term. You understand that there may be periods when the value of your investments could fall, but these are expected to be of limited impact because of the diversified investment strategy adopted.

3級風險級風險級風險級風險 –––– 審慎型審慎型審慎型審慎型的投資者的投資者的投資者的投資者作為審慎型的投資者，你會選擇保障你的投資價值，以對抗通脹的蠶食，因此願意考慮存款以外的低風險投資選擇，以取得長期穩定的回報。你明白投資價值在某些時期內可能會下跌，但因採取分散的投資策略，跌幅只會產生有限度的影響。

20 – 23

Risk Level 4: Balanced

As a balanced investor you are looking to grow the value of your investment over the longer term and generate an absolute return ahead of inflation. You are prepared to invest across a diversified portfolio of assets to achieve this goal and understand that there may be periods when the value of your capital can fall.

4級風險級風險級風險級風險 –––– 均衡型的投資者均衡型的投資者均衡型的投資者均衡型的投資者作為均衡型的投資者，你會以投資價值長期增長並產生超逾通脹的絕對回報為目標。你願意投資於多元化的資產組合以達到此目標，並且明白你的資本價值在某些時期內可能會下跌。

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24 – 29

Risk Level 5: Moderately Adventurous

As a moderately adventurous investor you are looking to grow the value of your investment over the longer term and generate an absolute return well ahead of inflation. You are comfortable with a more focused portfolio of assets to achieve this goal and understand that there may be periods when the value of your capital can fall sharply.

5級風險級風險級風險級風險 –––– 中度冒險型的投資者中度冒險型的投資者中度冒險型的投資者中度冒險型的投資者作為中度冒險型的投資者，你會以投資價值長期增長並產生超逾通脹的絕對回報為目標。你願意投資於較集中的資產組合以達到此目標，並明白資本價值在某些時期內可能會大幅下跌。

30 – 32

Risk Level 6: Adventurous

As an adventurous investor you are looking to considerably grow the value of your investment over the longer term by selecting a concentrated portfolio of more speculative asset types and are comfortable with a higher risk and reward strategy this approach involves. You understand that periods of strong gains as well as significant falls in the value of your investment are likely in future.

6級風險級風險級風險級風險 –––– 冒險型的投資者冒險型的投資者冒險型的投資者冒險型的投資者作為冒險型的投資者，你會選取一個集中的組合，包含較多投機性的資產類別，以達致投資價值長期有可觀增長為目標，並且願意承受此策略所帶來的較高風險及回報。你明白投資價值將來在某些時期內既會錄得強勁的收益，亦會錄得大幅下跌的虧損。

33 – 35

Risk Level 7: Very Adventurous

As a very adventurous investor you are looking to maximise the value of your investment over the longer term by selecting a very concentrated portfolio of more speculative asset types and are comfortable with a higher risk and reward strategy this approach involves. You understand that periods of strong gains as well as significant falls in the value of your investment are likely in future.

7級風級風級風級風險險險險 –––– 非常冒險型的投資者非常冒險型的投資者非常冒險型的投資者非常冒險型的投資者作為非常冒險型的投資者，你會選取一個十分集中的組合，包含較多投機性的資產類別，以達致投資價值長期有最高增長為目標，並且願意承受此策略所帶來的較高風險及回報。你明白投資價值將來在某些時期內既會錄得強勁的收益，亦會錄得大幅下跌的虧損。

This risk profile questionnaire serves as a discussion basis between you and your Financial Adviser on setting investment objective(s) and selecting investment product(s) appropriate for you. It is considered as a reference when you make an investment decision. It is recommended that you fully understand the risks associated with individual investments before making any investment decisions. You should not purchase an investment product unless you understand it and it has been explained to you how it is suitable to you. The final decision is yours. 此風險取向問卷只作為你和你的財務顧問在商討制訂投資目標及選擇適合你的產品時的討論根據，並只供你作投資決定時參考之用。在作出任何投資決定前，請完全明白個別投資所面對的風險。除非你了解有關的投資產品，並獲講解該產品是如何適合你，否則你不應購買有關的投資產品。你應作最後決定。

Date 日期

Name of the First (or only) Applicant 第一(或唯一)申請人姓名


Date 日期

Name of the Second Applicant 第二申請人姓名



10 Ver 24/02/11

Part 4 – EVALUATION AND RECOMMENDATIONS EVALUATION AND RECOMMENDATIONS

第四部分第四部分第四部分第四部分 ---- 評估及建議評估及建議評估及建議評估及建議

A. EVALUATION AND RECOMMENDATIONS 評估及建議評估及建議評估及建議評估及建議

Evaluation

評估評估評估評估

Total Income Needs 總收入需要

Total Usable Assets 總可用資產

Total Amount of Assets needed to meet the needs 所需的總資產金額以滿足需要

Recommendation 建議建議建議建議

Product 產品

Premium Amount 保費金額

Term 年期

Investment-linked fund Choice 投資相連基金選擇

Reasons (Please continue on a separate sheet where necessary) 原因 (如有需要，請另紙繼續書寫)

I hereby declare that the information contained in the Financial Needs Analysis Form above is an accurate and complete record of the information provided to me by the proposed policyholder(s). 本人謹此聲明以上財務需要分析表格所載的資料為建議保單持有人向本人提供之正確及完整記錄。

Date 日期

Name of the Adviser 顧問姓名

Signature of the Adviser 顧問簽署

11 Ver 24/02/11

B. CLIENT ACKNOWLEDGMENT 客戶確認客戶確認客戶確認客戶確認

I/ We acknowledge that the information provided in the Financial Needs Analysis Form above is complete, true and accurate to the best of my/our knowledge (except where I/we have indicated that I/we have chosen not to provide this information). 本人／我們確認就本人／我們所知所及，以上財務需要分析表格所載的資料為完整、真實及準確(除本人／我們指明不提供資料的情況外)。

I/We understand and acknowledge that by either not fully or accurately completing the Financial Needs Analysis Form above, any recommendation or advice given by my Financial Adviser in these circumstances may be inappropriate to me/ our needs and that I/we risk making a financial commitment to a policy which may be inappropriate for my/ our needs. I/ We further confirmed that the discussion is conducted in the language that I am/ we are familiar with and no undue influence exerted to me/us. 本人／我們明白及確認如不完整地或不實地填寫以上財務需要分析表格，本人／我們的財務顧問在這些情況下給予的建議或意見或會不適合本人／我們的需要，並可能導致本人／我們購買不適合本人／我們的保單。本人／我們並且確認有關商討乃以本人／我們熟悉的語言進行，並無任何人士不當地影響本人／我們作出投保的決定。

Date 日期 Name of the First (or only)

Applicant 第一(或唯一)申請人姓名


Date 日期 Name of the Second

Applicant 第二申請人姓名



12 Ver 24/02/11

Part 5 – Applicant’s Declarations

第五部分第五部分第五部分第五部分 ---- 申請人聲明申請人聲明申請人聲明申請人聲明

INVESTMENT LINKED ASSURANCE SCHEME APPLICANT’S DECLARATIONS

投資相連壽險計劃申請人聲明投資相連壽險計劃申請人聲明投資相連壽險計劃申請人聲明投資相連壽險計劃申請人聲明書書書書

Section I 甲部甲部甲部甲部 Disclosure Declaration披露聲明披露聲明披露聲明披露聲明

The insurance broker, (Company Name) _

(CIB/PIBA Registration number) has conducted a financial needs analysis for me and I have read the Product Key Facts Statement (as applicable), Principal Brochure and marketing materials of the product(s) that I am applying for. I declare and agree that I fully understand and accept the following relating to my application(s) for this insurance policy: 保險經紀（公司名稱) _（CIB/PIBA 登記號碼）_______ 已為本人分析財務需要，本人已閱讀本人所申請計劃的產品資料概要( 如適用者)、主要推銷刊物及銷售資料。本人聲明及同意本人完全明白並接受以下有關本人申請投購本保單的資料：

• Product features including the policy term and all charges and fees;

• Amount of premium and premium term;

• Any loss that I may suffer as a result of early surrender of my policy; any cash withdrawal; premium reduction; and any permissible premium suspension/premium holiday entitlement.

• Investment returns are not guaranteed;

• Potential loss associated with any market value adjustment;

• The potential risks as disclosed in the Product Key Facts Statement (as applicable), returns, and losses associated with my investment(s);

• If I switch my investment choices, I may be subject to a charge and my risk may be increased or decreased, I have the right to seek professional financial advice when in doubt;

• The investment and asset allocation advice associated with this investment has been formulated by the insurance broker, based on information given by me to the broker in the Financial Needs Analysis Form / Risk Profile Questionnaire, including any supplementary information provided by me to my insurance broker in writing, and not by the insurance company that manufactures and issues the product (“Insurance Company”). The Insurance Company does not assess the investment or asset allocation risk at any time during this process;

• This application is for the purpose of the Capital Investment Entrant Scheme (“CIES”) (if applicable); and

• I confirm that I have received a copy of the HKFI’s education pamphlet entitled “Questions you need to ask before taking out an ILAS product”.

• 產品特色，包括保單年期及所有收費與費用；

• 保費金額及繳付保費年期；

• 任何因本人選擇提早退保、提取現金、遞減保費及任何保單提供的暫停繳付保費／保費假期等而引致之損失；

• 投資回報並非保證；

• 市場價格調整帶來之潛在損失；

• 產品資料概要(如適用者)披露的潛在風險，與本人的投資有關之回報及損失；

• 若本人轉換投資選擇，可能需要支付費用，及本人相關之投資風險會因此而增加或減低。如有疑問，本人有權尋求專業的財務意見﹔

• 保險經紀是根據本人在「財務需要分析表格」及「風險承擔能力問卷」填寫的資料，包括本人向保險經紀以書面形式提供之任何補充資料，向本人提供關於是項投資的投資及資產分配意見。在整個銷售過程中，保險公司只負責制定及簽發產品，並沒有評估本人的投資或資產分配之風險﹔

• 本申請為「資本投資者入境計劃」之用(如適用者)﹔以及

• 本人確認已收到由香港保險業聯會印製的「購買投資相連壽險 – 問多點知多點」教育小冊子一份。







13 Ver 24/02/11

Section II 乙乙乙乙部部部部 Suitability Declaration 適合性聲明適合性聲明適合性聲明適合性聲明

I understand and agree that (please tick one only): 本人明白並同意（任擇一項）：

A � The features and risk level of the product(s) and my selected mix of underlying investment choices are suitable for me based on my disclosed current needs and risk profile as disclosed to my insurance broker during the completion of a Needs Analysis Form and Risk Profile Questionnaire. These needs have been assessed by the insurance broker, and not by the Insurance Company. 根據本人填寫「財務需要分析」及「風險承擔能力問卷」時向保險經紀披露的現時需要及投資風險概況，有關產品之特色及其風險級別與本人所選擇的相關投資組合均適合本人。有關分析是由保險經紀進行，而非由保險公司完成。

OR 或

despite the fact that the features and/or risk level of the product(s) and/or my selected mix of underlying investment choices may not be suitable for me based on the information disclosed to my insurance broker during the completion of a Needs Analysis Form and Risk Profile Questionnaire, I confirm that it is my intention and desire to proceed with my application(s) as explained below: 儘管根據本人填寫「財務需要分析」及「風險承擔能力問卷」時披露的現時需要及投資風險概況，有關產品之特色及／或風險級別及／或本人選擇的相關投資組合可能並不適合本人，但本人確認基於下述原因，本人打算及意欲申請本保險計劃：

B �

(If Box B is ticked, then Applicant must complete explanation in own handwriting in this box) （如選擇「B」項，申請人必須親筆於此欄內提供原因）

OR 或

despite the fact that I am required to complete the Financial Needs Analysis and Risk Profile Questionnaire to ensure that the product(s) to be purchased are suitable for me, I confirm that it is my intention and desire to proceed with my application(s) without complying with the said requirement for the reason(s) below: 儘管本人必須完成「財務需要分析」及「風險承擔能力問卷」，以確保所選購的產品適合本人，但本人確認基於下述原因，不遵從有關要求的情況下，本人打算及意欲申請本保險計劃：

C �

(If Box C is ticked, then Applicant must complete explanation in own handwriting in this box) （如選擇「C」項，申請人必須親筆於此欄內提供原因）

14 Ver 24/02/11

I acknowledge I should not purchase this product and/or the selected mix of underlying investment choices unless I understand these and their suitability has been explained to me and that the final decision is mine. 本人確認，除非本人清楚了解本產品和相關投資項目的選擇組合，並得悉本產品如何切合本人的需要，否則本人不應選購此產品。本人擁有最終的決定權。

I understand that the Insurance Company:

(a) does not provide/ accept any responsibility for the financial advice given by my appointed insurance broker who acts on my behalf and independently of the Insurance Company; and

(b) will retain copy(ies) of the completed Needs Analysis Form and Risk Profile Questionnaire for record purpose but will have no responsibility for reviewing/ assessing whether a particular insurance product and any underlying investment choices are suitable for me in light of my personal circumstances.

本人明白保險公司： (a) 對獨立代表我的保險經紀所提供之財務意見，概不負責；及

(b) 將保留已填妥的「財務需要分析」及「風險承擔能力問卷」副本作記錄之用，但對保險產品及其相關投資項目是否適合本人之評估，概不負責。







Declaration by Intermediary 中介人聲明中介人聲明中介人聲明中介人聲明

I, ((Name) (Registration number) , confirm that I have fully explained the contents of the Applicant Declarations to the Applicant in a language of the Applicant’s choice. 本人，（姓名) （登記號碼）確認已採用申請人選擇之語言，向申請人詳盡解釋「申請人聲明書」的內容。

Date 日期 Name 姓名

Signature 簽署

Note: 註註註註：：：：

1. For the purpose of this Declaration, the singular shall impart the plural; the word “I” share include “we”; & the word ‘my” shall include “our”. For joint applicants, all applicants must sign both sections. 就本聲明而言，單數等同複數；「本人」包括「我們」的涵義；及「本人的」包括「我們的」的涵義。若為聯名申請人。所有申請人必須在甲、乙兩部內簽署。

2. You are required to inform your intermediary or us (the insurance company) if there is any substantial change of information provided in the form before the policy is issued. 本表格內提供的資料如有更改，你在保單未簽發前需要通知本公司或你的中介人。

15 Ver 24/02/11

Notes 備註備註備註備註

16 Ver 24/02/11

Notes 備註備註備註備註

Documents

Client Needs Analysis 客戶需要分析