Zurich HomeCare Householder Insurance Plan

Zurich HomeCare Householder Insurance Plan offers you a comprehensive home contents insurance. We are protecting your home and its contents to provide you complete peace of mind.

With Zurich HomeCare Householder Insurance Plan, you and your family can enjoy the following protection:

Property care

✓ Sum Insured for Contents Insurance increases according to the gross floor area of your home up to HKD1,250,000

✓ Coverage will not deduct depreciation

✓ Accidental damage cover for valuables in home such as jewelleries, watches, antiques, etc up to HKD250,000

✓ Outdoor Property Cover

Liability care

✓ Owner’s, Occupier’s and Personal Liability Cover up to HKD10,000,000

Pets care

✓ Pet Accommodation – provides reimbursement of pet accommodation expenses if your home is made uninhabitable

Lifestyle care

✓

Green Living Benefit – when you need to replace a product marked with the “Energy Efficiency Label” due to accidental loss or damage, our Green Living Benefit will reimburse you up to 110% of the value of the lost or damaged product

Beyond home protection

✓ 24 hour Emergency Assistance Services with up to HKD500 protection for plumbing, electrical or locksmith assistance

✓ Meal allowance – HKD500 per day and up to HKD2,500 as a meal allowance to you and your family if your home is made uninhabitable

✓ Feng Shui consultation following damage to Home – up to HKD3,000

✓ Increase maximum benefit at special dates (Lunar New Year, Christmas and wedding day of you or your family members) by 10%

Table of Benefits

Coverage Maximum Benefits (HKD)

Basic coverage

Owner, tenant, occupier, pet owner and personal legal liability

- Accidental bodily injury or property damage to third party and legal costs

Free extensions

- Owner’s liability in common area of the building of which your home forms part

- Your domestic helper‘s liability while working for you and your family

10,000,000

Accidental damage to home contents protection1

- Covers any accidental loss destruction or damage to your home contents

Gross floor area (sq. ft.) Saleable area (sq. ft.) 700 or below 560 or below 701 to 1,500 561 to 1,200 1,501 or above 1,201 or above

- Sub-limits : Valuables (such as jewelleries, furs, watches,

antiques etc)- Including accidental loss, destruction or damage

to your electronic communication products like tablets at your home caused by fire, lightning or by a burglary or attempted burglary

Other Contents

Free extensions1

• Loss or damage of home contents during home removal

• Loss or damage of home contents during home renovation (renovation period not exceeding 2 months)

• Loss or damage of home contents that are temporarily removed for repair or cleaning

• Cost of temporary accommodation following damage to home

• Cost of removal of debris following accidental damage to home

• Loss resulting from unauthorized use of credit cards and cash loss due to burglary at home

• Cost of repair of broken doors, locks and windows due to burglary

• Cost of deterioration of frozen food following damage to the domestic refrigerator

• Burglary harm allowance - if you or your family sustains injury caused by burglars at home2

• Loss of personal belongings in office• Damage by firemen• Outdoor property cover• Personal money & belongings on business trips• Green living cover • Cost of Feng Shui consultation following damage

to home• Cost of meal allowance following damage to home• Cost of pet accommodation following damage

to home

750,000

1,000,000 1,250,000

250,000 in total(20,000 / item)

100,000 / item

as per Sum Insured

100,000

50,000

50,000 (1,500 / day)

5,000

5,000

5,000

3,000 (1,500 / incident)

5,000

2,500as per Sum Insured

50,000 (2,000 / item)2,500

Extra 10% of Sum Insured3,000

2,500 (500 / day)2,500

Coverage Maximum Benefits (HKD)

Worldwide personal accident protection

• Accidental death3 100,000

Emergency assistance services

• Plumbing, electrical or locksmith assistance

• Other free referral services such as home nursing care, household appliance repairing, home cleaning and pest control, etc.

500 / incident

Optional coverage

Building4

- Accidental damage to building protection

Free extensions

Sub-limits:

• Landslide and subsidence

• Professional architect consultation fees

• Removal of debris following property damage

Rebuilding cost

Rebuilding cost

5% of rebuilding cost

5% of rebuilding cost

Worldwide personal possessions protections5

1. Unspecified personal possessions

Sub-limit:

This covers the belongings you normally wear and carry, e.g. eyeglasses, pen, camera, portable AV equipment, etc. It is not required to submit any valuation or sales receipt.

2. Specified personal possessions

Note: This covers any specified personal belongings which are worth more than HKD5,000. The sum insured can be determined based on the value of the personal belongings. It is required to give the description, sum insured and attach a valuation or sales receipt of each item to be insured.

Sub-limits:

• Theft of money

• Unauthorized use of credit card

• Replacement cost for loss of personal identification document due to theft

As selected

The maximum benefit per item is 5,000 or 20%

of the sum insured, whichever is lower.

As selected

2,500

10,000

3,000

1 The excess under Home Contents Section is the first HKD250 of each and every claim.2 Provided that Insured persons’ injury results in granting of sick leave of not less than 4

consecutive days.3 The age limit for insured persons in respect of the worldwide personal accident protection

section is 16 - 64 years old.4 The excess under accidental damage to building section is the first HKD3,000 each and

every claim (except fire, lightning and explosion). The excess under landslide and subsidence extension is the first HKD10,000 or 10% of adjusted loss each and every claim, whichever is greater.

5 The excess is at least the first HKD250 each and every claim for the worldwide personal possessions protections.

Premium Table

Annual Premium (HKD)

Floor Area (Sq Ft)# Basic Coverage

Building (Optional)

Gross Floor Area Saleable Area

500 or below 400 or below 650 500

501-700 401-560 900 630

701-1,000 561-800 1,200 1,020

1,001-1,500 801-1,200 1,650 1,530

1,501-2,000 1,201-1,600 1,950 2,040

2,001 or above 1,601 or above individual considerations

Optional Coverage Annual Premium (HKD)

Worldwide personal possessions protections individual considerations

# Amount of premium payable will be determined on the basis of the calculation method selected and the corresponding floor area.

Zurich Insurance Company Ltd(a company incorporated in Switzerland)

25-26/F, One Island East, 18 Westlands Road, Island East, Hong KongTelephone: +852 2968 2288Fax: +852 2968 0639Website: www.zurich.com.hk

Major Exclusions :Unexplained loss, Illegal building works; electrical and mechanical breakdown; wear and tear; war; terrorism; radioactive contamination; nuclear; pollution contamination.

This leaflet is only an illustration and does not constitute any part of the insurance contract. For full terms and conditions and exclusions, please refer to the policy document itself which shall prevail in case of inconsistency. We reserve the right of final approval and decision. (The English version shall prevail in case of inconsistency between the English and Chinese versions)

ZHA

/001

/08/

2013

About ZurichBeing part of Zurich Insurance Group, Zurich Insurance (Hong Kong) offers a full range of flexible general insurance and life insurance products for individuals as well as corporate customers, catering to their insurance, protection and investment needs. Our presence in Hong Kong dates back to 1961. We are one of the top 10 insurers in Hong Kong.

Zurich Insurance Group is a leading multi-line insurance provider with a global network of subsidiary and offices in Europe, North America, Latin America, Asia-Pacific and the Middle East as well as other markets. Founded in 1872, the Group is headquartered in Zurich, Switzerland. With over 60,000 employees serving customers in more than 170 countries, our ambition is to become the best global insurer as measured by our shareholders, customers and employees.

「居安保」 住戶保險計劃

面對風災、雨災的威脅，我們自當防患未然。蘇黎世「居安保」住戶保險計劃為您提供至全面的家居保障。

「居安保」住戶保險計劃為您及您的家人提供以下保障：

照顧您的財物

✓ 家居財物之最高保障額隨家居呎數遞增，最高保障額高達1,250,000港元

✓ 所有賠償均不會扣減折舊

✓ 貴重財物保障（如珠寶首飾、手錶、古董等）高達250,000港元

✓ 室外家居財物保障

關注您的個人責任

✓ 業主、住戶及個人責任保障高達10,000,000港元

照顧您心愛的寵物

✓ 寵物臨時居所保障–若您的居所因意外損毀而不能居住，將可獲賠償您的寵物貓、狗之臨時居所費用

關心您的生活態度

✓ 綠色生活保障–當您需要更換因意外損毀或損失的「能源效益標籤電器」時，我們的綠色生活保障會按該「能源效益標籤電器」之價值的110%作為賠償上限

超越家居保障

✓ 24小時家居緊急支援服務（水電維修及開鎖服務最高賠償額為500港元）

✓ 若您的居所因意外損毀而不能居住，為您及您的家人提供每日高達500港元之膳食津貼（最高賠償為2,500港元）

✓ 居所因意外損毀而不能居住，若須查詢風水顧問的意見，有關之風水顧問保障高達3,000港元

✓ 在特別日子如農曆新年、聖誕節及家庭成員新婚日，為您的家居財物保障提升10%最高賠償額

保障表

保障範圍 最高保障額 （港元）

基本保障

身為業主、租客、佔用人或寵物主人及個人法律責任

- 因疏忽而導致第三者身體受傷或財物損失所招致的法律責任及有關訴訟費用

免費附加保障

- 作為業主在大廈公眾地方所發生之意外而須負上之法律責任

- 您的家傭於工作期間所發生之意外而須負上之法律責任

10,000,000

家居財物意外損毀保障 1

- 家居財物意外損毀保障

建築面積 （平方呎） 實用面積 （平方呎） 700或以下 560或以下 701 – 1,500 561 – 1,200 1,501或以上 1,201或以上

- 個別限額：

貴重財物（例如珠寶首飾、皮草、手錶、古董等）

- 包括於家中因火災、閃電、爆竊或意圖盜竊所引致之電子通訊產品，如平板電腦等之意外損毀

其他財物

免費附加保障 1

• 搬遷時家居財物意外損毀保障

• 裝修期內家居財物意外損毀保障（裝修期不超過兩個月）

• 財物暫時搬離家作維修或清潔期間意外損毀保障

• 意外後安排臨時居所費用

• 意外後清理災場費用

• 因家居爆竊而信用卡被盜用及金錢損失

• 修理因爆竊而損壞之門、門鎖及窗之費用

• 雪櫃損壞導致冷藏食物腐壞之損失

• 投保人或其家屬於家中因被爆竊而受傷，可享有現金賠償津貼 2

• 個人物品在辦公室損毀

• 消防員導致之損毀

• 室外家居財物保障

• 於商務旅途中意外遺失金錢或財物

• 綠色生活保障

• 居所因意外損毀而不能居住所引致之風水顧問費用

• 居所因意外損毀而不能居住所引致之膳食費用

• 居所因意外損毀而不能居住所引致之寵物臨時居所費用

750,000

1,000,000 1,250,000

總額250,000 （每件20,000）

每件100,000

視乎保障額

100,000

50,000

50,000（每日1,500）

5,000

5,000

5,000

3,000 (每次1,500)

5,000

2,500

視乎保障額

50,000（每件2,000）

2,500

額外10%保障額

3,000

2,500（每日500）

2,500

保障範圍 最高保障額 （港元）

全球人身意外保障

• 意外死亡 3 100,000

家居緊急支援服務

• 水電維修及開鎖服務

• 其他免費轉介服務如緊急電召看護、電器維修、家居清潔及滅蟲等

每次500

自選保障

樓宇 4

- 樓宇結構意外損毀保障

免費附加保障：

個別限額：

• 地陷及山泥傾瀉

• 專業建築顧問費用

• 意外後清理災場費用

樓宇重建費用

樓宇重建費用

樓宇重建費用之5%

樓宇重建費用之5%

全球私人財物保障 5

1. 一般個人財物保障

個別限額：

保障範圍例如眼鏡、金筆、相機或手提影音器材等隨身個人財物，投保時毋須呈交任何估價書或收據

2. 指定受保財物保障

註：凡價值超過5,000港元的隨身個人財物均可投保；投保額可按財物的價值而釐定，投保時須呈交每項投保財物的名稱、投保額及附上估值書或收據

個別限額：

• 因遇劫導致金錢損失

• 因遇劫導致信用卡被盜用

• 遇劫後補領個人身份證明文件費用

自選保額

每件5,000或投保額的20%，以較低者為準。

自選保額

2,500

10,000

3,000

1 家居財物意外損毀保障範圍的自負額為每宗賠償的首250港元。2 受保人須獲予至少連續4天病假。3 全球人身意外保障範圍的受保人年齡限於16 - 64歲。4 樓宇結構意外損毀保障範圍的自負額為每宗賠償的首 3,000港元（火災、閃電及爆炸除外）。地陷及山泥傾瀉附加保障的自負額為每宗賠償的首10,000港元或損失額的10%，以較高者為準。

5 全球私人財物保障範圍的自負額為每宗賠償的首250港元起。

保費表

每年保費 （港元）

單位面積（平方呎）# 基本保障 樓宇結構意外損毀保障

（自選保障）建築面積 實用面積

500或以下 400或以下 650 500

501-700 401-560 900 630

701-1,000 561 – 800 1,200 1,020

1,001-1,500 801 – 1,200 1,650 1,530

1,501-2,000 1,201 – 1,600 1,950 2,040

2,001或以上 1,601或以上 個別計算

自選保障 每年保費 （港元）

全球私人財物保障 個別計算

# 保費將根據所選擇計算方法之單位面積計算。

主要不承保事項：無法解釋的損失，違例僭建、機件故障、自然損耗、戰爭、恐怖活動、核能輻射、污染等。

本宣傳資料只供參考之用，並不構成保險合約的一部份，有關此項保障計劃的內容細則及不承保事項將詳列於保單之內，如有任何差異，均以保單內之條款細則為準，我們保留最終批核及決定權。（如中文譯本與英文有異，以英文本為準。）

蘇黎世保險有限公司（於瑞士註冊成立之公司）香港港島東華蘭路18號港島東中心25 - 26樓電話：+852 2968 2288傳真：+852 2968 0639網址：www.zurich.com.hk

關於蘇黎世蘇黎世保險（香港）是蘇黎世保險集團轄下之機構，竭誠為個人及企業客戶提供全面又靈活的一般保險及人壽保險服務，照顧他們在保險、保障及投資上的需要。集團在香港的業務始於 1961年，至今已成為本港十大保險公司之一。

蘇黎世保險集團是一家全球領先的多險種保險供應商，其全球網絡的分支機構和辦事處遍及歐洲、北美洲、拉丁美洲、亞太和中東等地區。集團成立於 1872年，總部設立於瑞士的蘇黎世。集團有逾 60,000名員工在 170多個國家為客戶提供服務。我們矢志成為我們的股東、客戶和員工眼中全球最佳的保險公司。

1

Zurich HomeCare HouseholderInsurance Plan Enrollment Form 蘇黎世「居安保」住戶保險計劃投保表格

Proposer’s information 投保人資料

Mr 先生 Mrs 太太 Ms 女士

Surname 姓 First Name 名 Other Name 別名

HKID card no./Passport no.香港身份證號碼／護照號碼*

Date of birth#出生日期# D日 M月 Y年 Sex#性別# Male男 Female女

Occupation#職業# Marital Status#婚姻狀況#

Risk address

投保地址

Flat/ Rm.*室 /單位* Floor樓 Block座 Building大廈

Estate name/ street no. & name/ lot no.*屋苑名稱 /街名及門牌 /地段*

District地區 HK/ KLN/ NT*香港 /九龍 /新界*

Correspondence address

通訊地址

(如與上述地址不同 if different

from above)

Flat/ Rm.*室 /單位* Floor樓 Block座 Building大廈

Estate name/ street no. & name/ lot no.*屋苑名稱 /街名及門牌 /地段*

District地區 HK/ KLN/ NT*香港 /九龍 /新界*

Contact Number (Please fill in at least one) 聯絡電話（請填寫最少一項） Email address#

電郵地址#Mobile phone no.

流動電話號碼

Day time telephone no.

日間聯絡電話

1

Enquiry no. 查詢電話：+852 2903 9391 Fax 傳真：+852 2968 0639 Please tick the appropriate box and * delete where inappropriate. 請適用方格及於*號刪去不適用者。Please complete in BLOCK LETTERS. 請以英文正楷大寫填報。All fields are mandatory, except the fields marked with #. 所有項目必須填報，惟#號之項目除外。

Agent Name 代理人姓名：________________________

Agent No 代理人編號： ________________________

2

Plan selection 所需保障

Effective date of insurance 保障生效日期 D日 M月 Y年

Basic coverage 基本計劃

Household Floor area (sq. ft.) 單位面積（ 平方呎） Annual Premium (HKD) 每年保費（港元）

Gross Floor Area 建築面積

< = 500

501-700

701-1,000

1,001-1,500

1,501-2,000

> 2,000

Saleable Area 實用面積

< = 400

401-560

561-800

801-1,200

1,201-1,600

> 1,600

650

900

1,200

1,650

1,950

Individual considerations 個別計算

Property Type 樓宇類型

Multi-storey building多層大廈 Village house 村屋 Detached house 獨立屋

Building age 樓齡

Below 10 years 十年以下 Over 10 years to 25 years 超過10年至25年 Over 25 years to 35 years 超過25年至35年

Over 35 years超過35年– Any recent renovation done in the unit and/or the whole building 該單位及／或整幢大廈最近作出之保

養維修工程：

Extend cover to the following facilities 額外設施保障 (Under Legal Liability section 於法律責任保障範圍下）

Car parking space 停車場位置 Garden / Yard 花園 / 庭院 Flat roof天台 Private pool私人泳池

Optional coverage 附加保障

Building coverage 樓宇結構保障

Household Floor area (sq. ft.) 單位面積（ 平方呎） Annual Premium (HKD) 每年保費（港元）

Gross Floor Area 建築面積

< = 500

501-700

701-1,000

1,001-1,500

1,501-2,000

> 2,000

Saleable Area 實用面積

< = 400

401-560

561-800

801-1,200

1,201-1,600

> 1,600

500

630

1,020

1,530

2,040

Individual considerations 個別計算

Worldwide personal possessions protections全球私人財物保障

Unspecified item一般個人財物 + Sum insured投保額 :__________________

Specified items指定受保財物（Sum insured 投保額）

+If the above space is insufficient, please attach a separate sheet.如上表不敷填寫，請另加紙詳述。

Please provide relevant sales receipt or valuation reports.請提供有關單據或估值報告。

Applications in relation to any building over 25 years or with structural extension, village house or detached house will be subject to separate consideration.

有關樓齡超過25年或附有任何額外設施或村屋 / 獨立屋之投保申請需作個別考慮。

2

3

Declaration 聲明 1. I declare that my home is built of bricks, stone or concrete and roofed with concrete.

2. I declare that to the best of my knowledge and belief the information on this enrolment form is true and complete in every respect. I understand that this enrolment form and declaration will form the basis of the contract between me and Zurich Insurance Company Ltd (the“ Company”).

3. I understand that if I am not completely satisfied with Zurich HomeCare Householder Insurance Policy “( the Policy”), I can return it to the Company within 14 days upon receipt and any premium charged during this period will be refunded in full.

4. I understand that I shall refer to the Policy for details of the insurance coverage, exclusion clauses and terms and conditions.

5. I understand I must complete and provide all information requested in this form, failing which the Company cannot process my application for the Policy.

1. 本人聲明本人的住宅是用磚石或石屎建成，並蓋有石屎屋頂。

2. 本人特此聲明此投保表格的資料乃根據本人所知及所信為確實及完全而填報，屬實無訛。本人明白本人與蘇黎世保險有限公司（「貴公司」）的保險合約將照此投保表格及聲明而訂立。

3. 本人明白本人如對保單條款未盡滿意，可於收到保單後14天內退回保單，所繳之保費將獲原銀奉還。

4. 本人明白所有保障範圍、不承保事項、條款及細則概以蘇黎世「居安保」住戶保險計劃保單為準。

5. 本人明白本人必須完成及提供此表格之所有資料，貴公司將不會受理本人資料不全之保單申請。

This insurance application will not be in force until the application has been accepted by the Company and the premium has been paid.

此保險申請需待貴公司覆核，接納投保書及已繳付保費後才能生效。

4

Insurance details 保險資料

If your answer to the following questions is“ Yes”, please provide full details.以下問題若答‘是 ’者，請指出及詳細列明事件細節及日期。

Yes 是

No 否

Have you ever been refused by other insurance companies with similar coverage? If yes, please state:

閣下曾否遭保險公司拒絕接受投保同類型保險計劃? 如有，請列明 :

____________________________________________________________________________________________________________

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During the past 12 months, have you sustained any loss whether insured or otherwise, in connection with the cover which insurance has been requested? If yes, please state:

過去十二個月內，閣下有否蒙受任何與現申請保障有關之損失? 不論已投保與否，如有，請列明︰

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Notice to Customers relating to the Personal Data (Privacy) Ordinance (“Ordinance”) 有關個人資料（私隱）條例（「私隱條例」）的客戶通知1. The personal information of customers (include policy owners, insured persons, beneficiaries, premium payors, trustees, policy assignees

and claimants) collected or held by Zurich Insurance Company Ltd (“Company”) may be used by the Company for the following obligatory purposes necessary in providing services to the customers (otherwise the Company is unable to provide services to customers who fail to provide the required information):

1) to process, investigate (and assist others to investigate) and determine insurance applications, insurance claims and provide ongoing insurance services;

2) to process requests for payment, and for direct debit authorization; 3) to manage any claim, action and/or proceedings brought against the customers, and to exercise the Company’s rights as more

particularly defined in applicable policy wording, including but not limited to the subrogation right; 4) to compile statistics or use for accounting and actuarial purposes; 5) to meet the disclosure requirements of any local or foreign law, regulations, codes or guidelines binding on the Company and/or its

group (“Zurich Insurance Group”) and conduct matching procedures where necessary; 6) to comply with the legitimate requests or orders of the courts of Hong Kong and regulators including but not limited to the Insurance

Authority, Hong Kong Federation of Insurers, auditors, governmental bodies and government-related establishments; 7) to collect debts; 8) to facilitate the Company’s authorized service providers to provide services to the Company and/or the customers for the above

purposes; and 9) to enable an actual or proposed assignee of the Company to evaluate the transaction intended to be the subject of the assignment.2. The Company may provide any personal information of customers to the following parties, within or outside of Hong Kong, for the

obligatory purposes: 1) companies within the Zurich Insurance Group, or any other company carrying on insurance or reinsurance related business, or an

intermediary; 2) any agent, contractor or third party service provider who provides administrative, telecommunications, computer, payment or other

services to the Zurich Insurance Group in connection with the operation of its business; 3) third party service providers including legal advisors, accountants, investigators, loss adjusters, reinsurers, medical and rehabilitation

consultants, surveyors, specialists, repairers, and data processors; 4) credit reference agencies, and, in the event of default, any debt collection agencies or companies carrying on claim or investigation

services; 5) any person to whom the Zurich Insurance Group is under an obligation to make disclosure under the requirements of any law binding

on the Zurich Insurance Group or any of its associated companies and for the purposes of any regulations, codes or guidelines issued by governmental, regulatory or other authorities with which the Zurich Insurance Group or any of its associated companies are expected to comply;

6) any person pursuant to any order of a court of competent jurisdiction; 7) any actual or proposed assignee of the Zurich Insurance Group or transferee of the Zurich Insurance Group’s rights in respect of the

policy owners.3. Certain personal information of policy owners and insured persons collected or held by the Company, in particular, names, contact

information, age, gender, identity document reference, marital status, policy information, claim information, and medical history may be used by the Company for the following voluntary purposes:

1) to provide marketing materials and conduct direct marketing activities in relation to insurance and/or financial products and services of the Zurich Insurance Group and/or other financial services providers, and/or other related services of business partners, with whom the

Company maintains business referral or other arrangements; 2) to perform customer analysis, profiling and segmentation; and 3) to conduct market research and insurance surveys for the Zurich Insurance Group’s development of services and insurance products. The Company is not allowed to use the personal information of any customer for the above voluntary purposes without such customer’s

consent. In the absence of any “opt-out” request, the Company shall treat the insurance application and continuation of the policy(ies) held with the Company as an indication of no objection of such policy owner and insured person to the Company’s use of their personal information for the above voluntary purposes.

4. The Company may provide certain personal information, in particular, name, contact information, age, gender and policy information of a policy owner and an insured person, upon such policy owner’s and insured person’s written consent, to the following parties, within or outside of Hong Kong, for the voluntary purposes:

1) companies within the Zurich Insurance Group; 2) other banking/financial institutions, commercial or charitable organisations with whom the Company maintains business referral or

other arrangements; 3) third party marketing service providers and insurance intermediaries. The Company is not allowed to provide to any third party the personal information of any customer, specifically, policy owners or insured

persons, for the above voluntary purposes without their written consent.5. All customers have the right to access to, correct, or change any of their own personal information held by the Company, and in the case

of policy owners and life insured, opt-out of the Company’s use and transfer of their personal information for the voluntary purposes, by request in writing to the Company’s Personal Data Privacy Officer at the address below. Requests for opt-out must state clearly the full name, identity document number, policy number, telephone number and address of the person making such request. Policy owners and insured persons may otherwise delete both the above paragraphs 3 and 4 (in italics) to indicate their wish to opt-out altogether.

Personal Data Privacy Officer 26/F, One Island East 18 Westlands Road Island East Hong Kong6. In accordance with the Ordinance, the Company has the right to charge a reasonable fee for processing any data access request.7. In the event of any discrepancy or inconsistencies between the English and Chinese versions of this notice, the English version shall prevail.

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I confirm that all information provided by me in this application form is true, correct and accurate. I further confirm my agreement to all sections in this application form, including without limitation, the above Declaration and the Notice to Customers relating to the Personal Data (Privacy) Ordinance (“Ordinance”).

本人確認由本人於此申請表格提供之所有資料均為事實正確無誤。本人更確認同意本申請表格內之所有部分，包括但不限於上列之聲明細則及有關個人資料（ 私隱）條例（「私隱條例」）的客戶通知。

Signature of proposer 投保人簽署：

Day 日 Month 月 Year 年

Date日期

Zurich Insurance Company Ltd (a company incorporated in Switzerland) 蘇黎世保險有限公司（於瑞士註冊成立之公司）

25-26/F, One Island East, 18 Westlands Road, Island East, Hong Kong香港港島東華蘭路18號港島東中心25-26樓Telephone 電話：+852 2968 2288 Fax 傳真：+852 2968 0639 Website 網址：www.zurich.com.hkZH

A/A

F/A

GT/

04/2

014r

Notice to Customers relating to the Personal Data (Privacy) Ordinance (“Ordinance”)(continued) 有關個人資料（私隱）條例（「私隱條例」）的客戶通知（續）1. 由Zurich Insurance Company Ltd （「本公司」）收集或持有的客戶（包括保單持有人、受保人、受益人、保費付款人、信託人、保單受讓人及索償人）個人資料，均可供本公司使用作以下強制性用途，以便為客戶提供服務（否則本公司將無法為未能提供所需資料的客戶提供服務）：

1) 辦理，調查（及協助他人調查）和決定保險申請、保險索償及提供持續的保險服務； 2) 辦理付款要求及直接付款授權； 3) 處理任何對客戶的索償、訴訟及／或司法程序；以及行使本公司的權利（詳情見適用保單條款所定），包括但不限於代位權； 4) 編撰統計數字，或作會計及精算用途； 5) 符合對本公司及／或其所屬集團（「蘇黎世保險集團」）具約束力的任何本地或外國法例、規則、守則或指引的披露規定及如需要時進行

核對程序； 6) 遵循香港法院及監管機構作出的合法要求或指令，包括但不限於保險業監理處、香港保險業聯會、核數師、政府組織和政府相關機

構； 7) 債務追討 ; 8) 便利本公司的認可服務供應商，就上述目的為本公司及／或客戶提供服務；及 9) 使本公司的實際或建議承讓人能夠評核擬進行涉及有關轉讓的交易。2. 本公司可就強制性用途，向以下於香港境內或境外的人士提供任何客戶個人資料： 1) 蘇黎世保險集團成員公司，或任何進行保險或再保險相關業務的其他公司或中介人； 2) 任何向蘇黎世保險集團提供行政、電訊、電腦、付款或其他與其業務運作有關的服務的代理人、承包商或第三方服務供應商； 3) 第三方服務供應商，包括法律顧問、會計師、調查員、理賠師、再保公司、醫護及復康顧問、考察員、專家、維修人員、及資料處理

者； 4) 信貸諮詢機構、而在客戶欠賬時，任何債務追收代理或進行索償或調查服務的公司； 5) 根據對蘇黎世保險集團或其任何關連機構具約束力的任何法例，及就任何由政府、監管或其他機關所頒佈且蘇黎世保險集團或其任何

關連機構預期須遵守的任何規例、守則或指引而言，蘇黎世保險集團有責任向其作出披露的任何人士； 6) 根據主管司法權區的法院的任何頒令的任何人士；及 7) 蘇黎世保險集團的任何實際或建議承讓人或蘇黎世保險集團對保單持有人的權利的受讓人。3. 由本公司收集或持有的保單持有人及受保人的某些個人資料，特別是姓名、聯絡資料、年齡、性別、身份證明文件資料、婚姻狀況、保單資料、索償資料、及醫療紀錄等，均可供本公司使用作以下自願性用途：

1) 為蘇黎世保險集團及／或與本公司維持業務引薦關係或其他安排之其他金融服務供應商的保險及／或金融產品及服務，及／或其他商業合作伙伴之相關服務，提供市場推廣資料及進行直接市場推廣活動；

2) 進行客戶研究分析及分層；及 3) 就蘇黎世保險集團的服務及保險產品發展進行市場調查及保險研究。 未經客戶同意，本公司不得使用任何客戶的個人資料作上述自願性用途。在未有收到任何「反對」要求，本公司將把有關保險申請及持續投保，視作有關保單持有人及受保人之不反對本公司使用其個人資料作上述自願性用途。

4. 經保單持有人及受保人書面同意後，本公司可就上述自願性用途，向以下於香港境內或境外的人士提供其某些個人資料，特別是姓名、聯絡資料、年齡、性別、保單持有人及受保人的保單資料等：

1) 蘇黎世保險集團成員公司； 2) 與本公司維持業務引薦關係或其他安排的其他銀行／金融機構、商業或慈善組織； 3) 第三方市場推廣服務供應商及保險中介人。 未經客戶書面同意，本公司不得向任何第三方提供有關客戶（特別指保單持有人及受保人）的個人資料作上述自願性用途。5. 所有客戶均有權以書面向本公司之個人資料私隱主任（地址如下）要求查閱、修正及／或更改由本公司所持有有關其本身的任何個人資料。如保單持有人及受保人欲反對本公司使用及提供其個人資料作上述自願性用途，亦可向本公司提出，並於有關反對要求中清楚註明要求人士之全名、身份證明文件編號、保單編號、電話號碼和地址。保單持有人及受保人亦可同時刪劃以上第3及4段（見斜字）以提出有關所有自願性用途之反對要求。

個人資料私隱主任 香港港島東華蘭路18號 港島東中心26樓6. 根據私隱條例，本公司有權收取合理費用，藉以處理任何資料的查閱要求。7. 本通知的中英文版本如有任何歧異或不一致，概以英文版為準。