SUN HUNG KAI PROPERTIES INSURANCE LTD
Rm2309-16 Sun Hung Kai Centre,
30 Harbour Road, Wanchai, Hong Kong.
Telephone : 2827 8111 Facsimile : 2827 0622
Web Site:http://www.shkpinsurance.com.hk
E-Mail: shkpi@shkp.com.hk
CLAIM FORM SECTION A
INSURED'S INFORMATION
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(1)
Name:
()
(2)
Correspondence
Address:
()
(3)
(#)
(4)
Home Tel.
Office Tel.
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E-mail Address
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Policy No.:
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SECTION B
CLAIM INFORMATION
()
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(1)
Date of accident or loss
For Office Use Only Date Submitted
Type of Policy :
Mobile/Pager No.
Fax No.
(a)
Householder
(b)
Houseowner
Claim Number :
01
Time
2
Place
()
(2)
345()*+,-678
State the circumstances of the loss or damage with full particulars
()
(3)
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In the case of Theft, please give full details showing how access to the property was effected
(#)
(4)
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Amount claimed (for details see overleaf) (4 7 3 O P Q )
(R)
(5)
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Is the Claimant the sole owner of the property lost for damged?
T Yes
U No
([)
(6)
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Are there any other insurances upon the same property? If yes, please give full particulars.
T Yes
U No
(j)
(7)
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Has the claimant sustained other losses of the same nature? If yes, please give full particulars.
T Yes
U No
MN
HKD
SUN HUNG KAI PROPERTIES INSURANCE LTD
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SECTION C
Rm2309-16 Sun Hung Kai Centre,
30 Harbour Road, Wanchai, Hong Kong.
Telephone : 2827 8111 Facsimile : 2827 0622
Web Site:http://www.shkpinsurance.com.hk
E-Mail: shkpi@shkp.com.hk
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THIRD PARTY LIABILITY ACCIDENT
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By furnishing this report form the Company makes no admission of liability.
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(a)
, - ( ) X 4 7 ( 1 ) FULL DESCRIPTION OF ACCIDENT
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Cause and manner of occurence
(%)
(b)
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Was accident due to want of care upon part of injured person?
T Yes
U No
bT= 9B,If so, how?
(r)
(c)
BXˆ‰Œ‹()X,Whose negligence caused the accident?
(Ž)
(d)
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What right did the inured party have on the premises?
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(a)
† ‡ S 7 „ ( 2 ) PERSON INJURED
Name
Address
(%)
(b)
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Nature and extent of injuries
(r)
(c)
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Where was the injured taken?
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(a)
(%)
(b)
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Name of Owner
Address:
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Kind of property
(r)
(c)
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Nature and extent of damage
(Ž)
(d)
Ÿ ¡¢£¤b¥
Estimated cost of repairs
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(#
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(a)
(%)
(b)
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Has claim been made upon you?
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Is claimant insured?
(r)
(c)
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Have you in any way admitted liability to the claimant ?
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Age
p•
Sex
( 3 ) DAMAGE TO PROPERTY OF OTHERS
“”
p•
Age
Sex
( 4 ) THIRD PARTY CLAIM
T Yes
U No
T Yes
U No
HIJ'b¥
If so, for what amount ?
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Name of Company
T Yes
U No
SUN HUNG KAI PROPERTIES INSURANCE LTD
Rm2309-16 Sun Hung Kai Centre,
30 Harbour Road, Wanchai, Hong Kong.
Telephone : 2827 8111 Facsimile : 2827 0622
Web Site:http://www.shkpinsurance.com.hk
E-Mail: shkpi@shkp.com.hk
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¬ ( 5 ) WITNESSES
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Whenever possible please obtain names and addresses of witness, bystanders or persons in the immediate vicinity who may have
seen the accident or heard statements made by any of the persons involved.
Name
Address
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([
(6)
“”
Age
p•
Sex
Tel
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Have the Police Authorities / Fire Service Department been informed?
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yÁ ./
Police Station
Reported Date
¼ÂÃÁ
Police Report No.
T Yes
U No
Ä Å g Æ ‘ { DECLARATION AND AUTHORIZATION
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I / We declare that the above information is true and complete to the best of my / our knowledge and belief and I / we have not
withheld any material information connected with this claim. I / We understand that the Company can request for more
information.
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I / We hereby authorize any authorities or organization that has any records or knowledge of me / us or my / our accident to
furnish to Sun Hung Kai Properties Insurance Ltd or its authorized representative, any and all information with respect to my / our
report of accident for the purpose of assessment of my / our present case. A photostat copy of this authorization shall be
considered as effective and valid as the original.
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Signature of Insured _________________________________________
(With company chop if appropriate)
./
Date : ____________________________
SUN HUNG KAI PROPERTIES INSURANCE LTD
Rm2309-16 Sun Hung Kai Centre,
30 Harbour Road, Wanchai, Hong Kong.
Telephone : 2827 8111 Facsimile : 2827 0622
Web Site:http://www.shkpinsurance.com.hk
E-Mail: shkpi@shkp.com.hk
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Sun Hung Kai Properties Insurance Limited (the "Company")
Circular to Customers relating to the Personal Data (Privacy) Ordinance
Use of Personal Data
We hereby give you notice that the personal data supplied or to be supplied by you to us in connection with this Policy will be used for:(a)
(b)
(c)
(d)
(e)
(f)
our daily operation, and for our provision of insurance, financial or other services;
processing applications for the issue of insurance policies and their renewal;
providing subsequent services for any insurance policies and other financial products or services;
processing, analyzing and investigating any claim under any insurance policy;
designing and marketing to you or otherwise our products and services; and
facilitating communication between you and us.
The personal data in respect of you and the Insured Person(s), whether supplied by you or collected by us through other means, will be treated with the strictest
level of confidence but may be disclosed to:
(a)
(b)
(c)
(d)
(e)
our employees, agents and intermediaries;
any of our associated, holding, subsidiary or related companies, and any other companies carrying on insurance or reinsurance business;
any of our claims investigation companies, legal advisors, accountants or other service providers;
any association, federation or other organization of the insurance industry; and
any law enforcement agencies under any law binding on us.
Pursuant to the Personal Data (Privacy) Ordinance, you and the Insured Person(s) are entitled to have access to your or the relevant Insured Person's own personal
data which are held by us and/or to correct such data on payment of a reasonable fee to cover our administrative charges and expenses. Such request should be
made in writing with 7-days advance notice to :
Data Privacy Compliance Officer,
Sun Hung Kai Properties Insurance Limited,
2309-16, Sun Hung Kai Centre,
30 Harbour Road,
Wanchai,
Hong Kong.
Thank you for your attention.
March 2000
SUN HUNG KAI PROPERTIES INSURANCE LTD
Rm2309-16 Sun Hung Kai Centre,
30 Harbour Road, Wanchai, Hong Kong.
Telephone : 2827 8111 Facsimile : 2827 0622
Web Site:http://www.shkpinsurance.com.hk
E-Mail: shkpi@shkp.com.hk
Rm2309-16 Sun Hung Kai Centre,
30 Harbour Road, Wanchai, Hong Kong.
Telephone : 2827 8111 Facsimile : 2827 0622
Web Site:http://www.shkpinsurance.com.hk
E-Mail: shkpi@shkp.com.hk
SCHEDULED OF LOSS
+ W h i (î
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Description of Lost Articles
(including cash)
AB¨ñ
From Whom Acquired
¨ñ./
Date Acquired
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Original Cost`
Óñóô
Replacement Cost
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TOTAL AMOUNT CLAIMED
& ' K L (M
M N)
Amount Claimed
(HKD)