Manulife Domestic HelperInsurance宏利家傭全險

A comprehensive insurance providingpeace of mind for you and your

Domestic Helper一份為閣下及家傭提供全面保障的計劃

THe MAnulIfe DoMesTIc Helper InsurAnce protects both employer and Domestic Helper. Its comprehensive coverage is designed to look after your Domestic Helper in the event of illness, covering clinical, dental and hospital expenses incurred in the course of employment. It also includes Employees’ Compensation cover that is legally required for your Domestic Helper and other extra benefits.宏利家傭全險是一項可同時保障僱主及家傭的保險計劃。其全面的保障包括家傭於受僱期間因病所產生的診療、牙科及住院費用；亦包括依據法律規定僱主所須履行的勞工賠償責任及其他額外保障項目。

MeDIcArD convenIence for clInIcAl servIcesWith the QBE MediCard, your Domestic Helper is entitled to use quality clinical services rendered by Quality HealthCare Medical Services doctor panel with locations throughout Hong Kong.醫療保險咭提供便捷門診服務閣下之家傭可憑昆士蘭聯保簽發之醫療保險咭，於全港「卓健」診所網絡享有各項優質門診醫療服務。

5. PersonalAccidentBenefits 個人意外受傷賠償

In the event of accidental injury to your Domestic Helper during rest days or not arising out of work, a cash benefit to her family shall be provided for death or permanent disablement resulted within 12 months from the date of such accident in accordance with the extent of disability described below up to HK$200,000 in aggregate.

Accidental death HK$200,000 Permanent total disablement HK$200,000 Loss of two or more limbs HK$200,000 Loss of sight of both eyes HK$200,000 Loss of one limb and sight of one eye HK$200,000 Loss of one limb HK$100,000 Loss of sight of one eye HK$100,000

(Loss of limb shall mean physical amputation of a hand or foot at or above the wrist or ankle or of an arm or leg at or above elbow or knee. Loss of sight shall mean total and irrecoverable loss of all sight.)

閣下的家傭在休假期間或非因工而意外受傷，並於12個月內因傷導致死亡或永久性傷殘，將依下列情況獲得最高總額可達200,000港元之賠償：

意外死亡 200,000港元

永久性完全傷殘 200,000港元

喪失肢體中任何兩肢或以上 200,000港元

雙目失明 200,000港元

喪失一肢及一目失明 200,000港元

喪失一肢 100,000港元

一目失明 100,000港元

（喪失肢體即在手腕或足踝或以上斷失，而失明即不可復原的永久性視力完全喪失。）

6. loss of services cash Allowance 中斷服務現金津貼

In the event that your Domestic Helper is hospitalised due to sickness or injury, this policy shall pay you a daily cash allowance of HK$200 for the loss of services commencing from the 1st day of the Domestic Helper’s confinement, subject to a maximum of HK$6,000 for each 12-month period.

如閣下的家傭因生病或意外而需入院接受治療，為補償服務損失，由首日起計，閣下每天可獲200港元現金津貼，每12個月最高不超逾6,000港元。

7. repatriation expenses 遺體運送費用

In the event of serious sickness or injury to your Domestic Helper resulting in her being certified by a legally qualified and registered medical practitioner as medically unfit to work leading to the termination of her employment contract or resulting in her death, the policy shall pay the expenses for:(a) the repatriation of the Domestic Helper to her country of origin by

scheduled flight (economy class) including any transportation for ambulance transfer to and from the airport; or

(b) the treatment of the Domestic Helper’s post-mortem and transportation of the mortal remains to the airport nearest to the place of burial in her country of origin.

The policy shall pay the expenses reasonably and necessarily incurred under (a) or (b) up to a maximum of HK$20,000 for each 12-month period.

如閣下的家傭經註冊醫生證明因受傷或嚴重疾病而死亡或不能工作而導致僱傭合約被終止，本計劃將代為支付以下之費用：

(a)以定期航班(經濟客位)將家傭送返原居國家，包括行程起止兩地之機場接送；或

(b)處理遺體及將遺體運送至原居地最近葬殮處的機場。

本計劃支付(a)或(b)項下之合理及必須之費用，惟費用總額每12個月不超過20,000港元。

8. replacement Helper expenses 重新聘用家傭費用

In addition to the expenses incurred for the repatriation of your Domestic Helper as described in Section 7 above, this policy shall pay you the expenses reasonably and necessarily incurred for employing a Replacement Helper, maximum limit is HK$10,000 for each 12-month period.

如閣下於上列第七項保障所述之情況下運送家傭回國，閣下除可獲賠償運送費用外，本計劃將支付因重新聘請家傭所須之實際費用，最高賠償額為每12個月10,000港元。

9. fidelity Guarantee 家傭忠誠保障

The policy shall pay you the financial loss arising from a dishonest act of your Domestic Helper, subject to a maximum amount of HK$10,000 for each 12-month period.

* Compensation for unauthorised long distance calls subject to a sub-limit of HK$3,000 for each 12-month period.

因家傭之欺詐行為導致閣下蒙受金錢上之損失，本計劃將補償閣下之實際損失，每12個月最高賠償額為10,000港元。

*家傭在未經僱主許可下使用長途電話，每年最高賠償額為 3,000港元。

10. Domestic Helper’s liability 家傭個人法律責任保障

The policy also covers legal liability of your Domestic Helper to a third party (other than you and your family members) for bodily injury or property damage as a result of his/her negligence during the course of employment, subject to a maximum amount of HK$500,000 in annual aggregate at nil excess.

保障閣下的家傭在受僱期間因其疏忽導致他人(不包括閣下及閣下之家屬)身體受傷或財物受損所須承擔之法律責任，每年度最高賠償額為500,000港元，不設自負額。

11. family Member’s Medical expenses 僱主家庭成員診療費用

The policy shall pay the medical expenses reasonably and necessarily incurred by your family member under the age of 3 as a result of bodily injury (evidence by police report) caused by your Domestic Helper’s intentional act, subject to a maximum amount of HK$20,000 for each 12-month period.

閣下三歲以下之家庭成員如因家傭之蓄意行為導致其身體受傷而需接受治療(必須於發現時立刻報警並取得警方正式報告)，閣下將獲得賠償合理及必須之醫療費用，每12個月最高賠償額為20,000港元。

Promotionfor limited period

、

BenefITs 保障利益

1. employer’s liability 僱主責任(僱員補償保險)

In the event your Domestic Helper suffers injury or disease arising out of and in the course of her employment, the policy shall indemnify you against legal liability to pay compensation, costs and/or expenses. Maximum indemnity for any one Event: HK$100,000,000.

保障閣下在僱員補償法例規定下，對家傭在受僱期間因工作引起生病、受傷或死亡而須承擔之賠償責任。每宗事故最高賠償額為100,000,000港元。

2. clinical expenses (at Designated network clinics) 診療費用(於指定網絡診所)

The policy shall cover the outpatient clinical consultation, treatment and/or medication of your Domestic Helper with a valid MediCard at any of the appointed medical services providers in the designated network clinics. Services include:

Benefit Co-paymentReferralletter MaxNo.ofvisits (a) General - - 25 visits per consultation 12-month period (b) Specialist HK$200 Yes (1 visit per day) consultation

(c) Physiotherapy* HK$120 Yes

(d) Chinese Medicine Practitioner treatment Yes^ - * (c) + (d) shall not (including bone-setting

exceed 5 visits per

and acupuncture) * 12-month period

閣下的家傭如因生病或意外導致身體受傷，只需於指定醫療服務機構之網絡診所出示有效的醫療保險卡，即可接受會診、治療及/或藥物服務。服務包括：

保障利益 自負額 醫生轉介信 最高門診次數

(a)一般門診 - - 受保期內每12個 (b)專科門診 200港元 需要 月25次

(c)物理治療* 120港元 需要 (每天一次)

(d)中醫門診(包括跌 *唯(c)及(d)項每12個月

打及針灸治療)* 需要^ -

3. surgical and Hospitalisation expenses 外科手術及住院費用

In the event your Domestic Helper is hospitalised for surgery or treatment of sickness or injury, the policy shall pay the actual, necessary and reasonable expenses incurred up to:

Benefit Max Amount payable (per Disability)(a) Room and board & misc charges HK$300 per day(b) Surgical fee HK$10,000 (c) Anaesthetist’s fee 25% of (b)(d) Operating theatre fee 12.5% of (b)Total amount payable per Disability HK$30,000The total amount payable for each 12-month period shall not exceed HK$30,000 in aggregate.

閣下的家傭如因生病或身體受傷而需入住醫院接受外科手術或治療，閣下所支付之實際、必須及合理之費用將獲得賠償，惟賠償金額不超過下列規定：

保障利益 最高賠償金額(每一傷病)

(a)住院費及雜費 300 港元/天

(b)外科手術費 10,000 港元

(c)麻醉師費用 (b)項之百份之二十五

(d)手術室費用 (b)項之百份之十二點五

每一傷病最高賠償金額 30,000 港元

受保期內每12個月之最高賠償額不超過30,000 港元。

4. Dental expenses 牙科費用

In the event your Domestic Helper requires oral surgery, treatment of abscesses, X-rays, extractions or fillings as a result of dental disease, the policy shall pay two-thirds of the actual necessary and reasonable expenses incurred up to a maximum of HK$3,000 for each 12-month period, provided such treatment is rendered by a legally qualified and registered dentist.

閣下的家傭如因牙齒疾患需要接受口腔手術、治療膿腫、X光檢查、脫牙或補牙，將獲得賠償實際及必須支付費用的三份之二，惟受保期內每12個月之總賠償金額以3,000港元為限，而所有治療必須由註冊牙科醫生進行。

合共不超過5次

^ Chinese Medicine Practitioner treatment: HK$30; Bone-setting and acupuncture: HK$80.

^中醫門診需自負30 港元；跌打及針灸均需自負80 港元。

Manulife Domestic HelperInsurance宏利家傭全險

A comprehensive insurance providingpeace of mind for you and your

Domestic Helper一份為閣下及家傭提供全面保障的計劃

THe MAnulIfe DoMesTIc Helper InsurAnce protects both employer and Domestic Helper. Its comprehensive coverage is designed to look after your Domestic Helper in the event of illness, covering clinical, dental and hospital expenses incurred in the course of employment. It also includes Employees’ Compensation cover that is legally required for your Domestic Helper and other extra benefits.宏利家傭全險是一項可同時保障僱主及家傭的保險計劃。其全面的保障包括家傭於受僱期間因病所產生的診療、牙科及住院費用；亦包括依據法律規定僱主所須履行的勞工賠償責任及其他額外保障項目。

MeDIcArD convenIence for clInIcAl servIcesWith the QBE MediCard, your Domestic Helper is entitled to use quality clinical services rendered by Quality HealthCare Medical Services doctor panel with locations throughout Hong Kong.醫療保險咭提供便捷門診服務閣下之家傭可憑昆士蘭聯保簽發之醫療保險咭，於全港「卓健」診所網絡享有各項優質門診醫療服務。

5. PersonalAccidentBenefits 個人意外受傷賠償

In the event of accidental injury to your Domestic Helper during rest days or not arising out of work, a cash benefit to her family shall be provided for death or permanent disablement resulted within 12 months from the date of such accident in accordance with the extent of disability described below up to HK$200,000 in aggregate.

Accidental death HK$200,000 Permanent total disablement HK$200,000 Loss of two or more limbs HK$200,000 Loss of sight of both eyes HK$200,000 Loss of one limb and sight of one eye HK$200,000 Loss of one limb HK$100,000 Loss of sight of one eye HK$100,000

(Loss of limb shall mean physical amputation of a hand or foot at or above the wrist or ankle or of an arm or leg at or above elbow or knee. Loss of sight shall mean total and irrecoverable loss of all sight.)

閣下的家傭在休假期間或非因工而意外受傷，並於12個月內因傷導致死亡或永久性傷殘，將依下列情況獲得最高總額可達200,000港元之賠償：

意外死亡 200,000港元

永久性完全傷殘 200,000港元

喪失肢體中任何兩肢或以上 200,000港元

雙目失明 200,000港元

喪失一肢及一目失明 200,000港元

喪失一肢 100,000港元

一目失明 100,000港元

（喪失肢體即在手腕或足踝或以上斷失，而失明即不可復原的永久性視力完全喪失。）

6. loss of services cash Allowance 中斷服務現金津貼

In the event that your Domestic Helper is hospitalised due to sickness or injury, this policy shall pay you a daily cash allowance of HK$200 for the loss of services commencing from the 1st day of the Domestic Helper’s confinement, subject to a maximum of HK$6,000 for each 12-month period.

如閣下的家傭因生病或意外而需入院接受治療，為補償服務損失，由首日起計，閣下每天可獲200港元現金津貼，每12個月最高不超逾6,000港元。

7. repatriation expenses 遺體運送費用

In the event of serious sickness or injury to your Domestic Helper resulting in her being certified by a legally qualified and registered medical practitioner as medically unfit to work leading to the termination of her employment contract or resulting in her death, the policy shall pay the expenses for:(a) the repatriation of the Domestic Helper to her country of origin by

scheduled flight (economy class) including any transportation for ambulance transfer to and from the airport; or

(b) the treatment of the Domestic Helper’s post-mortem and transportation of the mortal remains to the airport nearest to the place of burial in her country of origin.

The policy shall pay the expenses reasonably and necessarily incurred under (a) or (b) up to a maximum of HK$20,000 for each 12-month period.

如閣下的家傭經註冊醫生證明因受傷或嚴重疾病而死亡或不能工作而導致僱傭合約被終止，本計劃將代為支付以下之費用：

(a)以定期航班(經濟客位)將家傭送返原居國家，包括行程起止兩地之機場接送；或

(b)處理遺體及將遺體運送至原居地最近葬殮處的機場。

本計劃支付(a)或(b)項下之合理及必須之費用，惟費用總額每12個月不超過20,000港元。

8. replacement Helper expenses 重新聘用家傭費用

In addition to the expenses incurred for the repatriation of your Domestic Helper as described in Section 7 above, this policy shall pay you the expenses reasonably and necessarily incurred for employing a Replacement Helper, maximum limit is HK$10,000 for each 12-month period.

如閣下於上列第七項保障所述之情況下運送家傭回國，閣下除可獲賠償運送費用外，本計劃將支付因重新聘請家傭所須之實際費用，最高賠償額為每12個月10,000港元。

9. fidelity Guarantee 家傭忠誠保障

The policy shall pay you the financial loss arising from a dishonest act of your Domestic Helper, subject to a maximum amount of HK$10,000 for each 12-month period.

* Compensation for unauthorised long distance calls subject to a sub-limit of HK$3,000 for each 12-month period.

因家傭之欺詐行為導致閣下蒙受金錢上之損失，本計劃將補償閣下之實際損失，每12個月最高賠償額為10,000港元。

*家傭在未經僱主許可下使用長途電話，每年最高賠償額為 3,000港元。

10. Domestic Helper’s liability 家傭個人法律責任保障

The policy also covers legal liability of your Domestic Helper to a third party (other than you and your family members) for bodily injury or property damage as a result of his/her negligence during the course of employment, subject to a maximum amount of HK$500,000 in annual aggregate at nil excess.

保障閣下的家傭在受僱期間因其疏忽導致他人(不包括閣下及閣下之家屬)身體受傷或財物受損所須承擔之法律責任，每年度最高賠償額為500,000港元，不設自負額。

11. family Member’s Medical expenses 僱主家庭成員診療費用

The policy shall pay the medical expenses reasonably and necessarily incurred by your family member under the age of 3 as a result of bodily injury (evidence by police report) caused by your Domestic Helper’s intentional act, subject to a maximum amount of HK$20,000 for each 12-month period.

閣下三歲以下之家庭成員如因家傭之蓄意行為導致其身體受傷而需接受治療(必須於發現時立刻報警並取得警方正式報告)，閣下將獲得賠償合理及必須之醫療費用，每12個月最高賠償額為20,000港元。

Promotionfor limited period

、

BenefITs 保障利益

1. employer’s liability 僱主責任(僱員補償保險)

In the event your Domestic Helper suffers injury or disease arising out of and in the course of her employment, the policy shall indemnify you against legal liability to pay compensation, costs and/or expenses. Maximum indemnity for any one Event: HK$100,000,000.

保障閣下在僱員補償法例規定下，對家傭在受僱期間因工作引起生病、受傷或死亡而須承擔之賠償責任。每宗事故最高賠償額為100,000,000港元。

2. clinical expenses (at Designated network clinics) 診療費用(於指定網絡診所)

The policy shall cover the outpatient clinical consultation, treatment and/or medication of your Domestic Helper with a valid MediCard at any of the appointed medical services providers in the designated network clinics. Services include:

Benefit Co-paymentReferralletter MaxNo.ofvisits (a) General - - 25 visits per consultation 12-month period (b) Specialist HK$200 Yes (1 visit per day) consultation

(c) Physiotherapy* HK$120 Yes

(d) Chinese Medicine Practitioner treatment Yes^ - * (c) + (d) shall not (including bone-setting

exceed 5 visits per

and acupuncture) * 12-month period

閣下的家傭如因生病或意外導致身體受傷，只需於指定醫療服務機構之網絡診所出示有效的醫療保險卡，即可接受會診、治療及/或藥物服務。服務包括：

保障利益 自負額 醫生轉介信 最高門診次數

(a)一般門診 - - 受保期內每12個 (b)專科門診 200港元 需要 月25次

(c)物理治療* 120港元 需要 (每天一次)

(d)中醫門診(包括跌 *唯(c)及(d)項每12個月

打及針灸治療)* 需要^ -

3. surgical and Hospitalisation expenses 外科手術及住院費用

In the event your Domestic Helper is hospitalised for surgery or treatment of sickness or injury, the policy shall pay the actual, necessary and reasonable expenses incurred up to:

Benefit Max Amount payable (per Disability)(a) Room and board & misc charges HK$300 per day(b) Surgical fee HK$10,000 (c) Anaesthetist’s fee 25% of (b)(d) Operating theatre fee 12.5% of (b)Total amount payable per Disability HK$30,000The total amount payable for each 12-month period shall not exceed HK$30,000 in aggregate.

閣下的家傭如因生病或身體受傷而需入住醫院接受外科手術或治療，閣下所支付之實際、必須及合理之費用將獲得賠償，惟賠償金額不超過下列規定：

保障利益 最高賠償金額(每一傷病)

(a)住院費及雜費 300 港元/天

(b)外科手術費 10,000 港元

(c)麻醉師費用 (b)項之百份之二十五

(d)手術室費用 (b)項之百份之十二點五

每一傷病最高賠償金額 30,000 港元

受保期內每12個月之最高賠償額不超過30,000 港元。

4. Dental expenses 牙科費用

In the event your Domestic Helper requires oral surgery, treatment of abscesses, X-rays, extractions or fillings as a result of dental disease, the policy shall pay two-thirds of the actual necessary and reasonable expenses incurred up to a maximum of HK$3,000 for each 12-month period, provided such treatment is rendered by a legally qualified and registered dentist.

閣下的家傭如因牙齒疾患需要接受口腔手術、治療膿腫、X光檢查、脫牙或補牙，將獲得賠償實際及必須支付費用的三份之二，惟受保期內每12個月之總賠償金額以3,000港元為限，而所有治療必須由註冊牙科醫生進行。

合共不超過5次

^ Chinese Medicine Practitioner treatment: HK$30; Bone-setting and acupuncture: HK$80.

^中醫門診需自負30 港元；跌打及針灸均需自負80 港元。

投保人（僱主）簽署

Signature of Proposer (Employer)

AGENT CODE 代理人編號

eXclusIons 不保事項

General exclusions Applicable to All sections適用於所有保障項目

War and allied perils, terrorism (except Employer’s Liability), asbestos, nuclear fission or fusion and radioactive contamination, suicide, pregnancy or childbirth, intoxication by alcohol, narcotics or drugs not prescribed by a registered medical practitioner, pre-existing conditions, acquired immune deficiency syndrome (AIDS) or AIDS related complex (ARC), violation of the law or resisting arrest.戰爭及有關風險、恐佈主義活動(除僱主責任外)、石棉、核能分裂聚合或輻射引致之死亡或損失、自殺、懷孕或生育、酗酒、或服用非經註冊醫生處方指定之麻醉品或藥物，愛滋病或其相關的病徵及在保險生效前已存在的傷病及其他身體狀況，違法或拒捕。

SpecificExclusionsApplicableto個別保障項目之特定不保事項

1. employer’s liability: Pneumoconiosis, Mesothelioma, nuclear energy and radiation, any late payment surcharge that the Insured may become liable under the legislation.

2. clinical expenses, surgical and Hospitalisation expenses, and loss of services cash Allowances: Nervous or mental disease, venereal disease, congenital anomalies or deformities, infertility, sterilisation, contracep-tion, heart disease, cancer, rest cure, physical check-ups and cosmetic or plastic surgery unless to correct an injury covered under the policy.

3. Dental expenses: Routine examination, scaling, polishing, cleaning, crowning, bridges, braces and dentures.

4.PersonalAccidentBenefits: Driving or riding in any kind of race, un-derwater activities involving the use of breathing apparatus.

5. repatriation expenses: Any repatriation or transportation of mortal remains originating outside Hong Kong.

6. Domestic Helper’s liability: Employer’s liability; property held in care, custody or control; fines, penalties, punitive damages; libel or slander etc.

Declaration and Signature 聲明及簽署I / WE DECLARE THAT 本人/ 吾等謹此作下列聲明：1. All answers and statements made in the proposal are accurate in every respect and no information has been

withheld which is likely to affect acceptance of this proposal. 本投保書內所有答題及述詞均為全部真實及正確，並無隱瞞而可能影響有關接納投保與否之決定。

2. Any question not answered shall be taken in the negative. 所有不作答的問題均視為否定回答。

3. This proposal and declaration shall be the basis of the policy and considered as being incorporated therein. 本投保書及聲明將為保單之根本依據，並視作保單之一部份。

4. I / We shall accept a policy subject to the usual conditions prescribed by the Company therein. 本人 / 吾等接受註有通敘條款之承保公司保單。

5. I / We understand that any claim for Accidental Death benefit under Section 5 of the Policy shall be payable to the Domestic Helper’s legal representative.

本人 / 吾等明白根據條款第五項作出之意外死亡賠償，將給與被保人之合法代表人。

6. I / We have never had my/our domestic helper insurance declined, cancelled or refused to renew by any insurance company. 本人 / 吾等之家傭保險從未有被保險公司拒絕投保，取消或拒絕續保。

(本投保書及章程中文內容力求符合英文原義，惟有關條文解釋及引用，則以英文為準。)

1.僱主責任：肺積塵病、間皮瘤、核能放射，或法例下僱主因不依期作工傷賠償而須付之罰款。

2.診療費用、外科手術及住院費用，及中斷服務現金津貼：精神病、性病、先天性異常或畸形、不育、絕育、避孕、心臟病、癌病、療養、體格檢查、美容或整形手術(但由本保單範圍內損傷引致之矯形手術除外)。

3.牙科費用：口腔檢查、洗牙、磨牙、鑲裝牙冠、牙橋、牙箍及假牙等。

4. 個人意外受傷賠償：任何形式之騎策、駕車比賽及用供氧設備輔助呼吸之水中活動。

5. 運送費用：遺體從香港以外地區運返原居地及因任何在香港以外地區發生之事故而引致受保人或其遺體之遣返或運送返回原居地。

6. 家傭個人責任：僱主責任；受看顧、掌管之財物；罰款、違約金、懲罰性賠償；誹謗責任。

AGELIMIT:18-60年齡限制：18-60

WAITInG perIoD 等候期A 10-day waiting period from the effective date of the policy shall be applicable under Sections 2, 3, 4 and 6. No benefits shall be payable under these sections in respect of any event occurring during the waiting period.任何有關第2, 3, 4及6項所支付的費用於保單生效後10天內將不受保障。

preMIuM TABle (HK$) 保費表(港元) optional cover – cancer and Heart plan Disease Medical 1 year 2 years 計劃 expenses extension 一年 兩年 自選保障 – 癌症及心臟病治療 費用附加保障

Yes 1,050 786* 1,890 1,415*A)Items 1-11 選擇

第1至11項 No 800 680* 1,440 1,224*

不選擇

Yes# 820 695 1,476 1,251B) Items 1, 3 & 5 選擇#

第1、3及5項 No 不選擇

570 1,026

C) Items 1 & 5 450 810

第1及5項Minimum premium per policy: HK$450每保單最低保費：450港元

Remarks: This brochure is only a summary. Please refer to the Policy for full terms and conditions.注意： 此小冊子只供作參考之用，所有條款及細則概以保險單為準。

Remarks: * 15% premium discount for Plan (A) is included. # For Plan (B), Optional Cover applicable on Surgical & Hospital Expenses only.備註： *計劃(A) 已包括保費85折優惠。 # 計劃 (B) 自選保障之範圍只適用於外科手術及住院費用。

Manulife Domestic Helper Insurance proposal form 宏利家傭全險投保書Please complete in BLOCK LETTERS 請以英文正楷填寫1. Name of Proposer (Employer) 投保人姓名(僱主) Occupation Mr / Mdm 先生/ 女士 職業

Postal Address 通訊地址 Passport / HKID No. 護照/香港身份証號碼

Domestic Helper’s Employment Address 家傭受僱地址 Date of Birth (D / M / Y) 出生日期(日/月/年)

Home Tel. No. 住宅電話 Office Tel. No. 公司電話

E-mail Address 電郵地址 Fax No. 傳真號碼

2. Name of Employment Agency (if applicable) Tel No. 電話 僱傭代理公司名稱(如適用)

3. Name of Domestic Helper Nationality Sex Date of Birth (D / M / Y) Passport No. 家傭姓名 國籍 性別 出生日期(日/ 月/ 年)// 護照號碼

4. Annual Wages (HK$) 每年工資(港元)(Minimum allowable wages applies if blank 如不填寫則按現行規定最低工資為準） 5. Contract Period 受僱期限 From 由// To 至// (D / M / Y) (日/ 月/ 年) (D / M / Y)(日/ 月/ 年)6. Effective Date of Insurance 起保日期 Please Tick 請以(4)選擇 From 由// To 至// (D / M / Y)(日/ 月/ 年) (D / M / Y)(日/ 月/ 年)

7. Are you aware of any condition for which your Domestic Helper may require medical or surgical treatment? 你是否知道上述家傭可能因某種病症而需要接受治療或手術？ o Yes 是 o No 否 If “Yes”, please give details如「是」，請詳述：

personal Information collection statement 收集個人資料聲明The information you provide to us is collected to enable us to carry on insurance business and may be used for the purpose of any insurance or financial related product or service or any alterations, variations, cancellation or renewal of such product or service; any claim or investigation or analysis of such claim; and exercising any right of subrogation. The said information may be transferred to 1. any related company or any other company carrying on insurance or reinsurance related business or an intermediary or a claims or investigation

or other service provider providing services relevant to insurance business for any of the above or related purposes, 2. Manulife (International) Limited, its associated/related companies/or its intermediaries for their promotion of products and services,3. any association, federation or similar organization of insurance companies (“Federation”) that exists or is formed from time to time for any of

the above or related purposes or to enable the Federation to carry out its regulatory functions or such other functions that may be assigned to the Federation from time to time and are reasonably required in the interest of the insurance industry or any member(s) of the Federation, and

4. any members of the “Federation” by the “Federation” for any of the above or related purposes.Moreover, QBE Hongkong & Shanghai Insurance Ltd. is hereby authorized to obtain access to and/or to verify any of your data with the information collected by the Federation from the insurance industry. You have the right to obtain access to and to request correction of any personal information concerning yourself held by QBE Hongkong & Shanghai Insurance Ltd. Requests for such access can be made to the General Administration Officer of QBE Hongkong & Shanghai Insurance Ltd. through our hotline at 2877 8488 or Fax No. 3607 0300.閣下提供的資料，為本公司提供保險業務所需，並可能使用於下列目的。任何與保險或財務有關的產品或服務，或該等產品或服務的任何更改、變更、取消、或續期;任何索償，或該等索償的調查或分析;行使任何代位權。以上資料，可移轉予1. 任何有關的公司，或任何其他從事與保險或再保險業務有關的公司、或與保險業務有關的中介人或索償或調查或其他服務提供者，以達到任何上述或有關目的;2. 宏利人壽保險（國際）有限公司，其聯營/有關公司/或其中介人進行宣傳/推廣產品及服務，3. 現存或不時成立的任何保險公司協會或聯會或類同組織(「聯會」)，以達到任何上述或有關目的，或以便「聯會」執行其監管職能，或其他基於保險業或任何

「聯會」會員的利益而不時在合理要求下賦予「聯會」的職能，及4. 或透過「聯會」移轉予任何「聯會」的會員，以達到任何上述或有關目的。此外，在此授權昆士蘭聯保保險有限公司由「聯會」從保險業內收集的資料中查閱及/或核對閣下任何資料。閣下有權查閱及要求更正由昆士蘭聯保保險有限公司持有有關閣下的個人資料，如有需要，可向昆士蘭聯保保險有限公司行政事務主任提出。（電話: 2877 8488或傳真: 3607 0300）

pAYMenT opTIon 付款方法 o Please debit the premium from my credit card account 請由本人之信用卡戶口扣取保費 Credit Card Cardholder’s Name Credit Card No. 信用卡 信用卡持有人姓名 信用卡號碼

o VISA o MasterCard Expiry Date 有效日期至 // Cardholder’s Signature 簽署

o CHEQUE 支票 Cheque No. 支票號碼： Bank 付款銀行： Cheque should be made payable to “QBE Hongkong & Shanghai Insurance Ltd.” 支票抬頭人請寫「昆士蘭聯保保險有限公司」

If paying by credit card, please fax the completed form to 3607 0519. 如使用信用卡支付保費，請將填妥的投保書傳真至3607 0519。

Amount 金額：

POLICY NO. 保單號碼

Date日期

Manulife (International) Limited is a member of the Manulife Financial group of companies. Manulife Financial is a leading Canadian-based financial services group operating in 22 countries and territories worldwide. For more than 120 years, clients have looked to Manulife for strong, reliable, trustworthy and forward-thinking solutions for their most significant financial decisions. Our international network of employees, agents and distribution partners offers financial-protection and wealth-management products and services to millions of clients. We provide asset-management services to institutional customers worldwide as well as reinsurance solutions, specialising in life and property and casualty retrocession. Funds under management by Manulife Financial and its subsidiaries were Cdn$475 billion (HK$3713.8 billion) as at December 31, 2010. The company operates as Manulife Financial in Canada and Asia and primarily as John Hancock in the United States. Manulife Financial Corporation trades as “MFC” on the TSX, NYSE and PSE, and under “945” on the SEHK. Manulife Financial can be found on the Internet at www.manulife.com.

宏利人壽保險(國際)有限公司乃宏利金融集團屬下的成員公司。

宏利金融為加拿大的主要金融服務機構，業務遍及全球二十二個國家及地區。

過去逾一百二十多年來，宏利金融就客戶的重大理財決策提供穩健可靠、深

受信賴而且達遠前瞻的理財方案。透過其環球僱員、保險代理及銷售夥伴網

絡，宏利金融為數以百萬計客戶提供財務保障及財富管理產品和服務，並為

各地的機構客戶提供資產管理服務。宏利金融亦提供各種再保險方案，並以

人壽、財產及意外保險的轉再保業務為主。截至二零一零年十二月三十一日

止，宏利金融及其附屬公司的管理資產規模達四千七百五十億加元(約三萬

七千一百三十八億港元)。宏利業務遍及加拿大、亞洲及美國(主要通過恆康)。

宏利金融有限公司在多倫多、紐約及菲律賓證券交易所的股份代號為MFC，在

香港聯交所的股份代號為945，其網址為www.manulife.com。

For enquiries, please contact your Manulife Insurance Advisor:如有疑問，請聯絡閣下的宏利保險顧問：

UWD.MIL.BDMH.V2-2.1.1110

About Manulife (International) limited 宏利人壽保險(國際)有限公司概覽

Edition: October 2011 Edition: October 2011

o One Year o Items 1-11 o Items 1,3 & 5 o Cancer & Heart Disease Medical Expenses Extension 一年 第一至第十一項 第一、三及五項 癌症及心臟病治療費用自選保障

o Two Years o Items l & 5 兩年 第一及第五項

Underwritten by 承保機構

QBe HonGKonG & sHAnGHAI InsurAnce lTD.昆士蘭聯保保險有限公司

A member of the worldwide QBE Insurance Group 澳洲昆士蘭保險集團成員

opTIonAl cover 自選保障

cancer and Heart Disease Medical expenses extension「癌症及心臟病」治療費用

With an additional premium, the benefits under Clinical and Surgical & Hospitalisation Expenses are extended to cover “Cancer and Heart Disease”.Also, you will enjoy an automatic benefit upgrade in surgical and Hospitalisation expenses. • Higher benefits up to HK$100,000 in aggregate• New lab test expenses at any licensed centre up to HK$5,000Remarks: This optional cover applies to Domestic Helpers who are in good health

conditions and have never been diagnosed or treated for heart disease or cancer at the time of applying.

閣下只需支付額外保費，保障範圍中的診療費用、外科手術及住院費用將伸延至「癌症及心臟病」治療。

同時，外科手術及住院費用將自動升級。• 全年賠償額高達100,000港元• 新增持牌化驗中心化驗費用高達5,000港元備註：本保障適用於身體狀況良好，並在投保時從未就「癌症或心臟病」接受診斷

治療之家傭。

投保人（僱主）簽署

Signature of Proposer (Employer)

AGENT CODE 代理人編號

eXclusIons 不保事項

General exclusions Applicable to All sections適用於所有保障項目

War and allied perils, terrorism (except Employer’s Liability), asbestos, nuclear fission or fusion and radioactive contamination, suicide, pregnancy or childbirth, intoxication by alcohol, narcotics or drugs not prescribed by a registered medical practitioner, pre-existing conditions, acquired immune deficiency syndrome (AIDS) or AIDS related complex (ARC), violation of the law or resisting arrest.戰爭及有關風險、恐佈主義活動(除僱主責任外)、石棉、核能分裂聚合或輻射引致之死亡或損失、自殺、懷孕或生育、酗酒、或服用非經註冊醫生處方指定之麻醉品或藥物，愛滋病或其相關的病徵及在保險生效前已存在的傷病及其他身體狀況，違法或拒捕。

SpecificExclusionsApplicableto個別保障項目之特定不保事項

1. employer’s liability: Pneumoconiosis, Mesothelioma, nuclear energy and radiation, any late payment surcharge that the Insured may become liable under the legislation.

2. clinical expenses, surgical and Hospitalisation expenses, and loss of services cash Allowances: Nervous or mental disease, venereal disease, congenital anomalies or deformities, infertility, sterilisation, contracep-tion, heart disease, cancer, rest cure, physical check-ups and cosmetic or plastic surgery unless to correct an injury covered under the policy.

3. Dental expenses: Routine examination, scaling, polishing, cleaning, crowning, bridges, braces and dentures.

4.PersonalAccidentBenefits: Driving or riding in any kind of race, un-derwater activities involving the use of breathing apparatus.

5. repatriation expenses: Any repatriation or transportation of mortal remains originating outside Hong Kong.

6. Domestic Helper’s liability: Employer’s liability; property held in care, custody or control; fines, penalties, punitive damages; libel or slander etc.

Declaration and Signature 聲明及簽署I / WE DECLARE THAT 本人/ 吾等謹此作下列聲明：1. All answers and statements made in the proposal are accurate in every respect and no information has been

withheld which is likely to affect acceptance of this proposal. 本投保書內所有答題及述詞均為全部真實及正確，並無隱瞞而可能影響有關接納投保與否之決定。

2. Any question not answered shall be taken in the negative. 所有不作答的問題均視為否定回答。

3. This proposal and declaration shall be the basis of the policy and considered as being incorporated therein. 本投保書及聲明將為保單之根本依據，並視作保單之一部份。

4. I / We shall accept a policy subject to the usual conditions prescribed by the Company therein. 本人 / 吾等接受註有通敘條款之承保公司保單。

5. I / We understand that any claim for Accidental Death benefit under Section 5 of the Policy shall be payable to the Domestic Helper’s legal representative.

本人 / 吾等明白根據條款第五項作出之意外死亡賠償，將給與被保人之合法代表人。

6. I / We have never had my/our domestic helper insurance declined, cancelled or refused to renew by any insurance company. 本人 / 吾等之家傭保險從未有被保險公司拒絕投保，取消或拒絕續保。

(本投保書及章程中文內容力求符合英文原義，惟有關條文解釋及引用，則以英文為準。)

1.僱主責任：肺積塵病、間皮瘤、核能放射，或法例下僱主因不依期作工傷賠償而須付之罰款。

2.診療費用、外科手術及住院費用，及中斷服務現金津貼：精神病、性病、先天性異常或畸形、不育、絕育、避孕、心臟病、癌病、療養、體格檢查、美容或整形手術(但由本保單範圍內損傷引致之矯形手術除外)。

3.牙科費用：口腔檢查、洗牙、磨牙、鑲裝牙冠、牙橋、牙箍及假牙等。

4. 個人意外受傷賠償：任何形式之騎策、駕車比賽及用供氧設備輔助呼吸之水中活動。

5. 運送費用：遺體從香港以外地區運返原居地及因任何在香港以外地區發生之事故而引致受保人或其遺體之遣返或運送返回原居地。

6. 家傭個人責任：僱主責任；受看顧、掌管之財物；罰款、違約金、懲罰性賠償；誹謗責任。

AGELIMIT:18-60年齡限制：18-60

WAITInG perIoD 等候期A 10-day waiting period from the effective date of the policy shall be applicable under Sections 2, 3, 4 and 6. No benefits shall be payable under these sections in respect of any event occurring during the waiting period.任何有關第2, 3, 4及6項所支付的費用於保單生效後10天內將不受保障。

preMIuM TABle (HK$) 保費表(港元) optional cover – cancer and Heart plan Disease Medical 1 year 2 years 計劃 expenses extension 一年 兩年 自選保障 – 癌症及心臟病治療 費用附加保障

Yes 1,050 786* 1,890 1,415*A)Items 1-11 選擇

第1至11項 No 800 680* 1,440 1,224*

不選擇

Yes# 820 695 1,476 1,251B) Items 1, 3 & 5 選擇#

第1、3及5項 No 不選擇

570 1,026

C) Items 1 & 5 450 810

第1及5項Minimum premium per policy: HK$450每保單最低保費：450港元

Remarks: This brochure is only a summary. Please refer to the Policy for full terms and conditions.注意： 此小冊子只供作參考之用，所有條款及細則概以保險單為準。

Remarks: * 15% premium discount for Plan (A) is included. # For Plan (B), Optional Cover applicable on Surgical & Hospital Expenses only.備註： *計劃(A) 已包括保費85折優惠。 # 計劃 (B) 自選保障之範圍只適用於外科手術及住院費用。

Manulife Domestic Helper Insurance proposal form 宏利家傭全險投保書Please complete in BLOCK LETTERS 請以英文正楷填寫1. Name of Proposer (Employer) 投保人姓名(僱主) Occupation Mr / Mdm 先生/ 女士 職業

Postal Address 通訊地址 Passport / HKID No. 護照/香港身份証號碼

Domestic Helper’s Employment Address 家傭受僱地址 Date of Birth (D / M / Y) 出生日期(日/月/年)

Home Tel. No. 住宅電話 Office Tel. No. 公司電話

E-mail Address 電郵地址 Fax No. 傳真號碼

2. Name of Employment Agency (if applicable) Tel No. 電話 僱傭代理公司名稱(如適用)

3. Name of Domestic Helper Nationality Sex Date of Birth (D / M / Y) Passport No. 家傭姓名 國籍 性別 出生日期(日/ 月/ 年)// 護照號碼

4. Annual Wages (HK$) 每年工資(港元)(Minimum allowable wages applies if blank 如不填寫則按現行規定最低工資為準） 5. Contract Period 受僱期限 From 由// To 至// (D / M / Y) (日/ 月/ 年) (D / M / Y)(日/ 月/ 年)6. Effective Date of Insurance 起保日期 Please Tick 請以(4)選擇 From 由// To 至// (D / M / Y)(日/ 月/ 年) (D / M / Y)(日/ 月/ 年)

7. Are you aware of any condition for which your Domestic Helper may require medical or surgical treatment? 你是否知道上述家傭可能因某種病症而需要接受治療或手術？ o Yes 是 o No 否 If “Yes”, please give details如「是」，請詳述：

personal Information collection statement 收集個人資料聲明The information you provide to us is collected to enable us to carry on insurance business and may be used for the purpose of any insurance or financial related product or service or any alterations, variations, cancellation or renewal of such product or service; any claim or investigation or analysis of such claim; and exercising any right of subrogation. The said information may be transferred to 1. any related company or any other company carrying on insurance or reinsurance related business or an intermediary or a claims or investigation

or other service provider providing services relevant to insurance business for any of the above or related purposes, 2. Manulife (International) Limited, its associated/related companies/or its intermediaries for their promotion of products and services,3. any association, federation or similar organization of insurance companies (“Federation”) that exists or is formed from time to time for any of

the above or related purposes or to enable the Federation to carry out its regulatory functions or such other functions that may be assigned to the Federation from time to time and are reasonably required in the interest of the insurance industry or any member(s) of the Federation, and

4. any members of the “Federation” by the “Federation” for any of the above or related purposes.Moreover, QBE Hongkong & Shanghai Insurance Ltd. is hereby authorized to obtain access to and/or to verify any of your data with the information collected by the Federation from the insurance industry. You have the right to obtain access to and to request correction of any personal information concerning yourself held by QBE Hongkong & Shanghai Insurance Ltd. Requests for such access can be made to the General Administration Officer of QBE Hongkong & Shanghai Insurance Ltd. through our hotline at 2877 8488 or Fax No. 3607 0300.閣下提供的資料，為本公司提供保險業務所需，並可能使用於下列目的。任何與保險或財務有關的產品或服務，或該等產品或服務的任何更改、變更、取消、或續期;任何索償，或該等索償的調查或分析;行使任何代位權。以上資料，可移轉予1. 任何有關的公司，或任何其他從事與保險或再保險業務有關的公司、或與保險業務有關的中介人或索償或調查或其他服務提供者，以達到任何上述或有關目的;2. 宏利人壽保險（國際）有限公司，其聯營/有關公司/或其中介人進行宣傳/推廣產品及服務，3. 現存或不時成立的任何保險公司協會或聯會或類同組織(「聯會」)，以達到任何上述或有關目的，或以便「聯會」執行其監管職能，或其他基於保險業或任何

「聯會」會員的利益而不時在合理要求下賦予「聯會」的職能，及4. 或透過「聯會」移轉予任何「聯會」的會員，以達到任何上述或有關目的。此外，在此授權昆士蘭聯保保險有限公司由「聯會」從保險業內收集的資料中查閱及/或核對閣下任何資料。閣下有權查閱及要求更正由昆士蘭聯保保險有限公司持有有關閣下的個人資料，如有需要，可向昆士蘭聯保保險有限公司行政事務主任提出。（電話: 2877 8488或傳真: 3607 0300）

pAYMenT opTIon 付款方法 o Please debit the premium from my credit card account 請由本人之信用卡戶口扣取保費 Credit Card Cardholder’s Name Credit Card No. 信用卡 信用卡持有人姓名 信用卡號碼

o VISA o MasterCard Expiry Date 有效日期至 // Cardholder’s Signature 簽署

o CHEQUE 支票 Cheque No. 支票號碼： Bank 付款銀行： Cheque should be made payable to “QBE Hongkong & Shanghai Insurance Ltd.” 支票抬頭人請寫「昆士蘭聯保保險有限公司」

If paying by credit card, please fax the completed form to 3607 0519. 如使用信用卡支付保費，請將填妥的投保書傳真至3607 0519。

Amount 金額：

POLICY NO. 保單號碼

Date日期

Manulife (International) Limited is a member of the Manulife Financial group of companies. Manulife Financial is a leading Canadian-based financial services group operating in 22 countries and territories worldwide. For more than 120 years, clients have looked to Manulife for strong, reliable, trustworthy and forward-thinking solutions for their most significant financial decisions. Our international network of employees, agents and distribution partners offers financial-protection and wealth-management products and services to millions of clients. We provide asset-management services to institutional customers worldwide as well as reinsurance solutions, specialising in life and property and casualty retrocession. Funds under management by Manulife Financial and its subsidiaries were Cdn$475 billion (HK$3713.8 billion) as at December 31, 2010. The company operates as Manulife Financial in Canada and Asia and primarily as John Hancock in the United States. Manulife Financial Corporation trades as “MFC” on the TSX, NYSE and PSE, and under “945” on the SEHK. Manulife Financial can be found on the Internet at www.manulife.com.

宏利人壽保險(國際)有限公司乃宏利金融集團屬下的成員公司。

宏利金融為加拿大的主要金融服務機構，業務遍及全球二十二個國家及地區。

過去逾一百二十多年來，宏利金融就客戶的重大理財決策提供穩健可靠、深

受信賴而且達遠前瞻的理財方案。透過其環球僱員、保險代理及銷售夥伴網

絡，宏利金融為數以百萬計客戶提供財務保障及財富管理產品和服務，並為

各地的機構客戶提供資產管理服務。宏利金融亦提供各種再保險方案，並以

人壽、財產及意外保險的轉再保業務為主。截至二零一零年十二月三十一日

止，宏利金融及其附屬公司的管理資產規模達四千七百五十億加元(約三萬

七千一百三十八億港元)。宏利業務遍及加拿大、亞洲及美國(主要通過恆康)。

宏利金融有限公司在多倫多、紐約及菲律賓證券交易所的股份代號為MFC，在

香港聯交所的股份代號為945，其網址為www.manulife.com。

For enquiries, please contact your Manulife Insurance Advisor:如有疑問，請聯絡閣下的宏利保險顧問：

UWD.MIL.BDMH.V2-2.1.1110

About Manulife (International) limited 宏利人壽保險(國際)有限公司概覽

Edition: October 2011 Edition: October 2011

o One Year o Items 1-11 o Items 1,3 & 5 o Cancer & Heart Disease Medical Expenses Extension 一年 第一至第十一項 第一、三及五項 癌症及心臟病治療費用自選保障

o Two Years o Items l & 5 兩年 第一及第五項

Underwritten by 承保機構

QBe HonGKonG & sHAnGHAI InsurAnce lTD.昆士蘭聯保保險有限公司

A member of the worldwide QBE Insurance Group 澳洲昆士蘭保險集團成員

opTIonAl cover 自選保障

cancer and Heart Disease Medical expenses extension「癌症及心臟病」治療費用

With an additional premium, the benefits under Clinical and Surgical & Hospitalisation Expenses are extended to cover “Cancer and Heart Disease”.Also, you will enjoy an automatic benefit upgrade in surgical and Hospitalisation expenses. • Higher benefits up to HK$100,000 in aggregate• New lab test expenses at any licensed centre up to HK$5,000Remarks: This optional cover applies to Domestic Helpers who are in good health

conditions and have never been diagnosed or treated for heart disease or cancer at the time of applying.

閣下只需支付額外保費，保障範圍中的診療費用、外科手術及住院費用將伸延至「癌症及心臟病」治療。

同時，外科手術及住院費用將自動升級。• 全年賠償額高達100,000港元• 新增持牌化驗中心化驗費用高達5,000港元備註：本保障適用於身體狀況良好，並在投保時從未就「癌症或心臟病」接受診斷

治療之家傭。