BEA Visa Signature Card Travel Insurance
中文
Important Note
The Travel Insurance is only applicable to holders of BEA Visa Signature Card.
Before you enrol, please check your entitlement to a free travel insurance plan via Cyberbanking. The travel insurance premium (if applicable)
will be charged to your designated BEA Credit Card
. Please visit
www.hkbea.com
for premium details. (Credit Card > Choose Your Card > Visa Signature Card)
Apply
Confirm
Complete
Cardholder/Insured Person's Details
Important Notice:
If a cardholder enrols in the travel insurance plan using an ineligible BEA credit card, BEA will charge the applicable premium to the cardholder’s credit card account without prior notice.
Designated BEA Credit Card No.:
4384 37** ****
(Please select appropriate first 6 digits of credit card number and enter the last 4 digits of credit card number)
Card Expiry Date (mm/yyyy):
1
2
3
4
5
6
7
8
9
10
11
12
/
Please input Card Expiry Date
Please input valid Card Expiry Date
Cardholder Name:
Please input Cardholder Name in English
Invalid Input(tailing space is not necessary)
(Please enter the cardholder name embossed on the credit card)
HKID Card No.:
(
)
or Passport No.:
Age
(at travel commencement date):
18
19
20
21
22
23
24
25
26
27
28
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30
31
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98
99
Please select age
Travel Period (dd/mm/yyyy):
From
To
(Enrolment must be made no more than 30 days prior to the start of travel)
Plan (Family / Individual):
Individual
Family
Please select a plan
Mobile Phone No.:
(For receiving SMS confirmation)
Email Address:
(For receiving email confirmation)
Declaration
I have already read and understood the
Policy Schedule of Benefits and its Terms and Conditions
and the privilege terms and conditions (
BEA Visa Signature Card
) and agree to be bound by the same.
And I, hereby also declare and agree that:
The information and particulars provided on this enrolment are accurate, true and complete and are given to the best of my knowledge and belief. I have not withheld any material information and I hereby acknowledge that failure to supply true and accurate answers to this enrolment or inform the Company of all material information about my enrolment may render Blue Cross (Asia-Pacific) Insurance Limited (the “Company”) unable to accept or process this enrolment or the insurance coverage void.
No insured person is traveling contrary to the advice of a medical practitioner or for the purpose of obtaining medical treatment and that insured person(s) understand(s) that treatment of any pre-existing, congenital or hereditary medical conditions are not covered. I further declare that insured person(s) is(are) not aware of any condition, cause or circumstances that may necessitate the cancellation or curtailment of the journey as planned.
I have obtained the authorisation from the insured person(s) to provide the information requested on this enrolment and to deal with and receive or request information concerning the insured person(s) from the Company in relation to any matters arising from this enrolment and/or the insurance coverage provided pursuant to this enrolment. I further acknowledge that the insured person(s) has(have) been explicitly informed and agree(s) that his/her(their) personal data will be transferred to the Company for the purpose of this enrolment and has(have) been informed of his/her(their) rights under the Personal Data (Privacy) Ordinance.
I confirm having read and understood the Company’s
Personal Information Collection Statement
as accompanied with this form.
I further understand that my consent will be separately obtained if the Company intends to use my personal data for direct marketing
.
The applicant is the holder of a valid Hong Kong Identity Card.
The applicant is physically present in Hong Kong as at the date of this application.
All insurance product information available on this website is not and shall not be construed as an offer to sell or a provision of insurance products to any person in any jurisdiction outside Hong Kong or a solicitation to such person to buy insurance products.
Blue Cross (Asia-Pacific) Insurance Limited is a subsidiary of The Bank of East Asia, Limited and a member of the BEA Group. It is not affiliated with or related in any way to Blue Cross and Blue Shield Association or any of its affiliates or licensees.
© Copyright. Blue Cross (Asia-Pacific) Insurance Limited 2011. All rights reserved.