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Application Forms |
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General Insurance |
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Travelsure Protection Plan |
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Home Care Plus Plan |
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Domestic Helper Insurance Plan |
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Part-time Domestic Helper Insurance Plan |
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Personal Accident Insurance Plan |
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Personal Accident Insurance Plan (Upgraded) |
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Hospital Cash Plan |
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Relevant Forms for New Application |
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Life insurance |
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Medical Report Authorization Form (Form No. IL88) |
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Customer Protection Declaration Form (Form No. IL78) |
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Declaration – Family Member or Cohabiting Partner as Beneficiary (Form No. IL512) |
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Declaration – Non-cohabiting Partner as Beneficiary (Form No. IL513) |
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Claim Forms |
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Life insurance |
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Claimant’s Statement for Death Claim (Form No:IL27a) |
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Death Claim Form – Attending Physician’s report (Form No:IL27b) |
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Total & Permanent Disability/Disability/Accidental Dismemberment Claim Form (Form No:IL28a) |
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Major Illness/Critical Illness/Terminal Illness/Cancer/Lady Protection Claim Form (Form No: IL29a) |
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Attending Physician's Report - Cancer (Form No:IL29b6) |
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Attending Physician's Report - Stroke (Form No:IL29b27) |
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Attending Physician's Report - Terminal Illness (Form No:IL29b29) |
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Hospitalization, surgery and Bone-setting claim form (Form No:IL215) |
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Refundable Accident Protection Life Insurance Plan (Form No:IL371) |
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Cancerguard Refundable / Refundable Cancer Protection Life Insurance Plan Claim Form - Attending Physician’s report (Carcinoma-In-Situ Benefit) (Form No: IL322b+IL322c2) |
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General Insurance |
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Travelsure Claim Portal (claims.qbe.com/hk/travel) |
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Domestic Helper Insurance Claim Portal (claims.qbe.com/hk/helper) |
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Third Party Liability Accident Report (Form No. HSI78) |
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Employees' Compensation Insurance Notice of Accident (Form No. HSI79) |
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Hospital Cash Plan Claim Form (Form No. HSI80) |
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Personal Accident Insurance Claim Form (Form No. HSI81) |
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Burglary/Theft/Robbery Loss Claim Form (Form No. HSI82) |
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Report of Motor Car Accident (Form No. HSI84) |
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Credit Card Purchase Protection Plan Claim Form (Form No. HSI85) |
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Fire / Home Care Insurance Claim Form (Form no. HSI212) |
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Medical insurance - Individual health insurance scheme |
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Hospital Claim Form |
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Clinical Claim Form |
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Medical insurance - Group health insurance scheme |
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Hospital Claim Form (for employees) |
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Clinical Claim Form (for employees) |
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Policy Change Forms |
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Life insurance |
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Request for Policy Change - Non-Financial (Form No. IL11) |
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Request for Policy Change – Non-Financial (Only applicable to RewardYou Life Insurance Plan, SavourLife Annuity Life Insurance Plan, SavourLife II Annuity Life Insurance Plan, Treasure Life II Insurance Plan, Splendid Universal Life Insurance Plan, PreciousWay Education Life Insurance Plan, FutureEnrich Life Insurance Plan, EmbraceLife Insurance Plan , MaxiAnnuity Life Insurance Plan and PrimeLife Deferred Annuity Life Insurance Plan) (Form No. IL11a) |
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Request for Policy Change - Non-Financial (Only applicable to 10-Year Renewable Term Plan (Online Simplified Application Version), Refundable Hospital Cash Life Insurance Plan, CancerGuard Refundable Insurance Plan, Refundable Accident Protection Life Insurance Plan, SurgicalGuard Refundable Life Insurance Plan, SurgicalGuard II Refundable Life Insurance Plan, Refundable Critical Illness Life Insurance Plan, PreciousLife Critical Illness Life Insurance Plan, eCancerPro Insurance Plan, eFamilyPro Life Insurance Plan), ImperialDragon (RMB) Life Insurance Plan and The Choice 5-Year Life Insurance Plan) (Form No. IL11b) |
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Request for Policy Change - Financial related items (Form No. IL12) |
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Request for Policy Change – Financial Related Items (Only applicable to RewardYou Life Insurance Plan, SavourLife Annuity Life Insurance Plan, SavourLife II Annuity Life Insurance Plan, SavourLife II (RMB) Annuity Life Insurance Plan, MaxiAnnuity Life Insurance Plan and PrimeLife Deferred Annuity Life Insurance Plan) (Form No. IL12a) |
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Assignment of Policy as Collateral Security (Form No. IL09) |
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Transfer of Policy Ownership (Form No. IL10) |
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General Insurance |
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Application for Changing the Sum Insured Option of Mortgage Fire Insurance Plan (Form No. F286) |
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Policy Amendment Application Form (Form No. HSI30) |
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Medical insurance - Individual health insurance scheme |
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Registration Variation Form |
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Change of Payment Method and Account Number Form |
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Termination Form |
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Medical insurance - Group health insurance scheme |
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Request for Information Changes Form (for employers) |
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Reinstatement Forms |
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Life insurance |
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Life Insurance Reinstatement Form (Applicable to Full Underwriting Version) (Form No. IL344) |
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Life Insurance Reinstatement Form (Applicable to Simplified /Preferential Underwriting Version) (Form No. IL345) |
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Life Insurance Reinstatement Form (Applicable to Guaranteed Acceptance Version) (Form No. IL354) |
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Life Insurance Reinstatement Form (Applicable to Full Underwriting Version of Critical Illness Life Insurance Plan) (Form No. IL382) |
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Life Insurance Reinstatement Form (Applicable to Simplified/Full Underwriting Version of PreciousLife Critical Illness Life Insurance Plan and Splendid Universal Life Insurance Plan — Critical Illness Benefit attached) (Form No. IL421) |
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Medical insurance - Individual health insurance scheme |
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Reinstatement Application Form |
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Others |
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Life insurance |
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Application for Policy Loan, Withdrawal of Accumulated Policy Dividends/Cash Endowment/Educational Payment & Fund/Guaranteed Cash Bonus/Annuity Income/Monthly Income/Guaranteed Lump Sum Payment/Guaranteed Retirement Payment/Guaranteed Additional Bonus/Investment-Linked Fund Withdrawal (Form No. IL06) |
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Invest-Select Life Insurance Plan - Application for Statement/Suspension or Re-activation of Regular Premium/Change of Regular Premium/Change of Premium Allocation/Transfer of Funds (Investment-Linked Funds)/Fund Withdrawal (Form No. IL212) |
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FlexiSure Investment Life Plan - Application for Statement / Suspension or Re-activation of Regular Premium / Change of Regular Premium / Change of Premium Allocation / Transfer of Funds (Investment-Linked Funds) / Fund Withdrawal (Form No. IL468) |
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Lost Policy Declaration (Form No. IL07) |
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Direct Debit Authorisation (Form No. IL03) |
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Personal Information Collection Statement (Form No. IL108) |
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Explanation of a U.S. Address (Form no. IL430 - for Life Insurance only) |
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General insurance |
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Personal Information Collection Statement |
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Medical insurance - Individual health insurance scheme |
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Supplementary Health Declaration Form |
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Credit Card Authorisation Form |
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Direct Debit Authorisation Form |
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Cash Dollars Redemption Form |
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Declaration of Loss Card |
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Medical insurance - Group health insurance scheme |
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Declaration of Loss Card (for employees) |
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