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Signature of Proposer Company Chop Date / / dd/mm/yyyy FOR OFFICE USE ONLY PC IT CC AT DI AC M S O R SC REMARK P. If any of them has been altered PARTICULARS OF INSURED Company Name B. R. No. Individual Name Sex HKID Card No. Correspondence Address E-mail Address Contact Tel. No. Fax No. INSURANCE COVER Business Particulars of work Location / / Period of Insurance dd/mm/yyyy Limit of Indemnity From To For Months Both dates inclusive HKD for Any One Accident for Any One Period...

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