Get Application Form ???? - The Chinese University Of Hong Kong - Cuhk Edu

Filling out the Application Form for the Medical Insurance Plan for Retirees is an essential process for securing health coverage. This guide provides comprehensive, step-by-step instructions to help you accurately complete the form online.

Follow the steps to successfully complete your application form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter your personal information in the 'Applicant' section. This includes your surname, staff number, and eligibility start date.
3. Complete the 'Applicant’s Information' section. Fill in your HKID number, date of birth, marital status, country of residence, and occupation. Ensure that the details are accurate.
4. Provide your contact details by filling in your email address and contact telephone number, as well as your HKD bank account details.
5. In the 'Choice of Coverage' section, select your preferred deductible option by checking the appropriate box.
6. Prepare a cheque for the premium payment, made payable to 'Liberty International Insurance Limited.' Ensure to attach this cheque with your application.
7. Complete the 'Health Statement' section. Answer all questions truthfully regarding your and your spouse's medical history within the past three years.
8. In case of any 'Yes' responses in the Health Statement, provide the required details regarding medical history.
9. Fill in the name and contact information for your attending family physician.
10. Read and acknowledge the Personal Data Collection Statement before proceeding.
11. Provide your declaration and authorization, indicating your understanding and consent by signing the form.
12. Finally, save your changes, then download, print, or share the completed application form as needed.

Complete your application form online today to ensure your medical coverage without delay.