Pet Insurance Application Form

Pet Insurance Policy is underwritten by FWD General Insurance Company Limited. 寵物保險計劃由富衛保險有限公司承保。
(I) Details of Applicant 投保人資料
Title 稱謂: *
Our customer service team will contact you if insuring more than one pet. 如果你有多於一隻寵物需要投保,我們的客戶服務員會再聯絡你。

(II) Policy Particulars 投保詳情

(IIA) Information of the Pet 寵物資料

Insured pets can only be dogs or cats 投保寵物只適用於狗或貓

Microchip No. 晶片號碼 - Pets without microchip will not be accepted 沒有晶片之寵物將不獲接受: *
Coverage/Annual Premium (Excluding Insurance Levy) 保障/每年保費 (不包括保費徵費): *
Species (Dog or Cat only) 種類 (只限狗或貓): *
Sex 性別: *
Neuter 絕育: *

(III) General Information 其他資料

Has your pet received or required any treatment for an accident or illness in the last 90 days, except general checkup and preventive vaccinations? 過去90天內,您的寵物曾否因意外或患病接受或需要接受治療(一般檢查或預防性疫苗除外)? *
If “Yes”, is your pet currently under observation, treatment or medication? 如「是」,您的寵物現在是否接受觀察、治療或藥物治療? *
Has your pet ever taken any surgical operation other than desexualisation? 除閹割外,您的寵物曾否接受任何手術治療? *
Has your pet ever attacked or bitten any person or other animal, or does it have any aggressive or vicious tendency in the past 5 years? 過去5年內,您的寵物是否有暴力傾向,或曾攻擊、咬傷任何人或其他動物? *
Is your pet being used for or in connection with any trade or business? 您的寵物有否被用作商業用途? *
Does your pet suffer from any physical defects or ininfirmities? 您的寵物有否任何身體缺陷或殘疾? *


Opt-out marketing communications or materials and the Company’s intended use. 拒絕接收商業推廣訊息或資料及公司擬對本人個人資料的使用。 *