1、 平安团体人身险（帐户型）被保险人清单（一式两联，第一联公司留存）The insured list for Ping An Group Insurance (Account Management) (In duplicate, the first retained by the insurer)投保单位： 单证条形码号： 本页人数： 人； 共 页 第 页Insured group: Barcode: Number of insured of this page: ; pages in total Page 序号No.申请类型Type of Application被保险人姓名Name of In
2、sured证件类型Type of Document证件号码ID. No.性别Gender生日Date of Birth层级Rank险种:Insurance type:险种:Insurance type:保费合计Sum of Premium投资选择（）Investment options (%)A服务年数计算起始日Date of service year beginning职业及职业代码Profession and the code申请日期Date of application其他Others单位缴费Corporate contribution单位代缴Corporate pay for othe
3、rs个人缴费Individual contribution单位缴费Corporate contribution单位代缴Corporate pay for others个人缴费Individual contributionM1M2M3制表人Tabulation People： 制表日期Tabulation date： 年Year 月Month 日 Date 投保单位盖章Application Sealed:以下为保险公司填写The following will be completed by the company:业务员姓名Agent： 业务员代码Agent Code： 核保人Underwri
4、ter：说明：1、投资选择栏中M1代表稳健投资帐户；M2代表平衡投资帐户；M3代表进取投资帐户。Description：1、“M1”in “Investment options” means steady investment account;”M2”means balanced investment account;”M3”means aggressive investment account.2、A表示被保险人所属的归属比例职级。“A” means the rank of the belonged ratioof the Insured.3、归属比例计算起始日，如缺省，默认为保单生效日。If “the beginning date of belonged ratio” is blank, the default will be the effective date of the policy.4、申请类型为空则默认为契约，否则请填写详细保全申请项目。If “Type of Application” is blank, the default is contract, otherwise please fill out the details of the policy adjustment.备注：对中、英文文义的理解存在分歧的，以中文为准。
