외국인을 위한 보험 서비스 - 개인 보험

개인 보험

여행자 보험

1. Prior Consent to Make Medical Expense Coverage

   If the insured has double insurance policies to cover the same medical expense as this contract, the Company shall pay the medical expense in proportion to the indemnity limit of each policy against the aggregate indemnity limit of multiple policies. Do you understand that medical claims shall be proportionally indemnified in case that you already have other TA policies which cover the same medical expense?

   Term of Insurance	From___day____month 20____year, at________To ___day____month 20____year, at_______, ( )days ( )months
   Trip Destination		Trip Purpose		Entry Plan/Premium
   The Insured	Name			Resident Reg.No.
   	Nationality		e-Mail		Telephone (home)
   	Address				Cell Phone
   The Policyholder The Same as the Insured	Name			Resident Reg.No.
   	Nationality		e-Mail		Telephone (home)
   	Relations with the insured				Cell Phone
   	Address				Cell Phone
   How to pay premium	Bank	Account No. (Card No.): Card Validity:
   	Account Holder's Resident Reg. No.		Relations with Policyholder		Account Holder	(Sig.)
   	I agree you will draw the appropriate travel premium from my(my Co.) accnt(or card). (*If the ac-holder is diffent from the policyholder, attach the ac-holder's sig. and a copy of his/her bankbook.)
   Beneficiary for a claim against death	Name		Resident Reg. No.		Relations with the insured:
   Additional Insured	Name		Resident Reg. No.		Nationality	Entry Plan

   • Are you yet to depart or staying in a foreign country?

   This insurance is for a Korean resident's traveling overseas, overseas business trip, or studying abroad. If anyone is go overseas to stay in a foreign country, he/she is not allowed to buy this insurance. If anyone wants to buy this insurance while staying overseas, his/her buying this insurance may be restricted.

   • Do you have a plan to make a trip to or via Cuba, Afganistan, Iraq, Iran, Syria, the People's Republic of Congo, Liberia, or Sudan?

   No compensation will be made against any loss incurred by making a trip to or via the said area whether directly or indirectly.

2. Duty of Declaration before Contract]

Followings for the insured person (insured) are materials necessary for the Compay to accept the application for contract, and therefore, you must write down only true fact. If you do not declare true facts or declare untrue facts, your application may be refused or coverage restricted or the contract cancelled.

Reply "Yes" or "No" to the following questions:	Insured 1( ) Insured3 ( )	Insured 2( ) Insured4 ( )
1. Within the recent 3 months, did you ever undergo the following medical acts thru a doctor's checkup or examination? 1) firm diagnosis of a disease 2) a doctor's doubtful findings 3) treatment 4) hospitalization 5) operation (incl. Caesarian section) 6) administration of medicine -A doctor's checkup or examination includes normal medical checkup and a doctor's doubtful findings means you ever received a medical examination or a letter of doctor's findings.	□ Yes □ No □ Yes □ No	□ Yes □ No □ Yes □ No
2. Within the recent 5 years, did you ever undergo the following medical acts thru a doctor's checkup or examination? 1) hospitalization 2) operation (incl. Caesarian section) 3) treatment for consecutive 7 days or longer 4) administration of medicine for consecutive 30 days. - "Consecutive" here means the No. of days you underwent the administration of medicine or treatment continuously from the start of treatment or administration of medicine to the completion of treatment or administration of medicine.	□ Yes □ No □ Yes □ No	□ Yes □ No □ Yes □ No
3. Within the recent 5 years, did you ever undergo the following 10 most important medical acts thru a doctor's checkup or examination? ① cancer <② leukemia ③high blood pressure ④angina ⑤myocardial infarction ⑥valvular disease of the heart ⑦hepatocirrhosis ⑧stroke (cerebral hemorrhage, cerebral infarction) ⑨diabetes ⑩infection of AIDS or HIV 1) firm diagnosis 2) treatment 3) hospitalization 4) operation 5) administration of medicine	□ Yes □ No □ Yes □ No	□ Yes □ No □ Yes □ No
4. Within the recent one year, are you enjoying the following hobbies often or repeatedly or do you have related license for such hobbies? 1) scuba diving 2) hang gliding, para gliding 3) sky diving 4) water skiing 5) car or motorcycle race 6) bunge jump 7) ice wall climbing or rock wall climbing 8) jet skiing 9) rafting	□ Yes □ No □ Yes □ No	□ Yes □ No □ Yes □ No
* If your reply to the question above is "Yes", please state the details correctly. Question No. ( ) The insured's name ( ) Details:

I, the policyholder or insured confirm that my answers to the questions above about the matters of "Duty of Declaration before contract" are all true and correct in every detail and I have put down the answers by myself in person. In this connection, your company may confirm them separately, and I agree that the Company will let a doctor refer to or read the matters of my disease and health if necessary at the organizations concerned.



If the insured did not affix his/her own handwriting signature on the application, the contract if concluded will be nullified and then he/she will not be covered. If the policyholder or insured is minor, please the legal representative affix his/her signature on the behalf of the policyholder or insured. Branch: Insurance Agent   Handler's Code: Handler (Seal) Contace

Date of Application : _____day____month, 20___   Policyholder _____________________(Sig.) Insured 1 _______________________(Sig.) Insured 2 _______________________(Sig.) Insured 3 _______________________(Sig.) Insured 4 _______________________(Sig.) Legal Representative (parental right holder) Relations:( ) _____________________(Sig.) Legal Representative (parental right holder) Relations:( ) _____________________(Sig.)

3. Consent on Sharing, Referring to/ Use of Personal Credit Information

In connection with this agreement, if you want to share the personal information you have acquired from me with a third part or third parties or refer to it at credit information gathering organizations, you have to get my consent pursuant to the provisions of Article 32 of Act on Sharing and Protection of Personal Credit Information. I hereby agree that you will share my personal credit information below for the the purpose of making and executing insurance agreements with others or with public organizations to use as policy materials, and that you will refer to my personal credit information at credit information gathering organizations like General Insurance Association, etc.

1. Details of Sharing/Referring to Personal Credit Information>
• Sharing with: Credit information gathering organizations such as General Insurance Assocition, etc.; credit information providers and users like non-life insurers, life insurers, mutual-aid business companies, etc. and Insurance Development Institute of Korea, those who are entrusted with works necessary to carry out agreements such as loss adjusting, etc.
• The insurance company may share only the least information of the personal credit information provided by me only for the purpose of performing the works in accordance with the details of laws and decrees such as Insurance Act, etc. by the organizations which are to share my information mentioned above.
• Period of Time during which you can retain and use the information: from the date of this agreement until during the period of time when the agreement is effective (including the case wherein the agreement is changed due to renewal of the agreement).
• The period of time of retaining and using the information mentioned above will not apply to those who share the personal credit information in accordance with laws and decrees.
• The Details of Personal Credit Information to Share and Refer to: Personal Idendification Information (the policyholder and insured's name in full, address, resident reg. No., gender, nationality, occupation, the point of contact, etc.); Insurance Agreement Information (Date of Agreement, Policy No., Term of Insurance, Type of Insurance, Insurance Product Name, Name of Insurance Company Concerned, Premium, Insured Amount, Whether or Not the Insurance Agreement is to Maintain, etc.); Claim Payment Information (Date of Claiming a claim, Date of Covered Accident, Date of Payment
2. Details of Referring to Personal Credit Information>
• Details of Personal Credit Ifnformation to Refer to: Insurance Agreement Information (Name of Insurance Company Concerned, Policy No.Term of Insurance,Date of Agreement, Product Name, Details of Cover, Insured Amount, Premium, and/or Whether or Not the Insurance Agreement is to Maintain); Information on Payment of Claim(Date of Covered Accident, Date of Claiming a claim, Date of Payment of Claim, Amount of Claim Paid, Cause of Payment of Claim (including information on the disease in the case of loss covered due to disease)
• Purpose of Referring to: To maintain and follow up this agreement, and investigate the appropriate accident.
• Effective Period of Time for Consent on Reffering to the Information: From the date of this agreement until during the period of time when the agreement is effective (incl. the case wherein the agreement is changed due to renewal of the agreement).
• Referring to personal credit information by this letter of consent has nothing to do with your credit rating. Any change of the details above will be informed to you by posting it on our company's website.
• If you want to get other additional service and/or information on new products, please give us your consent.
  Date: ______________Day_____________Month, 20___________
4. Matters You, the Policyholder Must Know
1. Information on Protection of Depositors
• This Agreement will be protected by Korea Deposit Insurance Corporation in accordance with the provisions of Act on Protection of Depositors. However, if the policyholder is a corporation which pays premiums, the agreement will not be protected.
• If the Company is not able to pay claims, etc. due to its bankruptcy after paying off its debts, Korea Deposit Insurance Corporation will guarantee the payment of max. 50 million won of surrender value (or claims at the time of maturity or claims against accident) plus other payments per one policyholder.
2. Information on Withdrawal of Application

Notes with regard to Insurance Agreement

Notes Related to Payment of Claim

If the agreement is nullified, invalid or cancelled, refund of premium shall be made as follows: If it is nullified, invalid or cancelled for any reason not attributable to the policyholder, insured or beneficiary: in the case of nullification: the total of premium paid; in the case of cancellation, an amount of unearned premium calculated by day for the term of insurance that has not passed shall be refunded. If it is nullified, invalid or cancelled for any reason attributable to the policyholder, insured or beneficiary: for the term of insurance that has passed, an amount of balance after the earned premium calculated at short-term rate (applying to the term of insurance of less than 1 year) is deducted shall be refunded. You (the policyholder) may cancel this Policy within one (1) month from the date of the application and within 3 months in the case of actual-loss medical expense coverage if the Company did not give you the duplicates of the clauses and application or not briefed you on the important part of the clauses or you did not affix your own handwriting signature on the application when this agreement is made. In this case, the premium paid plus a prescribed interest will be refunded. Our company's travel insurance products are unrenewable products, and if you want to continue to be insured after expiration of the original term of insurance, you will have to take the same procedure as a new insurance application. In this case, the Company may turn down your application within 30 days of your application (see Article 1-1, 1-2, and 1-3 of General Clauses). If your application is turned down, the premium received will be refunded to you. For more details, please see the clauses.

The Company shall not pay for any loss caused by one of the followings: The policyholder, insured or beneficiary's willful act. The insured’s disease, mental and physical disorder or metal disease, The insured's pregnancy, childbirth (including Caesarian section), abortion or other similar medical treatment, War, foreign country’s use of armed force, revolution, etc. or other similar disaster, The insured's congenital brain disease or urinary system disorder, Medical expense for supplement or preservation of teeth, golden crowning, dentures, and/or implants, Non-allowance medical expense incurred by dental treatment or oriental medical treatment, rectal or anal treatment, etc. which is not covered by the National Health Insurance), Professional mountain climbing, glider operation, sky-diving, scuba-diving, hang-gliding, or similar dangerous activities, or motorboat or car (motorcycle) race, demonstration, operation, test-driving, or while boat crews, fishermen, or ferrymen, or other persons who board the boat for their occupation are on board. For more details, please see the clauses.

5. Information on Withdrawal of Application
1. You may withdraw your application within 15 days of your application (provided that you cannot withdraw your application for an agreement of which term of insurance is less than one year).
2. You may fill out the application form below and submit it to the branch near you in person or send it by post mail.
3. The account holder of the bank account must be the same as the policyholder.