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TR-F01 · 在线填写 · 存为 PDFTR-F01 · Fill in online · Save as PDF

寿险投保信息表 · 成人

Life Insurance Intake · Adult

直接在这一页填，填完点「保存为 PDF」，把 PDF 交给你的代理人。 你填的内容只留在这台设备的浏览器里，网站不接收、不保存；关掉页面就没了，所以请填完一次存好。 填了社安号或银行账号的 PDF 请当面交给代理人或加密传送，不要直接发微信、短信或普通邮件。

Fill this page in, then press Save as PDF and give the PDF to your agent. What you type stays in this device's browser; the site neither receives nor stores it, and it is gone when you close the page, so finish and save in one go. If the PDF holds an SSN or bank details, hand it to your agent in person or send it encrypted, never by WeChat, text or plain email.

空白 PDF（打印手写）Blank PDF (to print)

点「保存为 PDF」会打开打印窗口：电脑把「目标打印机」选成「另存为 PDF」； iPhone / iPad 点右上角分享图标 → 存储到「文件」；安卓把打印机选成「保存为 PDF」。Save as PDF opens the print dialog. On a computer, set the destination to “Save as PDF”. On iPhone / iPad, tap the share icon at the top, then Save to Files. On Android, choose “Save as PDF” as the printer.

寿险投保信息表 · 成人Life Insurance Intake · AdultLife Insurance Intake · Adult
TEAM RISETR-F01
请注意Please note

本表只用于面谈时整理信息，不是保险公司的申请书，正式投保以保险公司当期的申请表 / 电子投保（eApp）为准。填了社安号、银行账号的 PDF 是敏感文件：请当面交给代理人或加密传送，不要通过微信、短信或普通邮件发送；递交后由代理人删除。This sheet only organises information for our meeting. It is not the carrier's application — the carrier's current form or eApp governs. A PDF with an SSN or bank details in it is sensitive: hand it to your agent in person or send it encrypted, never by WeChat, text or plain email. Your agent deletes it after submission.

本次申请This application

缴费方式Payment mode

被保人基本信息Proposed insured

性别Sex
婚姻状况Marital status

身份与居留Citizenship and residency

身份Status

联系方式Contact

工作与财务Employment and finances

保单持有人（与被保人不同时填写）Owner (only if different from the insured)

受益人Beneficiaries

第一顺位（Primary）全部过世后才轮到第二顺位（Contingent）。同一顺位的百分比合计必须是 100%。受益人若是信托，写信托全名、签立日期、受托人与税号。Contingent beneficiaries receive only if no primary beneficiary survives. Percentages within each class must total 100%. For a trust, give its full name, date, trustees and tax ID.

顺位Class英文全名Full legal name与被保人关系Relationship出生日期DOBSSN（可选）SSN (optional)比例%

现有保险与在审申请Existing coverage and pending applications

保险公司Company保单号Policy no.类型Type (Term/WL/IUL/Annuity)保额 / 账户价值Face / value生效日Issue date是否会被替换？To be replaced?

过去 12 个月是否申请过其他人寿或伤残保险，或有尚在审核中的申请？Any life or disability application in the last 12 months, or one still pending?
是否打算用现有保单或年金的钱来交这份新保单的保费？（是，则需要替换表格）Will money from an existing policy or annuity fund this one? (If yes, replacement forms apply)

自动扣款银行信息Bank details for premium draft

对着支票底部那一行数字填：路由号码 9 位，不能以 5 开头；账号在路由号码右边。Copy them from the line along the bottom of a cheque: the routing number is nine digits and cannot begin with 5; the account number sits to its right.

账户类型Account type

医疗信息Medical information

吸烟 / 尼古丁（过去 5 年）Tobacco / nicotine (5 yrs)
过去 10 年是否住院、看急诊，或被建议住院 / 手术？Hospitalised, seen in an ER, or advised to have surgery in the last 10 years?
是否被诊断过心脏病、高血压、高胆固醇、糖尿病、癌症、中风、肝肾疾病、睡眠呼吸暂停或精神 / 情绪方面的疾病？Ever diagnosed with heart disease, high blood pressure, high cholesterol, diabetes, cancer, stroke, liver or kidney disease, sleep apnoea, or a mental-health condition?
是否有约好但还没去的检查、复诊或转诊？Any scheduled test, follow-up or referral not yet completed?
过去 10 年是否使用过大麻或其他管制药物，或被建议减少饮酒？Any marijuana or controlled-substance use, or advice to cut down on alcohol, in the last 10 years?
过去 5 年是否有 DUI、吊销驾照或多次交通违规？Any DUI, suspended licence or repeated moving violations in the last 5 years?

家族病史Family history

重点是父母在 60 岁前是否有心脏病、中风、糖尿病或癌症（乳腺、结肠、肺、前列腺、黑色素瘤等）。What matters most: heart disease, stroke, diabetes or cancer (breast, colon, lung, prostate, melanoma…) in a parent before 60.

家人Relative健在？Living?现年龄 / 过世年龄Age now / at death过世原因Cause of death重大疾病与诊断年龄Major illness, age at diagnosis
父亲Father
母亲Mother

备注Notes

需要准备的证件Documents to have ready

需要准备的证件（勾选已备好的）Documents to have ready (tick what you have)

Team Rise · 面谈信息收集用，不是保险申请书 · TR-F01Team Rise · For fact-finding only — not an insurance application · TR-F01

空白 PDF（打印手写）Blank PDF (to print)

本表是 Team Rise 团队自制的面谈信息表，不是保险公司或计划服务商的申请书，填写不代表投保、承保或任何承诺。 正式申请以保险公司当期的申请表 / 电子投保与您的签名为准；税务与退休计划问题请咨询您的会计师或税务律师。

This is Team Rise's own fact-finding sheet, not an application to any carrier or plan provider; completing it does not apply for, bind or promise any coverage. The carrier's current application or eApp and your signature are what count; please take tax and retirement-plan questions to your CPA or tax attorney.