门诊理赔Medical treatment for outpatient and emergency

Please mail all the following document to the Beijing Ping An Endowment Insurance Co., Ltd

A护照及签证复印件Copy of passport and visa page of the Insured

B国税发票及费用清单，发票姓名与护照完全一致Original of receipt（Your name on receipt should be the same with your passport）and detailed expenditure sheet

C病例（与发票日期一致）、诊断证明、化验单、检查报告复印件等Medical record（same date with receipt）, and copy of examination report and laboratory test report of each respective treatment

D理赔申请Claim application form from International Students‘ Office（RM302）

E意外伤害证明/交警事故认定书Certificate of accident with signature/CIS’s stamp（when/where /how,ect.）in case of an accident， (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)

F银行开户信息单Your bank account information sheet with your signature

大病垫付及理赔Major accident injuries or inpatient service

Adirectly 4008105119 for medical consultation due to disease or accident and apply for advanced payment of medical expense .

Be-mail or fax the scan of your passport and visa page to cyry@lhgj.net (fax:010-58766773)

Ce-mai or fax power of attorney of payment (get from CIS) to cyry@lhgj.net(fax:010-58766773)

Document to be presented for settlement of claims

A护照及签证复印件Copy of passport and visa page of the Insured

B意外伤害证明/交警事故认定书Certificate of accident（when/where /how,ect.）with signature/CIS’s stamp in case of an accident， (in case of traffic accident, the traffic unit should issue a liability confirmation of traffic accident)

C国税发票及费用清单，发票姓名与护照完全一致Original of receipt （Your name on receipt should be the same with your passport）and detailed expenditure sheet for hospitalization

D病例、诊断证明、化验单、检查报告复印件等Medical record, copy of examination report and laboratory test report of each respective treatment

E出院小结复印件Copy of hospital discharge summary or medical record of hospitalization

F理赔申请Claim application form from International Students‘ Office（RM302）

G残疾证明Disability certificate when the Insured is disabled (an evaluation report shall be issued by the assigned evaluation body)

H银行开户信息单The beneficiaries‘ bank account information sheet with signature/ school-assigned bank account with school stamp（RM302）

I受益人与被保险人关系证明Certificate of relationship between the Insured and all the beneficiaries, and copy of identification proof of the beneficiaries

( Specific content please dial 4008105119 transfer 1 )

Please mail the above document to the following address!

Materials for claims of settlement sent to:北京市朝阳区东三环中路55号富力双子座B座303室（邮编100022）

Addressee:来华项目理赔部

Tel:010-59104919，4008105119 转 1

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Chinese explanation prevails in case of contradiction arising out of the aforementioned contents.