本人/我們 提供或填報之資料,是據自己所知所信, 真實正確的。I/We hereby declare that the information submitted is true and correct according to my/our best knowledge.
本人/我們 同意及明白,如所提供或填報資料不正確,可能影響保單內之權益。I/We understand and agree that untrue information provided to insurer may affect my/our rights under the policy.