团体保险被保险人健康告知书Health Statement for Group Insurance Insurants被保险人资料：Information of Insurant:投保人名称/ Company：被保险人姓名/ Name：证件类型/ Certificate Type□ID □Passport □Other证件号码/ Certificate No
健康告知：Health Statement:1、被保险人身高 cm，体重 kg，过去两年内体重是否增减超过 5 公斤
Height cm, Weight kg; during the last two years, have you gained/lost weight for over 5 kg
□是 Yes □否 No2、过去 2 年内是否曾因接受健康检查有异常情形而被建议接受其他检查或治疗
During the last two years, have you ever been suggested to receive other kinds of physical examinations or treatments owing to some abnormal findings detected during your routine health examination
□是 Yes □否 No3、最近六个月是否曾因受伤或生病接受药物治疗、外科手术或服用药物
During the most recent 6 months, have you ever taken pharmaceutical treatment, surgical operation or medicines owing to the cause of injury or sickness
□是 Yes □否 No4、目前身体是否有
