Mr.

Cheung Tak Kin

Pico International (HK) Ltd
c/o Ms Macqueena Fan
Lockton Companies (Hong Kong) Limited
16/F
Berkshire House Taikoo Place
25 Westlands Road
Quarry Bay Hong Kong
NELSONHINS
Department: NAH

Confidential 密件

Claim Statement 賠償單 Issue Date 發出日期 : 09 MAY 23

Contract No. 合約編號 : 01631700

The claim(s) shown below has been processed. Please refer to the Summary for the total claim reimbursement.
以下索償已完成處理。請參閱「 賠償摘要」了解可獲賠償的總金額。

Employee name 僱員姓名 : Cheung Tak Kin

Department 部門 : NAH

Member name 會員姓名 : Cheung Tak Kin

Membership number 會員編號 : 01631700 00058119
Eligible
Incurred Deducted Maximum benefit
Voucher Days expenses
Incurred date Benefit item expenses amount limit Remarks
number paid 合資格
治療日期 保障項目 申請索償金額 自費金額 最高保險限額 備註
索償表編號 日數 賠償金額
(HK$) (HK$) (HK$)
(HK$)
54276465 28 APR 2023 General Practitioner 001 135.00 27.00 108.00 220.00 - A
普通科醫生

Subtotal of eligible expenses 合資格賠償金額小計 (HK$) 108.00

Claim reimbursement賠償金額 (HK$) 108.00

Summary 賠償摘要
Total claim reimbursement 賠償總金額 (HK$) 108.00

Remarks 備註:
A : Maximum amount per visit 每日每次之最高賠償金額

You will be reimbursed by autopay to your designated bank account 2 working days from the date of this claim statement.
賠償金額將於本賠償單發出日兩個工作天後自動轉賬至閣下之指定銀行戶口。

The terms and policy descriptions used on our website, myBupa, customer forms and letters may be different from the
VHIS plans. For details, please refer to the glossary on Bupa’s website or myBupa.
保柏網站、myBupa、客戶表格及信件上使用的部份詞彙及保單用詞，可能與自願醫保計劃有所不同。詳情請查閱保柏網
站或myBupa上的詞彙表。

This document is computer-generated. No signature or official stamp is required.

此文件由電腦列印，無須簽署或公司蓋印作實。

Bupa (Asia) Limited 保柏（ 亞洲 ）有限公司

6/F, Tower 2, The Quayside, 77 Hoi Bun Road, Kwun Tong, Kowloon, Hong Kong
香港九龍觀塘海濱道77號海濱匯第2座6樓
Telephone 電話: (852) 2517 5388 Facsimile 傳真: (852) 2548 1848 Website 網址: www.bupa.com.hk

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