en-sg	| represent, to the best of my knowledge and belief, that since the date of the Application for the policy no person to be covered by the policy has, except as stated below, Had a change in health due to injury or sickness; or
zh-cn	本人表示，尽本人所知及所信，自保单申请书签署之日起，除下方所述以外，保单所承包的任何人均未：1. 由于受伤或疾病而发生健康状况的改变；或

en-sg	Consulted, been examined or been treated by any physician or practitioner; or
zh-cn	2. 接受任何医生或医务人员的诊症、检查或治疗；或

en-sg	Changed occupation, aviation or military status; or
zh-cn	3. 改变职业、航空或兵役状态；或

en-sg	Had any life or accident and sickness, or medical service benefits declined, modified, canceled, or been refused issue, renewal or reinstatement of such insurance or benefits; or
zh-cn	4. 有任何人寿或事故及疾病，或医疗服务赔偿被拒绝、修改、撤销，或者此类保险或赔偿被拒绝签发、续期或复效；或

en-sg	Applied for issuance or reinstatement of any insurance providing income during disability or providing hospital or medical expense benefits.
zh-cn	5. 申请签发或复效任何提供伤残收入或者提供医院或医疗费用赔偿的保险。

en-sg	Life Insured:
zh-cn	人寿保险投保人：

en-sg	The Application for Policy No. is amended as follows:
zh-cn	保单号码为                   的申请书修改如下：

en-sg	The only exceptions are: (State "none" if there are no exceptions)
zh-cn	唯一的例外是：（如无例外，请注明"无"）

en-sg	| declare that | have, in an identical manner, completed and signed this Amendment that is attached to and made part of the policy issued by the Company.
zh-cn	本人声明，本人已以同样的方式填写和签署附于公司所签发之保单且属于其一部分的此修改件。

en-sg	It is agreed that this Amendment shall be part of the Application for the policy.
zh-cn	本人同意，此修改件属于保单申请书的一部分。

en-sg	Signed at on
zh-cn	在                                     于                                  签署

en-sg	City, Country Date (mm/dd/yyyy)
zh-cn	城市，国家                           日期（月/日/年）

en-sg	Signature of Proposed Insured (or parent or guardian if Proposed Insured is a minor) Witness to Signature of Proposed Insured
zh-cn	准投保人（如准投保人未成年，则父母或监护人）签名    准投保人签名见证人

en-sg	Signature of Proposed Owner (if other than Proposed Insured) Witness to Signature of Proposed Owner
zh-cn	准所有人（如非准投保人）签名                           准所有人签名见证人

en-sg	| represent, to the best of my knowledge and belief, that since the date of the Application for the policy no person to be covered by the policy has, except as stated below, Had a change in health due to injury or sickness; or Consulted, been examined or been treated by any physician or practitioner; or Changed occupation, aviation or military status; or Had any life or accident and sickness, or medical service benefits declined, modified, canceled, or been refused issue, renewal or reinstatement of such insurance or benefits; or Applied for issuance or reinstatement of any insurance providing income during disability or providing hospital or medical expense benefits.
zh-cn	本人表示，尽本人所知及所信，自保单申请书签署之日起，除下方所述以外，保单所承包的任何人均未：1. 由于受伤或疾病而发生健康状况的改变；或 2. 接受任何医生或医务人员的诊症、检查或治疗；或 3. 改变职业、航空或兵役状态；或 4. 有任何人寿或事故及疾病，或医疗服务赔偿被拒绝、修改、撤销，或者此类保险或赔偿被拒绝签发、续期或复效；或 5. 申请签发或复效任何提供伤残收入或者提供医院或医疗费用赔偿的保险。