1/6

Print/Issue Date
2023/04/20

PRIVATE & CONFIDENTIAL Policy No.

505-4689657

CHEUNG TIN CHUI

RM 1503 15/F
Insured Name
CHEUNG TIN CHUI
CHUNG HAU HOUSE
LEI CHENG UK ESTATE Policy Date

CHEUNG SHA WAN KLN

2020/08/28

Plan Name
SMART MEDICARE
Annual Summary of Voluntary Health Insurance
Policy Currency
Scheme (VHIS) Certified Plan HKD

Policy Status
Inforce
This Annual Summary of your Voluntary Health Insurance Scheme
Certified Plan is for the year of assessment from 1 April 2022 to 31 March Your Financial Consultant
Name
2023.
AU YIN KWAN, ANNIE

Details of the VHIS Certified Plan Code

040004-04-030018
Name of VHIS Certified Plan : SMART MEDICARE
VHIS Certification No. : F00017-01-001-02 Contact No
25111883
Name of Insurer : AXA China Region Insurance Company (Bermuda)
Limited Date format used in this
(Incorporated in Bermuda with limited liability) document is yyyy/mm/dd

Name of Policy Holder : CHEUNG TIN CHUI

Name of Insured Person : CHEUNG TIN CHUI
Policy Number : 505-4689657
Type of Plan : BASIC PLAN

Customer Service Suite 2001, 20/F, Tower Two, Times Square, 1 Matheson Street, Causeway Bay, Hong Kong
客戶服務 香港銅鑼灣勿地臣街 1 號時代廣場 2 座 20 樓 2001 室 Tel 電話: (852) 2802 2812 Fax 傳真: (852) 2598 7623
Website 網址: www.axa.com.hk Email 電子郵件: [email protected]
 2/6

Summary of premiums paid during the year of assessment

All amounts in HKD
Total amount of premium due and paid $5,084.00
during the year of assessment
Less:
Non VHIS Certified Basic and Riders $612.00
Premium refund $0.00
Premium rebate $0.00
Total amount of premium NOT qualified for tax deduction ($612.00)

Total amount of VHIS Certified Plan due and paid during the $4,472.00
year of assessment

Important notes:

1. The Annual Summary of VHIS Certified Plan is to facilitate the completion of tax returns by the policy
holder with regard to the deduction claim of Premiums paid under a VHIS Certified Plan during a
year of assessment.
2. The amount of premium due and paid does not include levy.
3. In the event of refund of premiums, Policy Holder is reminded to notify the Commissioner of the
Inland Revenue of such refund within 3 months from the date of refund if the policy holder has
claimed tax deduction of the refunded premium.
4. For details of premiums paid during the year of assessment, please refer to the appendix.
5. For policy in currency other than the Hong Kong Dollars, policy holder may refer to the
published rates on the website of the Inland Revenue Department (https://www.ird.gov.hk/eng/
tax/ind_stp.htm).
6. For more information about VHIS Certified Plan, please visit our website at www.axa.com.hk or by
calling our hotline at 2802 2812.

Customer Service Suite 2001, 20/F, Tower Two, Times Square, 1 Matheson Street, Causeway Bay, Hong Kong
客戶服務 香港銅鑼灣勿地臣街 1 號時代廣場 2 座 20 樓 2001 室 Tel 電話: (852) 2802 2812 Fax 傳真: (852) 2598 7623
Website 網址: www.axa.com.hk Email 電子郵件: [email protected]
 3/6

列印/發出日期
2023/04/20

保險單編號
私人密件 505-4689657

被保人姓名
CHEUNG TIN CHUI

保單日期
2020/08/28

計劃名稱
真智安心醫療保障

自願醫保認可產品 保單年度摘要 保單貨幣

港元

保單現況
生效
此為您的自願醫保認可產品保單於2022年4月1日至2023年3月31日的
課稅年度之年度摘要。
理財顧問資料
姓名
自願醫保認可產品保單詳情 AU YIN KWAN, ANNIE
自願醫保認可產品保單名稱 : 真智安心醫療保障
自願醫保認可產品編號 : F00017-01-001-02 編號
040004-04-030018
保險人名稱 : 安盛保險(百慕達)有限公司
(於百慕達註冊成立的有限公司) 聯絡電話
保單持有人姓名 : CHEUNG TIN CHUI 25111883

保單被保人姓名 : CHEUNG TIN CHUI

保單編號 : 505-4689657 此通知書所示之日期格式為
計劃類別 : 基本計劃 年/月/日

Customer Service Suite 2001, 20/F, Tower Two, Times Square, 1 Matheson Street, Causeway Bay, Hong Kong
客戶服務 香港銅鑼灣勿地臣街 1 號時代廣場 2 座 20 樓 2001 室 Tel 電話: (852) 2802 2812 Fax 傳真: (852) 2598 7623
Website 網址: www.axa.com.hk Email 電子郵件: [email protected]
 4/6

課稅年度期間所繳付保費概要
所有金額為 港元
課稅年度期間到期及繳付的保單保費總額 5,084.00 元
減：
非自願醫保認可產品的基本計劃及附加保障 612.00 元
保費退還 0.00 元
保費折扣 0.00 元
不符合稅項扣除條件的保費總額 (612.00 元 )

課稅年度期間到期及已繳付的自願醫保認可產品保費總額 4,472.00 元

重要通知:

1. 自願醫保認可產品保單的年度摘要是為方便保單持有人按課稅年度期間，就自願醫保認可產
品保單所繳付的保費填寫報稅表。
2. 到期及已繳付的保費金額並不包括保費徵費。
3. 在具退還保費的情況下，如保單持有人已就缴付的自願醫保認可產品保費申請稅項扣除，保
單持有人須於保費退還日期後三個月內，通知稅務局局長有關該退款。
4. 在有關課稅年度內繳納保費的詳情，請參閱附錄。
5. 就以港元以外為保單貨幣的保單， 保單持有人可參考稅務局網站（https://www.ird.gov.hk/
chi/tax/ind_stp.htm）公佈的匯率。
6. 如欲查詢更多有關自願醫保認可產品的資料，請參閱我們的網站www.axa.com.hk或致電我
們的熱線2802 2812。

Customer Service Suite 2001, 20/F, Tower Two, Times Square, 1 Matheson Street, Causeway Bay, Hong Kong
客戶服務 香港銅鑼灣勿地臣街 1 號時代廣場 2 座 20 樓 2001 室 Tel 電話: (852) 2802 2812 Fax 傳真: (852) 2598 7623
Website 網址: www.axa.com.hk Email 電子郵件: [email protected]
 5/6

Appendix

Details of premiums paid for the during the year of assessment

Total amount of premium due and paid Premium All amounts in HKD
during the year of assessment Payment Date
2022/08/14 $5,084.00
$5,084.00
Less:
Non VHIS Certified Basic and Riders $612.00
Premium refund $0.00
Premium rebate $0.00
Total amount of premium NOT qualified for tax deduction ($612.00)
Total amount of VHIS Certified Plan due and paid during the $4,472.00
year of assessment*
*The total amount of VHIS Certified Plan premium covers the benefit coverage period of(2022/08/28 -
2023/08/27).

Customer Service Suite 2001, 20/F, Tower Two, Times Square, 1 Matheson Street, Causeway Bay, Hong Kong
客戶服務 香港銅鑼灣勿地臣街 1 號時代廣場 2 座 20 樓 2001 室 Tel 電話: (852) 2802 2812 Fax 傳真: (852) 2598 7623
Website 網址: www.axa.com.hk Email 電子郵件: [email protected]
 6/6

附錄

課稅年度期間所繳付保費詳請

課稅年度期間到期及繳付的保單保費總額 付款日期 所有金額為 港元

2022/08/14 5,084.00 元
5,084.00 元
減：
非自願醫保認可產品的基本計劃及附加保障 612.00 元
保費退還 0.00 元
保費折扣 0.00 元
不符合稅項扣除條件的保費總額 (612.00 元)
課稅年度期間到期及已繳付的自願醫保認可產品保費總額* 4,472.00 元

*保費涵蓋的保障期為(2022/08/28 - 2023/08/27).

Customer Service Suite 2001, 20/F, Tower Two, Times Square, 1 Matheson Street, Causeway Bay, Hong Kong
客戶服務 香港銅鑼灣勿地臣街 1 號時代廣場 2 座 20 樓 2001 室 Tel 電話: (852) 2802 2812 Fax 傳真: (852) 2598 7623
Website 網址: www.axa.com.hk Email 電子郵件: [email protected]