财产保险询价书

1、7 / 6财 产保险 询 价 书PROPERTY INSURANCE QUOTATION APPLICATIONm制删iimi删ill删ii删iifcAO4070D1-0rProducer Code(Internal Use Only)Producer Name(Internal Use Only)Policyholder Information投保单位基本信息Name of Policyholder 投保单位:License number营业执照编号 :(Remark: If policy premium over RMB200,000 or US$20,000, please provid

2、e copy of operation license)(说明：如保费超过RMB200,000或US$20,000,请提供营业执照复印件)Business Address 办公位置：Postcode 邮政编码:Contact Person 联络人:Contact Tel. No 了解电话：Fax No传真号码：Email Address 电子邮件:个别风险(Technical Team)电话 Phone/Ext :Risk Information 投保资料统一风险(Middle Market Team)业务员Producer:日期Date :被保险人Name of Insured :公司网站W

3、ebsite:行业性质Occupancy:保险期限 Period of Insurance :从From至To被保财产位置Locations of Property Insured :(Please list all locations; if many, please add as attachment)险种Coverage Type :1财产损失Property Damage :1火灾险Fire Insurance :Q火灾及附加灾险保险Fire and Allied Perils Insurance:口财产一切险Property All Risks Insurance :1 间接损失保险

4、Consequential Loss Insurance :第一部分财产损失Part I Property Damage (If multi locations, please provide attachment with breakdown by location)以卜保险价值系按照帐卸原值，如果需要按其他价值确定，请告知Valuation is on book value basis, if other valuation is requested, please specify :我保卜刻谷坝Insured Item保险价值（帐回原值）Book Value保险金额/损失限额Sum In

5、sured / Limit楼宇结构包括房东附属装置和设施但不包 括地基及排水设备 Building including Landlord ' s Fixturand Fittings but excluding Foundations and Drains机械设备、用具、工具但不包括任何类型工模Machinery, Utensils and Tools of Trade excluding Moulds of Any Kind库存物及/或成品、半成品或在成Stock in Tradeand/or Merchandise Manufactured, Unmanufactured or i

6、n the process of Manufacture商业办公家具附属装置及设施Business and Office Furniture Fixtures and Fittings其他(请说明)Others (Please specify)总额Total希望的免赔额Deductible requested人民币元，或损失之 %,以高者为准，每一次事故损失% of adjusted loss, min RMBfor each and every loss风险位置房屋数量（不包括仓库）Number of Buildings （excluding warehouse）:总面积Total Floo

7、r Area m2仓库数量Number of Warehouses :建筑类别(请在下面填写风险位置内各种所已有的建筑类型的面积)Construction Type (Please f川 in information below regarding the area of each construction type)钢筋混凝土结构2一般钢结构2Reinforced Concrete Structure :Steel Structure :砖木结构或木结构2其他结构，请说明2Brick Joisted or Wood Structure :Other, please specify :彩钢板结

8、构Sandwich panel present :有Yes无Noma如有，请告知彩钢板结构建筑所占之 %,以及中间之保温材料：If yes, please specify% of construction, and typeof insulation:厂区平面图Plant Layout Attached :有Yesj一无Ncr厂自有厂房厂租用厂房OwnedLeased有无共用单位：Co-tenants?有Yes无Nor |合租人从事何种生产Occupancy of cotenant :仓库及储存区域的详细情况(请填写以下有关仓库及库存区域的信息)Warehouse / Storage Area

9、 Details (Please fill in the information below regarding warehouse / storage)原材料、成品仓库及堆放区域 m2Raw Material & Finished Goods Storage Area :仓板货物堆高mMax. Pallet Storage Height :货架最大高度mMax. Height of Racks :周遍情况，请给出被保险财产位置四周的情况（例如，河流，森林，纺织厂等），及其和被保险位置的距离Exposure, please give details of exposure plus d

10、istance to north, south, east and west of location :行业描述Occupancy :请列出大致工艺流程Please give the brief details of work flow & process:工艺流程图Production Flow Chat attached:有Yes无Norr主要原料Raw Material Used:产成品Final Product :主要生产设备Key Machinery, please give brief details :大型液压设备Hydraulic Equipment Used:有 Ye

11、s无 Nonn带明火操作Fired Processes :烤炉Oven熔炉 Furnace tl 1其他，请说明 Other, please specify r干燥机Dryer加热器Heater防护措施(请填写以下有关防护措施的信息)Protection (Please f川 in the information below regarding protection facilities)自动喷淋系统Automatic Sprinkler :完全 Fully Protected部分 Partly Protected无喷淋 No SprinklersriH |货架内的水喷淋喷头In-rack S

12、prinklers Present inWarehouse / Storage Area :有Yes无Norn火警探头系统Automatic Fire Detection:有Yes 无No如果有，系统联网至If yes, connected to :消防局口控制室厂就地报警Fire DepartmentSecurity RoomLocal Alarm其他防火设备Other Fire Protection Facilities:请列出Please list :防盗报警系统Burglar Alarm :有Yes无No是否和保安公司或公安局联网If yes, is it connected to a

13、larm company or police station : 是 Yes 否 No24小时保安24 Hours Security :有Yes无NorTr木烟拈施动火许可制度和记录 厂内自检程序和记录Smoking Control Regulation Present . , ic,co<& EnforcedHot work Permit Present & EnforcedSelf Inspection Program Present & Enforced定期消防设施维护与记录 整理、整顿的规章条例与记录Fire Protection Maintenance

14、Present & EnforcedHousekeeping Stipulation Present & Enforced被保险位置附近的河流、湖泊、水库 离被保险位置的距离The distance between insured location and river / lake / reservoir close to the insured location :500 米以内 within 500 meters超过 500 米 above 500 meters第二部分利润损失（间接损失保险）Part II Consequential Loss Insurance保险项目I

15、nsured Item :保险价值Insured Value :赔偿期限Indemnity Period :口毛利润Gross Profit :所需赔偿期限为自损失发生之日起连续 月数Period for which indemnity is required consecutive months following the date of the damage.备注：当要求之赔偿期限超过12个月，左侧的投保金额应为该期间预计的毛利、租金、额外工作费用 和工资 Remarks: Where an indemnity period in excess of 12 months is requir

16、ed, the respective sum insured under left side should be represent the estimated Gross Profit, Loss of Rent, ICOW and Wages for the full period selected.口租金损失Loss of Rent口额外工作费用Increasing Cost of Working工资WagesET审计师费用Auditor 's Fees希望的免赔额个工作日，每一次事故损失Deductible requested :Working days, for each a

17、nd every loss生产的瓶颈(关键的生产设备由一家供应商提供)Production Bottlenecks:(Critical Single Source Production Machinery, etc)有Ye 百s无Nor如有，请说明If yes, please specify :财产损失及利润损失的扩展条款Extensions for Property Damage & Consequential Loss希望的扩展条款 Please list extensions requested财产损失Property Damage :利润损失Consequential Loss :5年的损失记录Loss record for past 5 years (Please list the loss record for past 5 yea