财产一切险投保单

1、财产保险投保单PROPERTY INSURANCE APPLICATION保单号Policy No.PSZ016/本投保单由投保人尽可能如实地、详细地填写并签章后作为向本公司投保财 产保险的依据。本投保单为该财产保险单的组成部分。The Applicant is required to fill in the following items with utmost faith and as detailed as possible, and affix signature to this application, which shall be the basis of application

2、to the Company for Property Insurance and constitute an integral part of the Insurance Policy.被保险人名称和地址 Name and Address of Insured: 地址：. 被保险贝才产地址 Location of Property Insured:. 营业性质 Nature of Business:.保险期限：个月，自年 月 日零时起至 年 月 日二十四时止 Period of Insurance: Months, from 0:00 of to 24:00 of.被保险项目及保险金额Ins

3、ured Items and Sums Insured: 项目 投保金额 每次事故*免赔额Insured Items Sums Insured Deductible for Any One Accident*保险财产Property Insured 建筑物(包括装修)Building(s)(including Decoration)机器设备Machinery and Equipment装置、家俱及办公设施或用品Furniture and Fixture includingOffice Equipment and Supplies仓储物品(模具除外)Stock(Mould Excluded)其它

4、Other附加费用 Additional Expenses消除残骸费用Removal of Debris Expenses灭火费用Fire Extinguishment Expenses专业费用Professional Expenses*每次事故指不论一次事故或一个事件引起的一系列事故The words “ANY ONE ACCIDENTshall mean any one accident or series of accident arising out of one event。其它费用一Other Expenses6.总保险金额 Total Sum Insured:7.保险费率 Pre

5、mium Rate:8.保险费 Premium:9.占用建筑物状况 Condition of Buildings Occupied by the Insured:防火措施灭火设施及器材名称 结构 层数 占用性质 Measure for Fire Facilities and EquipmentName Structure Stories Occupation Prevention for Extinguishment说明：（1）建筑物的结构指钢筋混凝土（A）、砖木（B）、其他（C）建筑物的占用性质指写字楼（A）、商场（B）、宾馆酒楼（C）、娱乐场所（D）、仓库（E）、生产车间（F）、其他（注明

6、）防火措施指禁止吸烟和使用明火（A）、禁止乱拉乱接电线（B）、使用防爆型的照明 灯具和电器设备（C）、装有导除静电装置（D）、装有防雷电装置（E）、其他（注明）（4）灭火设施及器材指室内消火栓（A）、室外消火栓（B）、火灾自动报警系统（C）、火 灾自动灭火系统（D）、手提灭火器（E）、消防水源（F）Note:Structure: Reinforced Concrete (A), Brick and Wood (B), other (C)Occupation: Office (A), Department Store (B), Hotel and Restaurant(C), Amusement

7、 Park (D), Warehouse (E), Workshop (F), Others(Please State)Measure for Fire Prevention: Smoking Prohibited and Nake Fire not to be Allowed (A), Prohibite Disorderly Setting of Electric Power Line (B), Lighting and Electric Apparatus with Protection against Explosion (C),Installation for Conduction

8、of Static Electricity (D), Lightning Conductor (E),Other (Please State)Facilities and Equipment for Fire Extinguishment: Indoor FireHydrant (A), Public Fire Hydrant (B),Automatic Fire Alarm System(C), Automatic Fire Extinguishing System (D), Portable FireExtinguisher (E), Water Sources for Fire Figh

9、ting (F)ElBEl.仓储物品Stock:主要物品的类别Classification of Major Stock燃烧性易燃易爆可燃难燃或不燃Combustibility Flammable and Explosive Combustible Not Flammable and NotCombustible易燃易爆物品是否存放在独立的危险品仓库内是 否solated Dangerous Goods Storage for Flammable and Explosive Articles ornot Yes No同.标的中有无玻璃等易碎易损物品？有 金额约 免赔额 无Does Proper

10、ty Insured Include Fragile or Brittle Articles? Yes AmountDeductible NoAJEl旦.生产状况 Nature of Production:原材料、半成品、成品的名称Name of Raw Materials , Semi-FinishedProducts and Finished Products0生产工艺采取的是常温常压Technique in Production Normal Temperature Normal Pressure高温高压High Temperature High Pressure生产过程为 自动化 手工

11、操作Production Method Automatic Hand Work 同生产过程中有无使用易燃或易爆材料有 名称无Are Flammable or Explosive Materials Used in Production Yes Name No生产过程中有无可燃性气体或粉尘产生有 名称无Any Flammable Gas and Dust Produced in Production Yes Specify No a 1b|.以往损失情况Loss Experience:以往有无发生过损失 有 无Any Losses Occured in the Past (if yes,Plea

12、se Specify. ) Yes No暴雨或洪水灾害 次，最近一次发生于 年 月 日，造成财产损失金额Heavy Shower or Flood Time (s), Recently on Date of ,Property Loss Amount 。火灾或爆炸事故 次，最近一次发生于 年 月 日，造成财产损失金额 事故原因。Fire or Explosion Accident Time (s), Recently Occured on Date ofProperty Loss Amount ,Due to the Accident Cause of 。同a|.防洪设施及措施 Facilit

13、ies and Measure for Flood Prevention: 防洪墙防洪闸门沙袋抽水机Flood Wall Flood Gate Sand Bag Water PumpQ仓储物品加垫板汛期建立24小时值班制度Stocks on Pallet 24 Hours Duty During the Flood0IIB回百叵.安全生产组织及管理 Organization and Management for Safe Production:有无组建消防队 专业 业余 无Any Fire Brigade Professional Amateur No消防队的人数，装备Numbers of F

14、ire Brigade Staff ,Equipment有无建立安全生产责任制或防火安全责任制有无Any System of Responsibility of Safety or Fire Prevention Yes No有无安全生产或防火安全管理组织有名称无Any Organization of Safety or Fire Prevention Yes Name No有无制定安全操作规程有无Any Method of Safe Operation Yes No有无取得由消防部门颁发的消防合格证书有 无Any Fire Prevention Qualification from Fire

15、 Control Department Yes No.特别条款 Special Provisions:.备注 Remarks:投保人兹声明所填上述内容属实，对贵公司就财产保险条款及附加内容（包括责任免除部分）的说明已经了解，同意按照该条款投保财产保险。I /We (the Applicant & the Insured) do hereby declare that the above contents are truly filled in, and that I/We have understood the Company s explanation on the clauses of Property Insurance and its additional contents contents (including exclusions) and t