1、財產保險投保單PROPERTY INSURANCE APPLICATION保單號Policy No.PSZ016/本投保單由投保人盡可能如實地、詳細地填寫并簽章后作為向本公司投保財 產保險的依據。本投保單為該財產保險單的組成部分。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.被保險人名稱和地址 Name and Address of Insured: 地址：. 被保險貝才產地址 Location of Property Insured:. 營業性質 Nature of Business:.保險期限：個月，自年 月 日零時起至 年 月 日二十四時止 Period of Insurance: Months, from 0:00 of to 24:00 of.被保險項目及保險金額Ins

3、ured Items and Sums Insured: 項目 投保金額 每次事故*免賠額Insured Items Sums Insured Deductible for Any One Accident*保險財產Property Insured 建筑物(包括裝修)Building(s)(including Decoration)機器設備Machinery and Equipment裝置、家俱及辦公設施或用品Furniture and Fixture includingOffice Equipment and Supplies倉儲物品(模具除外)Stock(Mould Excluded)其它

4、Other附加費用 Additional Expenses消除殘骸費用Removal of Debris Expenses滅火費用Fire Extinguishment Expenses專業費用Professional Expenses*每次事故指不論一次事故或一個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。其它費用一Other Expenses6.總保險金額 Total Sum Insured:7.保險費率 Pre

5、mium Rate:8.保險費 Premium:9.占用建筑物狀況 Condition of Buildings Occupied by the Insured:防火措施滅火設施及器材名稱 結構 層數 占用性質 Measure for Fire Facilities and EquipmentName Structure Stories Occupation Prevention for Extinguishment說明：（1）建筑物的結構指鋼筋混凝土（A）、磚木（B）、其他（C）建筑物的占用性質指寫字樓（A）、商場（B）、賓館酒樓（C）、娛樂場所（D）、倉庫（E）、生產車間（F）、其他（注明

6、）防火措施指禁止吸煙和使用明火（A）、禁止亂拉亂接電線（B）、使用防爆型的照明 燈具和電器設備（C）、裝有導除靜電裝置（D）、裝有防雷電裝置（E）、其他（注明）（4）滅火設施及器材指室內消火栓（A）、室外消火栓（B）、火災自動報警系統（C）、火 災自動滅火系統（D）、手提滅火器（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.倉儲物品Stock:主要物品的類別Classification of Major Stock燃燒性易燃易爆可燃難燃或不燃Combustibility Flammable and Explosive Combustible Not Flammable and NotCombustible易燃易爆物品是否存放在獨立的危險品倉庫內是 否solated Dangerous Goods Storage for Flammable and Explosive Articles ornot Yes No同.標的中有無玻璃等易碎易損物品？有 金額約 免賠額 無Does Proper

10、ty Insured Include Fragile or Brittle Articles? Yes AmountDeductible NoAJEl旦.生產狀況 Nature of Production:原材料、半成品、成品的名稱Name of Raw Materials , Semi-FinishedProducts and Finished Products0生產工藝采取的是常溫常壓Technique in Production Normal Temperature Normal Pressure高溫高壓High Temperature High Pressure生產過程為 自動化 手工

11、操作Production Method Automatic Hand Work 同生產過程中有無使用易燃或易爆材料有 名稱無Are Flammable or Explosive Materials Used in Production Yes Name No生產過程中有無可燃性氣體或粉塵產生有 名稱無Any Flammable Gas and Dust Produced in Production Yes Specify No a 1b|.以往損失情況Loss Experience:以往有無發生過損失 有 無Any Losses Occured in the Past (if yes,Plea

12、se Specify. ) Yes No暴雨或洪水災害 次，最近一次發生于 年 月 日，造成財產損失金額Heavy Shower or Flood Time (s), Recently on Date of ,Property Loss Amount 。火災或爆炸事故 次，最近一次發生于 年 月 日，造成財產損失金額 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|.防洪設施及措施 Facilit

13、ies and Measure for Flood Prevention: 防洪墻防洪閘門沙袋抽水機Flood Wall Flood Gate Sand Bag Water PumpQ倉儲物品加墊板汛期建立24小時值班制度Stocks on Pallet 24 Hours Duty During the Flood0IIB回百叵.安全生產組織及管理 Organization and Management for Safe Production:有無組建消防隊 專業 業余 無Any Fire Brigade Professional Amateur No消防隊的人數，裝備Numbers of F

14、ire Brigade Staff ,Equipment有無建立安全生產責任制或防火安全責任制有無Any System of Responsibility of Safety or Fire Prevention Yes No有無安全生產或防火安全管理組織有名稱無Any Organization of Safety or Fire Prevention Yes Name No有無制定安全操作規程有無Any Method of Safe Operation Yes No有無取得由消防部門頒發的消防合格證書有 無Any Fire Prevention Qualification from Fire

15、 Control Department Yes No.特別條款 Special Provisions:.備注 Remarks:投保人茲聲明所填上述內容屬實，對貴公司就財產保險條款及附加內容（包括責任免除部分）的說明已經了解，同意按照該條款投保財產保險。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