机器损坏险保险合同 <br>
机器损坏险投保单 <br>
machinery breakdown insurance application <br>
保单号:___________________ <br>
policy no. ________________ <br>
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机器损坏险的依据。本投保单为该机器损坏险保险单的组成部分。 <br>
the applicant is required to fill in the following items with utmost faith and as detailed as pos-sible. and affix signature to this application, which shall be the basis of application to the company for machinery breakdown insurance and constitute an integral part of the machinery breakdown in-surance policy. <br>
1.被保险人名称和地址name and address of the insured: <br>
2.营业性质nature of business: <br>
3.被保险机器所在地location of machinery to be insured: <br>
4.保险期限: 个月, 年 月 日零时起至 年 月 日二十四时止 <br>
period of insurance: months, from 0:00 of to 24:00of <br>
5.被保险项目及保险金额insured items and sum insured <br>
项目 保险金额 每次事故*免赔额 <br>
insured items sum insured deductible for any one accident* <br>
5.1 保险财产(详见背面) <br>
property insured(look overleaf) <br>
5.2 附加费用additional expenses <br>
清除残骸费用 <br>
debris removal expenses <br>
灭火费用 <br>
fire extinguishment expinses <br>
专业费用 <br>
professional expenses <br>
其他费用 <br>
other expenses <br>
6.总保险金额total sum insured: <br>
7.保险费率premium rate: <br>
8.保险费premium: <br>
*每次事故指不论一次事故或一个事件引起的一系列事故 <br>
the words any one accident chall mean any one accident or series of accident arising out of one event. <br>
被保险机器的详细说明 <br>
specification of machinery to be insured <br>
项目 <br>
item <br>
型号 <br>
model <br>
数量 <br>
qty. <br>
主要技术参数 <br>
major tech. parameter <br>
制造商manufacturer <br>
<br>