食品科技网-知识资料内容
机器损坏险投保单
MACHINERY BREAKDOWN INSURANCE APPLICATION
保单号：___________________
Policy No. ________________
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。
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.
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1.被保险人名称和地址Name and Address of the Insured: |
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2.营业性质Nature of Business: |
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3.被保险机器所在地Location of Machinery to be Insured: |
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4.保险期限：个月，年月日零时起至年月日二十四时止 Period of Insurance:Months, from 0:00 ofto 24:00of |
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5.被保险项目及保险金额Insured Items and Sum Insured 项目保险金额每次事故＊免赔额 Insured ItemsSum InsuredDeductible for Any One Accident* 5.1保险财产（详见背面） Property Insured(Look Overleaf) 5.2附加费用Additional Expenses 清除残骸费用 Debris Removal Expenses 灭火费用 Fire Extinguishment Expinses 专业费用 Professional Expenses 其他费用 Other Expenses |
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6.总保险金额Total Sum Insured: |
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7.保险费率Premium Rate: |
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8.保险费Premium: |
＊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 ACCIDENT chall mean any one accident or series of accident arising out of one event.
被保险机器的详细说明
Specification of Machinery to be Insured
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项目 Item |
型号 Model |
数量 Qty. |
主要技术参数 Major Tech. Parameter |
制造商Manufacturer |
制造年份 Year of Manu. |
保险金额 Sum Insured |
维护及保用期情况 Maintenance & Un-expiredGuarantee Perio |
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说明：（1）主要技术参数指机器的输出功率、速度、容量、负荷等，如属电器设备，应说明电压、电流量、转速，如属蒸气设备，应说明燃料、压力和温度。
（2）维护情况指自行维护（A）、由指定厂家维护（B）、由生产厂家维护（C）。
Note:(1)Major Technical Parameter:Output, Speed, Capacity, Loading etc. and for Electrical Equipment, Voltage, Amperage, Cycles. and for Steam Equipment, Fuel, Pressure and Temperature.
(2)Maintenance: By Insured(A), By Contractor(B), By Manufacturer(c).
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9.以前这些机器发生是否发生过损坏？（以往5年）是否 Previous Losses Experience(Last 5 Years)YesNo 项目Item 损坏时间Breakdown Timed 损失金额Loss Amount |
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10.有无制定操作规程？是否 Any Operating System? If Yes, Please State.YesNo |
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11.操作人员Operator: 11.1新员工上岗前是否进行岗位教育和培训？是否 Were the New Operator Trained before Taking up New Post?YesNo 11.2操作人员是否持证上岗？是否 Are the Operator Working With Qualitication Certificate?YesNo 11.3平均上岗时间是否 The Average Time of Employment in this PostYesNo
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12.维修情况Condition of Maintenance? 12.1有无配置专业维修人员？是否 Any Trained Maintenance Worker?YesNo 12.2是否进行日常的维修和保养？是否 Any Daily Maintenance?YesNo 12.3大修每隔＿＿＿＿个月进行一次Ovrhaul Every＿＿＿＿＿＿Months是否 YesNo 12.4是否按照生产厂家的要求和规定进行维修和保养？是否 Procedures Comply with the Requirement of Manufacturer?YesNo |
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责任编辑：Techoo-6
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