出口產(chǎn)品責(zé)任險(xiǎn)投保書

1、華泰財(cái)產(chǎn)保聆有限公司Huatai Properly & CasualtyInsurance Co,r Ltd.出口產(chǎn)品責(zé)任險(xiǎn)投保書EXPORTPRODUCTSLIABILITYINSURANCEAPPLICATION本公司對(duì)問卷各項(xiàng)填寫內(nèi)容，除作為核保及其它保險(xiǎn)程序上的參考外，不另為其它用途，并予以保密。Theinformationprovidedherewillbeusedforinsuranceunderwritingandrelatedprocessingonly,andwillbekeptconfidential.PartI-基本信息BasicInformation1-sSSW

2、"Name&addressofapplicant/insured(includingallsubsidiaries):2 .被保險(xiǎn)人成立形式TheLegalFormoftheInsured獨(dú)資Individual合彳PPartnership口司Corporation匚昌資Jointventure3 .請(qǐng)選出被保險(xiǎn)人的經(jīng)營(yíng)性質(zhì)PleasetickthebusinessnatureoftheInsured:制造商Manufacturer經(jīng)銷商Distributor貿(mào)易公司TradingCompany其它(請(qǐng)說明)other(pleasestate)4 .投保公司從事該行業(yè)幾年？如

3、果有的話，請(qǐng)?zhí)峁┕揪W(wǎng)址HowlonghastheInsuredbeeninthisbusiness?Pleaseprovidecompanywebaddress,ifthereisone.5 .被保險(xiǎn)人在美國(guó)或加拿大有分支機(jī)構(gòu)或代表處？如有，請(qǐng)?zhí)峁┮韵沦Y料DoestheInsuredhaveanysubsidiaries,affiliatesorrepresentativeofficeintheUSAand/orCanada?IfYES,pleasegivethefollowingdetails:DYesDNo公司名稱NameofCompany:公司性質(zhì)BusinessNature:地址Ad

4、dress:與被保險(xiǎn)人關(guān)系RelationshipwiththeInsured:PARTII-產(chǎn)品信息PRODUCT(s)INFORMATION(請(qǐng)附產(chǎn)品說明書、產(chǎn)品目錄、測(cè)t報(bào)告、用戶使用手冊(cè)。PleaseattachProductBrochures,Catalogue,TestingReports,UserManuals)1 .1)請(qǐng)簡(jiǎn)要說明貴公司目前所生產(chǎn)或銷售的所有產(chǎn)品，并說明所需承保的產(chǎn)品。Pleaselistallproductsproducedand/ordistributedbyyouandspecifytheproductstobeinsured.2)貴公司從事生產(chǎn)或銷售這些

5、產(chǎn)品多長(zhǎng)時(shí)間？Howmanyyearshaveyoubeenmanufacturingordistributingtheseproducts?2 .預(yù)期產(chǎn)品的生命期限Whatisthelifeexpectancyofyourproduct?3 .最近五年內(nèi)是否有已停止生產(chǎn)或銷售的產(chǎn)品？如有，請(qǐng)簡(jiǎn)要說明ArethereanyproductsthatarenolongermanufacturedordistributedbyyouduringthepastfiveYESNOyears?IfYES,pleasedescribe.4 .未來一年內(nèi)是否預(yù)計(jì)推出新的產(chǎn)品？如有，請(qǐng)說明。Areanynewp

6、roductsproposedforintroductionduringtheensuingyear?IfYES,pleasespecify:YESNO*請(qǐng)注意：任何新增加的產(chǎn)品必須通知本公司，并經(jīng)本公司書面同意后才能受本保險(xiǎn)保障。*Note:AnyadditionalproductmustbereportedtotheCompanyandwillbecoveredonlyuponwrittenacceptancebythecompany.5. 產(chǎn)品是否由貴公司自行設(shè)計(jì)？Areallofyourproductsdesignedbyyourself?口YESNO口6. 貴公司的產(chǎn)品是否作為其它產(chǎn)

7、品的零組件？若是，請(qǐng)指明Arethereanyproductssoldascomponentpartsforotherproducts?IfYES,pleasespecify:口YESNO口7. 1）貴公司所售的產(chǎn)品是否有以其它名稱來銷售？如有，請(qǐng)說明并提供其所占比例。Areanyofyourproductssoldunderanothernameorlabel?IfYES,pleasedescribeandgive口YESNO口Percentage.2）如有，請(qǐng)問此產(chǎn)品是由貴司設(shè)計(jì)還是買方設(shè)計(jì)？DYOURCOMPANYAresuchproductsmadetoyourspecificatio

8、northoseofthebuyer?口BUYER8 .貴公司是否向他人購(gòu)買原料或零組件？Doyoupurchasematerialsorcomponentsfromothers?口YES口NO9 ._貴公司的產(chǎn)品是否用于下列項(xiàng)目或與其有關(guān)Couldanyofyourproductsorservicesbeusedonorinconnectionwith:* 航空器/飛彈/太空方面aircraft/missile/aerospace?口YESNO口* 水上或海上交通工具watercraftoroffshore?口YESNO口* 內(nèi)陸交通運(yùn)輸transportation/transit?口YES

9、NO口* 維生、復(fù)健設(shè)備lifesupportservice?口YESNO口如有，請(qǐng)說明：IfYES,pleasespecify:PartIII-產(chǎn)品銷售額TURNOVER請(qǐng)列出投保產(chǎn)品下一年度與其銷售額及過去四年的實(shí)際銷售額（美元）Pleaseprovideestimatedturnoverfortheproductstobeinsuredandpast4yearsactualturnoverineachregion（inUSDollars）a.美加地區(qū)USA/Canada年度Year5fc品Product20192018201720162015b.澳洲和新西蘭Australia&N

10、ewZealand'年度Year5fc品Product20192018201720162015c.歐洲Europe_年度Year5fc品Product20192018201720162015Page3 of 5華泰財(cái)產(chǎn)保聆有限公司Hujtdi Properly & C3sudltyInsurance Co,. Ltd.d.其它地區(qū)RestoftheWorld牛Year5fc品Product-一_20192018201720162015PARTIV-產(chǎn)品質(zhì)量及安全控制PRODUCTQUALITYANDSAFETYCONTROL1 .1）貴公司是否有書面的產(chǎn)品質(zhì)量控6制措施？Ist

11、hereawrittenQualityControlProcedureinplace?2）是否有書面的產(chǎn)品回收計(jì)劃？Isthereawrittenproductrecallplan?2 .產(chǎn)品是否達(dá)到或超過相關(guān)國(guó)家政府與行業(yè)所訂的標(biāo)準(zhǔn)？如是，請(qǐng)列舉適用的標(biāo)準(zhǔn)及其影本AreyourproductsdesignedtomeetorexceedtherespectivegovernmentandindustryIfYES,pleaselistallapplicablestandardsandattachcopies.3 .產(chǎn)品測(cè)試ProductTesting1）有無書面的產(chǎn)品測(cè)試程序？Arewrit

12、tentestingproceduresinplaceforyourproducts?2）產(chǎn)品是否經(jīng)過專業(yè)機(jī)構(gòu)監(jiān)測(cè)合格。如有，請(qǐng)附復(fù)印本4.關(guān)于產(chǎn)品的潛在危險(xiǎn)、誤用或?yàn)E用，貴公司是否警告最終消費(fèi)者?如有，說明以下何種方式 YESNO口 YESNO口s standards?NO YES YESNO口 YESNO口Doyouapplyanythird-partylaboratories/testingcenters?Ifyes,pleaseattachcopyofthereports.Page6 of 5 YESNO口Arehazardsinherentinthefinalproduct,andw

13、arningsagainstforeseeablemisuseandabusemadeknowntotheultimateuser?IfYES,pleasespecifyhow:在產(chǎn)品危險(xiǎn)部位標(biāo)示警告事項(xiàng)warninglabelsatthepointofhazard?提供文字說明.writteninstructions?其它方式（請(qǐng)說明）othermeans（attachdetails）?5.對(duì)已售產(chǎn)品，貴公司能否能確定：Can you determine based on available records for all products you have sold:產(chǎn)品的制造日期？Whe

14、n any given product item was manufactured?產(chǎn)品銷售的對(duì)象及出售日期？To whom it was sold, and the date of sale?零件及材料的供貨商？Suppliers of the parts and materials? YES YES YESNO 口NO 口NO 口6.貴公司是否留存有關(guān)產(chǎn)品的舊的使用說明，操作手冊(cè)或廣告資料？Do you maintain copies of old instruction or operation manuals and advertising material? YESNO口Part V

15、 -經(jīng)銷商責(zé)任 Vendor' s Liability1.您是否需要“經(jīng)銷商責(zé)任”？若是，請(qǐng)?zhí)顚懸韵滦畔ⅲ篋o you require any Vendor Liability cover? If yes, please provide the following information:經(jīng)銷商名稱Vendor' s Name地址Address產(chǎn)品名稱Product Name使用品牌名稱Brand銷售額Sales2.您是否與經(jīng)銷商簽定任何形式的免責(zé)協(xié)議或其他類似的協(xié)議？Haveyoueverenteredintoanyholdharmlessorothersimilarcont

16、ractualagreementswithvendors?如是，請(qǐng)?zhí)峁┰敿?xì)子信息Ifyes,pleaseprovidedetails:3.經(jīng)銷商是否對(duì)產(chǎn)品實(shí)施質(zhì)量管理工作？Doesthevendorperformanyqualitycontrolworkontheproduct?4.您如何從相同或類似的產(chǎn)品中辨識(shí)您的產(chǎn)品Howdoyouidentifyyouproductsfromsimilarproducts?5.經(jīng)銷商是否對(duì)產(chǎn)品提供維修工作？Doesthevendorperformanyrepairworkontheproduct?PartV-損失紀(jì)錄LOSSEXPERIENCE1 .貴公

17、司是否曾因產(chǎn)品可能不安全而將產(chǎn)品收回？若有，請(qǐng)說明并告知回收比率Haveyoueverrecalledproductsbecauseofapotentialproductsafetyhazard?YESNODIfYES,pleaseattachdetailsandindicatepercentofrecovery.2 .貴公司產(chǎn)品(無論是否被承保)是否曾造成他人的醫(yī)療費(fèi)，身體傷害或財(cái)產(chǎn)損失？如果有，請(qǐng)?zhí)峁┕咀罱迥甑膿p失紀(jì)錄。YESNdHasanyoneeverrequestedpaymentofdamagesformedicalexpense,bodilyinjuryorPropertyd

18、amagecausedbyyourproduct(whetherinsuredoruninsured)?IfYES,pleaseprovideyourcompany'slosshistoryforthelast5years:年度Year損失金額IncurredLossAmount事故描述IncidentDetailsPARTVI保險(xiǎn)要求INSURANCEREQUIREMENT1.以往有無保險(xiǎn)公司退保或拒保貴司產(chǎn)品責(zé)任險(xiǎn)？若有，請(qǐng)說明Hasanyinsurerevercancelledordeclinedyourproductsliability?IfYES,pleaseexplain.

19、2 .請(qǐng)?zhí)峁┵F公司目前產(chǎn)品責(zé)任險(xiǎn)承保情況Pleaseprovidecurrentproductliabilityinsuranceinformation:(1)保險(xiǎn)公司：保險(xiǎn)期限Insurer:PolicyPeriod(2)責(zé)任限額每次事故限額保單期限累計(jì)限額LimitsofLiability:AnyoneoccurrenceAggregateperPolicyPeriod(3)免賠額Deductible(4)保單形式事故發(fā)生制索賠發(fā)生制(追溯日)CoverageForm:OccurrenceClaims-made(RetroactiveDate)3 .最新/續(xù)保需要的產(chǎn)品責(zé)任保險(xiǎn)要求New/

20、Renewalrequestedproductliabilityinsurance(1)保險(xiǎn)期限PolicyPeriod_(2)責(zé)任限額每次事故限額保單期限累計(jì)限額LimitsofLiability:AnyoneoccurrenceAggregateperPolicyPeriod(3)免賠額Deductible(4)保單形式事故發(fā)生制索賠發(fā)生制(追溯日)CoverageForm:OccurrenceClaims-made(RetroactiveDate)會(huì)華泰保隙tjVInsuranceGrvucPARTVII.登保人/被保險(xiǎn)人聲明THEINSURED/APPLICANTDECLARATION

21、1.本人填寫本投保單之前，保險(xiǎn)人已就本投保單及所附保險(xiǎn)條款的內(nèi)容，尤其是就保險(xiǎn)人免除及減輕責(zé)任的條款、投保人和被保險(xiǎn)人義務(wù)條款及本投保單中的特別約定條款向本人作了明確說明，本人對(duì)該保險(xiǎn)條款及保險(xiǎn)條件已了解并同意接受。I/wehavereadandunderstoodtheInsurer'sTerms&ConditionsoainSagreeetobeboundbythesetermsandconditions.I/weunderstandthatthePolicyisissuedstrictlyonthebasisofmy/ouragreementtothesetermsandconditionsasexplainedtome/usbytheInsurerpriortothecompletionoftheApplicationFormwhenmy/ourattentionwasdrawntothedutiesoftheInsuredandoftheInsurer.My/ourespecialattentionwasdrawntothoseclausesdealingwith