財產(chǎn)險投保單(2009版) 英 V1

14位單證流水號14位單證流水號中國人民財產(chǎn)保險股份有限公司財產(chǎn)××險（2009版）投保單PICCPropertyandCasualtyCompanyLimitedProposalFormfor××Insurance(2009)ProposalFormNO.：**********************投保人Applicant單位名稱Name通訊地址CorrespondingAddress郵編：Postalcode:組織機構(gòu)代碼OrganizationCode聯(lián)系人Contactperson聯(lián)系電話Telephoneno.被保險人Insured單位名稱Name通訊地址CorrespondingAddress郵編：Postalcode:組織機構(gòu)代碼OrganizationCode聯(lián)系人Contactperson聯(lián)系電話Telephoneno.行業(yè)類別：行業(yè)代碼：Industryclassification：IndustryCode：保險標的地址個數(shù)：共個,詳見《財產(chǎn)××險（2009版）投保標的項目清單》NumberofLocation(s)ofinsuredproperty：Fordetails,pleaserefertotheListofInsuredPropertyfor××Insurance(2009)保險標的地址：郵編：Location(s)ofInsuredProperty：Postalcode:被保險人資產(chǎn)及營業(yè)額狀況注冊資本：總資產(chǎn)：上一年度實際營業(yè)額：AssetsandturnoveroftheInsuredregisteredcapital:totalAssets:actualturnoveroflastyear:投保主險險種：□基本險□綜合險□一切險TypeofInsurance:□FireInsurance□PropertyInsurance□PropertyAllRisksInsurance有關(guān)保險標的投保信息，請見《財產(chǎn)××險（2009版）投保標的項目清單》；有關(guān)附加險條款投保信息，請見《財產(chǎn)××險（2009版）附加險條款投保清單》。上述投保清單為本投保單的組成部分。FordetailsaboutPropertyInsured,pleasefillintheListofItemsInsured;FordetailsaboutExtensionClause,pleasefillintheListofExtensionClause;TheaforementionedListsareeffectivepartsofthisProposalForm.除另有約定本保險合同的每次事故免賠額為元，或損失金額的%，二者以高者為準Unlessotherwiseagreed,theDeductibleofthisInsuranceContactshallbeor%ofloss,whicheveristhegreater.是否有其他有關(guān)保險合同：□有□無Doyouhaveanyotherrelevantinsurancecontact(s)?□YES□NO如有，請說明標的項目、保險金額、免賠額、保險公司名稱以及其他相關(guān)信息：IfYES,pleaseprovidedetailsofPropertyInsured,SumInsured,Deductible(s),Insurer’snameandanyotherrelevantinformation.是否為續(xù)保合同Isthisarenewalinsurancecontract□是□否□YES□NO總保險金額：人民幣(大寫)（小寫）:TotalSumInsured:RMB保險期間：月，自年月日零時起至年月日二十四時止PeriodofInsurance:months,from00:00to24:00總保險費：GrossPremium人民幣(大寫):（小寫）:RMB保險費交付時間：年月日Duedateofpremiumpayment:保險合同爭議解決方式：□訴訟□提交仲裁委員會仲裁SolutionofDispute:□Litigation□submittoarbitrationcommitteeforanarbitration特別約定：Specialtermsandconditions:投保人聲明DeclarationoftheApplicant保險人已向本人提供并詳細介紹了《中國人民財產(chǎn)保險股份有限公司財產(chǎn)××險條款（2009版）》及其附加險條款（若投保附加險）內(nèi)容，并對其中免除保險人責任的條款（包括但不限于責任免除、投保人被保險人義務(wù)、賠償處理、其他事項等），以及本保險合同中付費約定和特別約定的內(nèi)容向本人做了明確說明，本人已充分理解并接受上述內(nèi)容，同意以此作為訂立保險合同的依據(jù)，自愿投保本保險。WeherebydeclarethattheInsurerhas

providedandexplainedindetail<>anditsextensionclauses(ifany).TheInsurerhas

alsospecifiedtheexclusionclauses(includingbutnotlimittothe

exclusions,obligationoftheApplicant,

treatmentoftheclaims

andotheritems),aswellaspaymentagreementandspecialtermsandconditions.

Theundersignedhas

fullyunderstoodandacceptedthecontentmentionedabove,thusagreedto

concludethe

Policyonthebasisofthisdeclaration,andappliedforthisinsurancevoluntarily投保人簽章：年月日（以下公司內(nèi)部作業(yè)欄，客戶無須填寫）初審情況業(yè)務(wù)來源：□直接業(yè)務(wù)□個人代理□專業(yè)代理□兼業(yè)代理□經(jīng)紀人□網(wǎng)上業(yè)務(wù)代理（經(jīng)紀）人名稱：業(yè)務(wù)員簽字：年月日核保意見核保人簽字：年月日中國人民財產(chǎn)保險股份有限公司財產(chǎn)××險（2009版）投保標的項目清單PICCPropertyandCasualtyCompanyLimitedListofItemsInsuredfor××Insurance(2009)本清單為財產(chǎn)××險（2009版）投保單的有效組成部分。ThisListshallbeaneffectivepartoftheProposalFormfor××Insurance(2009)投保單號碼：共頁第頁ProposalFormNo.:Pageof1.保險標的地址：郵編：Location(s)ofPropertyInsured:Postalcode:2.保險標的地址內(nèi)被保險人所從事的生產(chǎn)經(jīng)營活動的簡要描述：PleasedescribethebusinessoperationinLocation(s)ofPropertyInsuredbriefly:*國民經(jīng)濟行業(yè)分類代碼：（此信息由保險人填寫）IndustryCode:(filledbytheInsurer)3.保險標的項目投保信息DetailsoftheItemsInsured序號No.保險標的名稱NameofItemInsured單位Unit數(shù)量Quantity保險金額/賠償限額SumInsured/LimitofIndemnity以何種方式確定保險價值CalculationofInsuredValue備注Remarks12345678910111213注：投保標的為特約標的時，請在備注欄中注明“特約”字樣。Note:IfanItemInsuredshallbespeciallyagreedbytheInsurer,pleasestate“speciallyagreed”intheRemarks.投保人（蓋章）SignatureofApplicant(Stamped)年月日Date:

年月日Date:中國人民財產(chǎn)保險股份有限公司財產(chǎn)××險（2009版）附加險條款投保清單PICCPropertyandCasualtyCompanyLimitedListofExtensionClausesfor××Insurance(2009)本清單為財產(chǎn)××險（2009版）投保單的有效組成部分。ThisListshallbeaneffectivepartofProposalFormfor××Insurance(2009)投保單號碼：ProposalFormNo.:共頁第頁Pageof1.保險標的地址：郵編：Location(s)ofPropertyInsuredPostalcode2.附加險條款投保信息DetailsofExtensionClauses序號No.附加險條款名稱NameofExtensionClauses保險金額/賠償限額SumInsured/LimitofIndemnity每次事故免賠額/免賠率Deductible備注Remarks123456789101112131415注：對于需明確保險價值、地域范圍等信息的附加險條款，請在“備注”欄內(nèi)填寫相關(guān)信息。Note:IftheInsuredValue,territoryorotherinformationshallbespecifiedintheExtensionClauses,pleasefillinsuchinformationinRemarks.投保人（蓋章）Applicant’sSignature(Stamped)年月日Date:中國人民財產(chǎn)保險股份有限公司財產(chǎn)××險（2009版）風險問詢表－－生產(chǎn)性企業(yè)PICCPropertyandCasualtyCompanyLimitedQuestionnairefor××Insurance(2009)Manufacturingrisk基本概況1.BasicInformation企業(yè)名稱：Nameofenterprise:詳細地址：郵政編碼：Address:Postalcode:國有企業(yè)□私有企業(yè)□合資企業(yè)□其他□□State-ownedenterprises□Privateenterprise□JointVenture□Others保險財產(chǎn)處于河（海、湖、水庫）邊，相距米□ 山坡上□山腳下□低洼處□平原□ThePropertyInsuredislocated□attheriverside(seasideorsidebylakeorreservoir),withdistancebetweenofM□onthehillside□atthefootofthehill□inlow-lyingareas□ontheplain保險財產(chǎn)的周圍環(huán)境SurroundingsofthePropertyInsured東：距離米，East：;Distance:M西：距離米，West：;Distance:M南：距離米，South：;Distance:M北：距離米，North：;Distance:M投產(chǎn)時間年月Productioninitiatingdate:yearmonth生產(chǎn)過程2.Procedure產(chǎn)成品：Products主要原料：Majormaterials:主要產(chǎn)品及年產(chǎn)量：Majorproductsandannualoutput:主要生產(chǎn)設(shè)備的制造年份及制造商：（有投保項目清單的可不填）ManufacturingDateandManufacturerofthemajormachineryandequipments.(youcanignorethis,ifsuchinformationisavailableintheListofPropertyInsured)設(shè)備名稱Nameofmachineryandequipment設(shè)備型號Type制造商或廠地Manufacturerandplaceofproduction制造年份Manufacturingyear工藝流程圖隨件附上□無法提供□ProcedureChartis□Attachedor□N/A生產(chǎn)工藝采取常溫□高溫，最高溫度為度□常壓□高壓，最高壓力為MPa□Whichofthefollowingisusedintheprocedure?□Normaltemperature□Hightemperature,withhighesttemperatureof℃□Normalpressure□Highpressure,withhighestpressureofMPa主要生產(chǎn)過程自動化□機械操作□手工操作□MajorProcedureis□automatic,□mechanizedor□manual.帶明火操作烤爐□熔爐□干燥機□加熱器□其他□Ifthemanufacturingprocedureiswithfire,whichofthefollowingmachineryorequipmentisused?□oven□smelter□drier□heater□others易燃易爆品液體□氣體□氣霧劑□其他□IfanyInflammableandexplosivematerialisused,pleasestatewhetheritis□liquid,□airor□aerosol.無塵室無□有□Isthereanydust-freeworkshop?□YES□NO等級100,000□10,000□1,000□100□其他□IfYES,thedustinessdegreeis□100,000,□10,000,□1,000,□100,or□others.存貨物資3.Stock儲存方式倉儲□露堆□罩棚□其他□Thestockisstored□inthewarehouse□intheopenair□undertheawning□inotherplaces存儲地點如多個地點，需列明1. 2.3.PleasestatetheLocation(s)ofStorage:1. 2.3.易燃易爆物質(zhì)無□有□名稱獨立的符合防火防爆要求的倉庫內(nèi)無□有□IsthereanyInflammableandexplosivematerial?□YES□NOIfYES,pleasestatethename:IfYES,isitstoredinanindependentfire-proofandexplosion-proofwarehouse?□YES□NO主要倉儲物品名稱易燃□、可燃□、難燃或不燃□名稱易燃□、可燃□、難燃或不燃□名稱易燃□、可燃□、難燃或不燃□Pleaseprovideinformationaboutthemajorstock:Nameofstock:Itis□flammable

,□combustible,

□noncombustible.Nameofstock:Itis□flammable

,□combustible,

□noncombustible.Nameofstock:Itis□flammable

,□combustible,

□noncombustible.液體儲罐所儲存的可燃物質(zhì)名稱體積Combustiblematerialstoredinliquidstoragetank.Name:Volume:防滅火設(shè)施防雷電口防靜電口防明火口自動滅火裝置口Fireprotectionfacilitiesforthestocks:□lightningprotectionfacility□electrostaticpreventionfacility□firepreventionfacility□automaticfireextinguishingequipment上年度存貨量最大值平均值Valueofstocklastyear:Maximumvalue:Averagevalue:建筑物情況4.Building(s)自有□租用□□ownedor□rented.有無共用單位有□無□Is/arethebuilding(s)usedwithothers?□YES□NO廠區(qū)平面圖隨件附上□無法提供□Thelayoutofthefactoryis□attached□N/A.主體建筑物結(jié)構(gòu)Structureofthemainbuilding(s):名稱Nameofbuilding結(jié)構(gòu)Structure高度m或?qū)訑?shù)heightorstorey占用性質(zhì)Occupation說明:Note:1.建筑物結(jié)構(gòu)：A鋼筋混凝土結(jié)構(gòu)B鋼結(jié)構(gòu)C磚砌/石頭D木材E其他，請注明；1.Structure:A.reinforcedconcretestructure,B.steelstructure,C.Brickorstonestructure,D.Woodenstructure,E.others,pleasestatehere:2.占用性質(zhì)：A辦公B宿舍C倉儲D生產(chǎn)(要注明類別:如機器加工、熱處理、噴漆、裝配、電鍍、焊接、注塑、印刷、粉碎等)；2.Occupation:A.Office;B.Dormitory;C.Warehouse;D.Plant(Pleasespecifythetypeofwork,forexample,machining,heattreating,spray-painting,assembling,electroplating,welding,injectionmolding,printing,pulverizing,etc.)3.對于非單一用途的多層建筑物要說明每一層次的使用情況。Ifamulti-storeybuildingisusedformulti-purpose,pleasestatetheoccupationforeachstorey.避雷設(shè)施無□有□套Isthereanylightningprotectionfacility□YES□NOIfYES,howmany?散熱、排煙裝置無□有□套Isthereanycoolingandventilationsystem□YES□NOIfYES,howmany?防火墻、門無□有□耐火時間小時Isthereanyfire-resistant

wallanddoor?□YES□NOIfYES,howlongwillit/theyresistthefire?hours.動力設(shè)備5.Power廠區(qū)能源燃油□天然氣□液化氣□煤□電□其他□Thepowerofthefactoryisproduced/providedby□fuel□naturalgas□liquefiedgas□coal□electricity□others變壓器進線1□2□臺數(shù)油浸式□干式□Transformer(s)進線1□2□NumberoftransformerTypeoftransformer(s):□Oil-immersed□Drytype功率＃1KVA＃2KVA＃3KVAPower＃1KVA＃2KVA＃3KVA鍋爐臺數(shù)Numberofboiler:類型蒸汽□熱水□其他□Typeofboiler(s):□Steam□Hotwater□others工作壓力額定壓力Workingpressure:Ratedpressure:燃料柴油□煤□其他□Fuel:□Diesel□Coal□Others防護設(shè)施6.Protectiveandpreventivefacilities自動水噴淋系統(tǒng)無□有□Isthereanyautomaticsprinklersystem?□YES□NO濕式□干式□預(yù)作用□雨淋□IfYES,pleaseprovidethefollowinginformation:Type:□Wettype□Drytype□Pre-acting□Deluge系統(tǒng)采用標準NFPA□GB□其他□Standardappliedforthesystem:□NFPA□GB□□Others面積覆蓋率噴頭型號噴頭孔徑Ratioofareacovered:Typeofsprinklerheads:Holediameterofsprinklerheads:相鄰噴淋管間距相鄰噴頭間距Spacebetweenneighboringsprinklerpipes:Spacebetweenneighboringsprinklerheads:設(shè)計噴水強度作用面積Designedsprinklingintensity:Areacovered:豎管底部流量豎管底部壓力Flowatthebottomofthestandpipe:Pressureatthebottomofthestandpipe:市政消防供水：主管直徑壓力靜壓殘壓Municipalfire-fightingwatersupply:Diameterofmainpipe:Pressure:HydrostaticpressureResidualvoltage:消防水箱數(shù)量儲存量M其他Fire-fightingwatertank(s):Quantity:Volume:MOthers消防水泵總數(shù)柴油□電力□自動□手動□Fire-fightingwaterpump(s):Quantity:Type:□Diesel□Electrical□Automatic□Manual消防泵＃1□2□出水量揚程Firepump(s):1□2□Wateroutflow:Pumphead:噴淋泵＃1□2□出水量揚程Sprinklingpump(s):1□2□Wateroutflow:Pumphead:室外消防栓數(shù)量Quantityofoutdoorfirepumps:室內(nèi)消防栓數(shù)量Quantityofindoorfirepumps:滅火器干粉□二氧化碳□泡沫□其他□數(shù)量Typeoffireextinguisher:□Drypowder□Carbondioxide□Foam□OthersQuantityofeach:_____________________________________________特殊消防系統(tǒng)無□有□Isthereanyspecialfire-fightingsystem?□YES□NO二氧化碳系統(tǒng)□煙烙系統(tǒng)□水噴霧系統(tǒng)□泡沫滅火系統(tǒng)□□carbondioxidesystem□INERGENsystem□watersprayingsystem□foamfire-fightingsystem煙霧抽取系統(tǒng)□自動噴淋系統(tǒng)□其他□□Smokeextractsystem□automaticsprinklingsystem□others火災(zāi)探測系統(tǒng)無□有□Istherefiredetectionsystem?□YES□NO感煙型□感溫型□采樣型□其他□□Smokedetectionsystem□Temperaturedetectionsystem□Samplingbaseddetectivesystem□Others報警信號送至警衛(wèi)室□控制中心□其他□Thefirealarmissentto□guardhouse□controlcentre□others現(xiàn)有消防設(shè)施是否取得由消防部門簽發(fā)的《建筑工程消防驗收意見書》或其它消防合格證書：是（）否（）HaveyougotFirePreventionInspectionReportonConstructionsorotherfirepreventioncertificationissuedbythefiredepartmentontheexistingfire-fightingfacilities?□YES□NO《建筑工程消防驗收意見書》內(nèi)說明的廠房或倉庫使用等級為：丙類及以下危險等級（）；超過丙類的危險等級（）Whatistheclassificationoftheplantand/orthewarehousestatedintheFirePreventionInspectionReportonConstructions?RiskclassequaltoorbelowCRiskclassaboveC防盜警報系統(tǒng)無□有□Isthereanyburglaryalarmsystem?□YES□NO紅外線□錄像監(jiān)控□門磁□其他□□Infrared□Closed-circuittelevision□Magneticswitch□Others警衛(wèi)人數(shù)公司雇員□保安公司□NumberofGuardsTheguardsareemployeeof□theInsured□securitycompany?巡邏無□有□頻率記錄有□無□Dotheguardspatrolthefactory?□YES□NOIfYES,howfrequentdotheguardspatrol?IfYES,arethepatrolsrecorded?□YES□NO廠內(nèi)全職消防隊無□有□隊員人數(shù)Aretherefull-timefirefightersinthefactory?□YES□NOIfYES,howmanyfirefighters?

離廠最近之消防隊距離反應(yīng)速度Whatisthedistancebetweenthefactoryandthenearestfirestation?Howlongwillittakeforthefirefightersfromthefirestationtothefactory?防洪設(shè)施 與市政雨水管網(wǎng)(河、溝、渠)相連的排雨水系統(tǒng)□防洪墻□高度米防洪閘門□沙袋數(shù)量袋汛期堆放位置 防洪抽水機□數(shù)量臺 倉儲物品加墊板□高度厘米Measurestakentocontrolorpreventfloodrisk:□Drainagesystemconnectingwithmunicipaldrainagesystem(orriver,raceway,oraqueduct)□Floodwall,(height:)□Floodgate□Sandbags,(quantity:,pilinglocationinfloodseason:)□Waterpumpforfloodprevention,(quantity:)□Platformboardforstocks,(height:) 管理7.Management禁煙措施 全廠禁煙□固定吸煙點□無禁煙條例□Isthereanysmoke-freemeasuretakeninyourfactory?□YES,thewholefactoryissmoke-free□YES,butthereissmokingareainthefactory□NO防滅火措施禁止吸煙和使用明火□良好的靜電接地□ 使用防爆型的電器設(shè)備和照明燈具□裝有可燃氣體濃度檢測報警裝置□ 防火分區(qū)□保持工作場所整潔□ 電氣設(shè)備和熱工設(shè)備周圍禁止堆放易燃或可燃物品□Firepreventionmeasures:□Prohibitiononfireandsmoking□Staticelectricityearth□Usageofexplosion-proofelectricalequipmentandlights□Detectionandalarmsystemtodetectthedensityofcombustiblegas□Firecompartment□Goodhousekeeping□Prohibitiononputtingcombustibleorflammablematerialsaroundtheelectricalequipmentorhotworkingequipment動火許可制度無□有□書面記錄有□無□Doyouhavehotworkpermit?□YES□NOIfYES,doyouhavewrittenrecord?□YES□NO定期消防設(shè)施維護無□有□書面記錄有□無□Doyoucheckandmaintainthefire-fightingfacilities?□YES□NOIfYES,doyouhavewrittenrecord?□YES□NO防火安全責任制無□有□Haveyoumadefirepreventionresponsibilityplan?□YES□NO防火安全管理機構(gòu)無□有□動火許可制度無□有□風險控制預(yù)案無□有□消防管理制度無□有□名稱Haveyouorganizedafirepreventionmanagementteam?□YES□NOHaveyougothotworkpermit?□YES□NOHaveyoumaderiskcontrolplan?□YES□NOHaveyousetupFire-fightingmanagementsystem?□YES□NO廠內(nèi)自檢程序無□有□書面記錄有□無□Isthereanyself-testprocedure?□YES□NOIfYES,doyouhavewrittenrecord?□YES□NO廠內(nèi)應(yīng)急編組無□有□人數(shù)訓(xùn)練頻度Doyouhaveanyinneremergencyteam?□YES□NOIfYES,howmanypeople?IfYES,onwhatfrequencyarethetrainingsprovidedforsuchteam?保安措施圍墻防護設(shè)施□防盜報警裝置□監(jiān)控攝像頭□數(shù)量個專職保安□人數(shù)人門衛(wèi)□出入大門登記制度□夜間、公休日和節(jié)假日均有人值班□Securitymeasures□Defensivehedge□Burglaryalarm□Closed-circuittelevision,quantity:□Fulltimeguards(quantity:)□Gatekeeper□Registrationforentranceandexit□Rotasystematnight,onweekendsandholidays自然災(zāi)害8.Naturehazards地震災(zāi)害記錄Earthquakerecord地震帶地震等級Seismicbelt:Earthquakeintensity(Metcalli)andmagnitude(Richer):建筑物特殊抗震設(shè)計Specialdesignfortheearthquakeresistanceofthestructure:暴雨、洪水災(zāi)害記錄Rainstormandfloodrecord附近水系及離廠距離Distanceawayfromnearestriver,lake,seaorotherwatersystem:風暴災(zāi)害記錄Windstormrecord:每年風暴發(fā)生次數(shù)Frequencyofwindstormperyear:其他Otherhazards:出險理賠記錄9.Claimsrecord:列明以前曾發(fā)生的索賠事例Pleasestateclaimshappenedinthepast.日期Date出險情況Lossordamage索賠金額Claimamount1234投保人聲明：上述陳述及詳細資料均屬真實，未錯報或隱瞞任何資料的實情。本人（本公司）同意以本調(diào)查表連同投保人提供的其他資料成為保險合同成立的基礎(chǔ)。WeherebydeclarethatthestatementsmadebyusintheQuestionnaireandProposalFormare,tothebestofourknowledgeandbelief,completeandtrue,andweherebyagreethatthisQuestionnaireandProposalFormconstitutethebasisandarepartofanypolicyissuedinconnectionwiththeaboverisks.投保人（簽章）SignatureoftheApplicant(Stamped)年月日Date

中國人民財產(chǎn)保險股份有限公司×××分公司財產(chǎn)××險（2009版）風險問詢表－－商業(yè)性企業(yè)PICCPropertyandCasualtyCompanyLimitedQuestionnairefor××Insurance(2009)Commercialrisk一、基本概況1.BasicInformation企業(yè)名稱：Nameofenterprise:詳細地址：郵政編碼：Address:Postalcode:國有企業(yè)□私有企業(yè)□合資企業(yè)□其他□□State-ownedenterprises□Privateenterprise□JointVenture□Others保險財產(chǎn)處于河（海、湖、水庫）邊，相距米□山坡上□山腳下□低洼處□平原□市區(qū)□郊區(qū)□ThePropertyInsuredislocated□attheriverside(seasideorsidebylakeorreservoir),withdistanceofM□onthehillside□atthefootofthehill□inlow-lyingareas□ontheplain□intheurbanarea□inthesuburb保險財產(chǎn)的周圍環(huán)境SurroundingsofthePropertyInsured東：距離米，East：;Distance:M西：距離米，West：;Distance:M南：距離米，South：;Distance:M北：距離米，North：;Distance:M開業(yè)時間年月平均日營業(yè)額Businessinitiatingdate:yearmonthAverageturnoverperday:主要經(jīng)營項目現(xiàn)有員工人數(shù)Generaloperations:Numberofemployees:營業(yè)時間每天小時Businesstime:_____hoursperday.二、存貨物資2.Stock儲存方式倉儲□露堆□罩棚□其他□Thestockisstored□inthewarehouse□intheopenair□undertheawning□inotherplaces存儲地點如多個地點，需列明1. 2.3.PleasestatetheLocation(s)ofStorage:1. 2.3.易燃易爆物質(zhì)無□有□名稱IsthereanyInflammableandexplosivematerial?□YES□NOIfYES,pleasestatethename:可燃液體的防滅火設(shè)施防雷電口防靜電口防明火口自動滅火裝置口Fireprotectionfacilitiesforcombustibleliquid:□lightningprotectionfacility□electrostaticpreventionfacility□firepreventionfacility□automaticfireextinguishingequipment上年度存貨量最大值平均值Valueofstockoflastyear:Maximumvalue:Averagevalue:三、建筑物3.Building(s)建筑物概況Basicinformationofthebuilding(s)名稱占地面積(m2)高度(m)層數(shù)層投入使用時間年月自有□租用□有無共用單位有□無□Name:Area:m2Height:MStorey:Thedateofcommercialuse:Thebuilding(s)is/are□owned□rented.Is/arethebuilding(s)usedwithothers?□YES□NO使用情況：（填A(yù)BC）建筑物名稱Nameofbuilding結(jié)構(gòu)Structure層次（包括地下室）Storey(includingbasement)用途Occupation保險財產(chǎn)項目PropertyInsured說明:Note:1.建筑物結(jié)構(gòu)：A鋼筋混凝土結(jié)構(gòu)B鋼結(jié)構(gòu)C磚砌/石頭D木材E其他，請注明；1.Structure:A.reinforcedconcretestructure,B.steelstructure,C.Brickorstonestructure,D.Woodenstructure,E.others,pleasestatehere:2.建筑物用途：A辦公B住宿C飲食D商場E娛樂場所F銀行G郵局H倉庫I車庫J小商品批發(fā)市場、K建材城(市場)、L其他（要注明）；2.Occupation:A.Office;B.Dormitory;C.FoodanddrinkD.ShopE.EntertainmentF.BankG.PostofficeH.WarehouseI.GarageJ.WholesalemarketforsmallcommoditiesK.ConstructionmaterialsmarketL.Others裝修:Decoration電氣線路有無穿套保護套管有□無□Aretheelectricalwireswithprotectivesleeves?□YES□NO有無可靠的保險裝置 有□無□Aretherereliablesafetydevices?□YES□NO 有無亂拉亂接電線？有□無□Aretheelectricalwiresingoodorder?□YES□NO電線是否老化？是□否□Aretheelectricalwiresaging?□YES□NO裝飾完工時間年月Completiondateofthedecoration:yearmonth有無足夠?qū)挾鹊南劳ǖ? 有□無□Istherefireescapewithenoughspace?□YES□NO消防通道有無被堵塞或占用有□無□Isthefireescapekeptclear?□YES□NO裝修工程是否經(jīng)過當?shù)毓蚕辣O(jiān)督機構(gòu)的審批是□否□Havethedecorationworkbeenapprovedbythelocalfiredepartment?□YES□NO建筑物內(nèi)有無使用明火 有□無□Isthereanyusageoffireinthebuilding?□YES□NO所在位置用途IfYES,pleasestatethelocationandpurposeofthefire.四、防護設(shè)施Protectiveandpreventivefacilities自動滅火裝置水噴淋滅火口二氧化碳滅火口鹵代烷滅火口泡沫滅火口Automaticfireextinguishingsystem:□Sprinklingsystem□Carbondioxidefireextinguishingsystem□Halonfireextinguishingsystem□Foamfire-fightingsystem市政消防供水：主管直徑壓力靜壓殘壓Municipalfire-fightingwatersupply:Diameterofmainpipe:Pressure:HydrostaticpressureResidualvoltage:消防水箱數(shù)量儲存量M其他Fire-fightingwatertank(s):Quantity:Volume:MOthers消防水泵總數(shù)柴油□電力□自動□手動□Fire-fightingwaterpump(s):Quantity:Type:□Diesel□Electrical□Automatic□Manual消防泵＃1□2□出水量揚程Firepump(s):1□2□Wateroutflow:Pumphead:噴淋泵＃1□2□出水量揚程Sprinklingpump(s):1□2□Wateroutflow:Pumphead:室外消防栓數(shù)量室內(nèi)消防栓數(shù)量Quantityofoutdoorfirepumps:Quantityofindoorfirepumps:滅火器干粉□二氧化碳□泡沫□其他□數(shù)量Typeoffireextinguisher:□Drypowder□Carbondioxide□Foam□OthersQuantityofeach:_____________________________________________特殊消防系統(tǒng)無□有□二氧化碳系統(tǒng)□煙烙系統(tǒng)□水噴霧系統(tǒng)□泡沫滅火系統(tǒng)□煙霧抽取系統(tǒng)□自動噴淋系統(tǒng)□其他□Isthereanyspecialfire-fightingsystem?□YES□NO□carbondioxidesystem□INERGENsystem□watersprayingsystem□foamfire-fightingsystem□Smokeextractsystem□automaticsprinklingsystem□others火災(zāi)探測系統(tǒng)無□有□Istherefiredetectionsystem?□YES□NO感煙型口感溫型口采樣型口其他口□Smokedetectionsystem□Temperaturedetectionsystem□Samplingbaseddetectivesystem□Others現(xiàn)有消防設(shè)施是否取得由消防部門簽發(fā)的《建筑工程消防驗收意見書》或其它消防合格證書：是（）否（）HaveyougotFirePreventionInspectionReportonConstructionsorotherfirepreventioncertificationissuedbythefiredepartmentontheexistingfire-fightingfacilities?□YES□NO《建筑工程消防驗收意見書》內(nèi)說明的使用等級為：丙類及以下危險等級（）；超過丙類的危險等級（）Whatistheclassificationoftheplantand/orthewarehousestatedintheFirePreventionInspectionReportonConstructions?Riskclassequaltoorbelow丙類Riskclasshigherthan丙類防盜警報系統(tǒng)無□有□紅外線□錄像監(jiān)控□門磁□其他□Isthereanyburglaryalarmsystem?□YES□NO□Infrared□Closed-circuittelevision□Magneticswitch□Others警衛(wèi)人數(shù)公司雇員□保安公司□NumberofGuardsTheguardsareemployeeof□theInsured□securitycompany?組建義務(wù)消防隊無□有□隊員人數(shù)一般員工是否會使用滅火器材是□否□Haveyouorganizedpart-timefirefightingteam?□YES□NOIfYES,howmanymembers?

Doyounormalemployeesknowhowtousethefirefightingfacilities?□YES□NO最近之消防隊距離反應(yīng)速度Whatisthedistancebetweenthefactoryandthenearestfirestation?Howlongwillittakeforthefirefightersfromthefirestationtothefactory?防洪設(shè)施 與市政雨水管網(wǎng)(河、溝、渠)相連的排雨水系統(tǒng)□ 防洪墻□高度米防洪閘門□ 沙袋數(shù)量袋汛期堆放位置 防洪抽水機□數(shù)量臺 倉儲物品加墊板□高度厘米Measurestakentocontrolorpreventfloodrisk:□Drainagesystemconnectingwithmunicipaldrainagesystem(orriver,raceway,oraqueduct)□Floodwall,(height:)□Floodgate□Sandbags,(quantity:,pilinglocationinfloodseason:)□Waterpumpforfloodprevention,(quantity: