機(jī)器損壞險(xiǎn)保險(xiǎn)合同

第第頁機(jī)器損壞險(xiǎn)保險(xiǎn)合同

機(jī)器損壞險(xiǎn)投保單

machinerybreakdowninsuranceapplication

保單號：___________________

policyno.________________

本投保單由投保人盡可能照實(shí)地、具體地填寫并簽章后作為向本公司投保機(jī)器損壞險(xiǎn)的依據(jù)。本投保單為該機(jī)器損壞險(xiǎn)保險(xiǎn)單的組成部分。

theapplicantisrequiredtofillinthefollowingitemswithutmostfaithandasdetailedaspos-sible.andaffi*signaturetothisapplication,whichshallbethebasisofapplicationtothecompanyformachinerybreakdowninsuranceandconstituteanintegralpartofthemachinerybreakdownin-surancepolicy.

1.被保險(xiǎn)人名稱和地址nameandaddressoftheinsured:

2.營業(yè)性質(zhì)natureofbusiness:

3.被保險(xiǎn)機(jī)器所在地locationofmachinerytobeinsured:

4.保險(xiǎn)期限：個(gè)月，年月日零時(shí)起至年月日二十四時(shí)止

periodofinsurance:months,from0:00ofto24:00of

5.被保險(xiǎn)項(xiàng)目及保險(xiǎn)金額insureditemsandsuminsured

項(xiàng)目保險(xiǎn)金額每次事故＊免賠額

insureditemssuminsureddeductibleforanyoneaccident*

5.1保險(xiǎn)財(cái)產(chǎn)〔詳見背面〕

propertyinsured(lookoverleaf)

5.2附加費(fèi)用additionale*penses

清除殘骸費(fèi)用

debrisremovale*penses

滅火費(fèi)用

firee*tinguishmente*pinses

專業(yè)費(fèi)用

professionale*penses

其他費(fèi)用

othere*penses

6.總保險(xiǎn)金額totalsuminsured:

7.保險(xiǎn)費(fèi)率premiumrate:

8.保險(xiǎn)費(fèi)premium:

＊每次事故指不論一次事故或一個(gè)事項(xiàng)引起的一系列事故

thewordsanyoneaccidentchallmeananyoneaccidentorseriesofaccidentarisingoutofoneevent.

被保險(xiǎn)機(jī)器的具體說明

specificationofmachinerytobeinsured

項(xiàng)目

item

型號

model

數(shù)量

qty.