[标准合同]机器损坏险保险合同.pdf

机器损坏险保险合同 1. 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 pany for Machinery Breakdown Insurance and constitute an integral part of the Machinery Breakdown In- surance Policy. 1. 被保险人名称和地址 Name and Address of the Insured: | | 2. 营业性质 Nature of Business: | | 3. 被保险机器所在地 Location of Machinery to be Insured: | | 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 of to 24:00of | | 第 1 页 共 12 页 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 Items Sum Insured Deductible 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 | | 6. 总保险金额 Total Sum Insured: | | 7. 保险费率 Premium Rate: | | 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 第 2 页 共 12 页 Specification of Machinery to be Insured 项目 型号 数量 主要技术参数 制造商 制造年份 保险金额 维护及保用期 情况 Item Model Qty. Major Tech. Manufacturer Year of Manu. Sum Insured Maintenance & Un-expired Parameter Guarantee Period | | | ________________________________________________ | | | | ________________________________________________ | | | | ________________________________________________ | | |