第1页共22页本文格式为Word版下载后可任意编辑和复制机器损坏险保险合同1.机器损坏险投保单MACHINERYBREAKDOWNINSURANCEAPPLICATION保单号PolicyNo.本投保单由投保人尽可能照实地、具体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。TheApplicantisrequiredtofillinthefollowingitemswithutmostfaithandasdetailedaspos-sible.andaffixsignaturetothisapplication,whichshallbethebasisofapplicationtotheCompanyforMachineryBreakdownInsuranceandconstituteanintegralpartoftheMachineryBreakdownIn-第2页共22页本文格式为Word版下载后可任意编辑和复制surancePolicy.--------------------------------------------1.被保险人名称和地址NameandAddressoftheInsured:|-------------------------------------------|2.营业性质NatureofBusiness:|-------------------------------------------|3.被保险机器所在地LocationofMachinerytobeInsured:|-------------------------------------------|4.保险期限:个月,年月日零时起至年月日二十四时止|PeriodofInsurance:Months,from0:00ofto24:00of|-------------------------------------------|5.被保险项目及保险金额InsuredItemsandSumInsured|项目保险金额每次事故*免赔额|InsuredItemsSumInsuredDeductibleforAnyOneAccident*|第3页共22页本文格式为Word版下载后可任意编辑和复制5.1保险财产(详见背面)|PropertyInsured(LookOverleaf)-----------------------|5.2附加费用AdditionalExpenses|清除残骸费用|DebrisRemovalExpenses-----------------------|灭火费用|FireExtinguishmentExpinses-----------------------|专业费用|ProfessionalExpenses-----------------------|其他费用|OtherExpenses-----------------------|-------------------------------------------|6.总保险金额TotalSumInsured:|-------------------------------------------|第4页共22页本文格式为Word版下载后可任意编辑和复制7.保险费率PremiumRate:|-------------------------------------------|8.保险费Premium:|--------------------------------------------*每次事故指不论一次事故或一个大事引起的一系列事故Thewords"ANYONEACCIDENT"challmeananyoneaccidentorseriesofaccidentarisingoutofoneevent.被保险机器的具体说明SpecificationofMachinerytobeInsured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状况ItemModelQty.MajorTech.ManufacturerYearofManu.SumInsuredMaintenanceUn-expiredParameterGuaranteePeriod第5页共22页本文格式为Word版下载后可任意编辑和复制----------------------------------------------------|||________________________________________________||||________________________________________________||||________________________________________________|||----------------------------------------------------被保险机器的具体说明SpecificationofMachinerytobeInsured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状况ItemModelQty.MajorTech.ManufacturerYearofManu.SumInsured第6页共22页本文格式为Word版下载后可任意编辑和复制MaintenanceUn-expiredParameterGuaranteePeriod----------------------------------------------------|||________________________________________________||||________________________________________________||||________________________________________________|||----------------------------------------------------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。第7页共22页本文格式为Word版下载后可任意编辑和复制(2)维护状况指自行维护(A)、由指定厂家维护(B)、由生产厂家维护(C)。Note:(1)MajorTechnicalParameter:Output,Speed,Capacity,Loadingetc.andforElectricalEquipment...
