機器損壞險投保單
machinery breakdown insurance application
保單號：___________________
policy no. ________________
本投保單由投保人儘可能如實地、詳細地填寫並簽章後作為向本公司投保機器損壞險的依據。本投保單為該機器損壞險保險單的組成部分。
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 company for machinery breakdown insurance and constitute an integral part of the machinery breakdown in-surance policy.
1.被保險人名稱和地址name and address of the insured:
2.營業性質nature of business:
3.被保險機器所在地location of machinery to be insured:
4.保險期限： 個月， 年 月 日零時起至 年 月 日二十四時止
period of insurance: months, from 0:00 of to 24:00of
5.被保險項目及保險金額insured items and sum insured
項目 保險金額 每次事故＊免賠額
insured items sum insured deductible for any one accident*
5.1 保險財產（詳見背面）
property insured(look overleaf)
5.2 附加費用additional expenses
清除殘骸費用
debris removal expenses
滅火費用
fire extinguishment expinses
專業費用
professional expenses
其他費用
other expenses
6.總保險金額total sum insured:
7.保險費率premium rate:
8.保險費premium:
＊每次事故指不論一次事故或一個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.
被保險機器的詳細說明
specification of machinery to be insured
項目
item
型號
model
數量
qty.
主要技術參數
major tech. parameter
製造商manufacturer