產(chǎn)品責(zé)任保險投保單樣本

1、產(chǎn)品責(zé)任險投保單PROPOSAL FOR PRODUCTS LIABILITY INSURANCE投保單號Proposal 用尊敬的投保人：歡迎您來本公司投保。請您在保險人明確說明本保險的保險條款后，如實 填寫本投保單及保險標(biāo)的風(fēng)險詢問表（如有），并特別注意保險條款及投 保單中的保險責(zé)任、責(zé)任免除及投保人、被保險人義務(wù)等內(nèi)容。投保人網(wǎng)址 Applicant Website 投保人地址郵編 Address of ApplicantPost Code聯(lián)系人電話電子信箱ContactTelephoneE-mail被保險人網(wǎng)址Insured被保險人地址Address of Insured聯(lián)系人Cont

2、act營業(yè)性質(zhì)Nature of Business保險期限Period of Insurance 電話TelephoneWebsite 郵編 Post Code電子信箱E-mail序號No.個月自年_日時起，至年_日時止Months From at Toat投保產(chǎn)品情況Information of the Insured Products銷售額Sales產(chǎn)品名稱型號規(guī)格單價上一年本年明年 Name of Product Standard of Type PriceLast year This year next year (estimate名稱 Name 供應(yīng)商 Supplier 原料及零部件

3、Raw Materialsand / or Parts直接及間接用途Direct &Indirect Use質(zhì)量標(biāo)準(zhǔn)Standard of Quality獲得何種xxAny License (s)銷售地區(qū)Market Area投產(chǎn)時間Put Into Production in產(chǎn)品的包裝Description of the Products產(chǎn)品的歷史History of The Products發(fā)生時間Time of Occurrence 事故原因Cause of Accident 損失金額 Loss Amount Limits of Indemnity免賠額/率Deductible賠

4、償基礎(chǔ)追溯期費率（o） Indemnity Basis Retroactive Rate預(yù)收保險費：幣種（大寫）（小寫）Deposit Premium Currency最低保險費：幣種（大寫）（小寫）Minimum Premium Currency年 月日保險費繳付日期Date of Payment承保區(qū)域司法管轄Coverage territory Jurisdiction其它保障 Other Extensions：是否已向其他保險公司投保與本保險標(biāo)的有關(guān)的保險？如是，請列明保險公司名稱、保險種類、保險金額和主要保險條件：特另U約定 Special Agreement1 .本保險合同適用中國

5、保險監(jiān)督管理委員會1998年12月2日保監(jiān)發(fā)【1998】3號頒布的財產(chǎn)險2000年問題除外責(zé) 任條款。The Contract of Insurance will be subject to those exclusions in respect of property damage arising from the Y2K issue (Millennium Bug), as promulgated by the Chinese Insurance Regulatory Commission (CIRC), December 2nd1998.2 .本保險合同自保險人核保并簽發(fā)保險單后成立，自

6、投保人依約繳費后生 效，保險人自本保險合同生效后開始承擔(dān)保險責(zé)任。3 .本保險合同一律采用書面形式，雙方不認(rèn)可其他形式的約定。Only the written form contract will be operated, any other form will be not approved.4 .因履行保險合同發(fā)生爭議的，一方可向仲裁委員會依該會屆時有效的仲裁 規(guī)則申請仲裁。In the event of any dispute arising from its implementation or enforcement,either of the parties to the Contr

7、act of Insurance may make application to the Arbitration Committee, whose judgements shall be given inaccordance with such rules of arbitration as are then in effect.隨附產(chǎn)品資料 Together With The Following Documents(1)產(chǎn)品說明書(2)質(zhì)量合格證書 (3)安全警告標(biāo)記ManualCertification of QualitySafety Warning Mark(5)質(zhì)量檢驗報告(6)銷售

8、合同(7)設(shè)計圖紙 Quality Inspection Report Contract of Sale Design Drawin我 人限額 Limits of Person :累計賠償限額 Aggregate Limits of Indemnity :(4) xx(8)其他License(s)Else投保人聲明：1 .本人填寫本投保單之前，保險人已就本投保單及所附保險條款的內(nèi)容，尤 其是就保險人免除及減輕責(zé)任的條款、投保人和被保險人義務(wù)條款及本投保單 中的特別約定條款向本人作了明確說明，本人對該保險條款及保險條件已了解 并同意接受。2 .本投保單及保險標(biāo)的風(fēng)險詢問表（如有）所填各項內(nèi)容均屬

9、事實，同 意以本投保單及保險標(biāo)的風(fēng)險詢問表（如有）作為保險人評定保險標(biāo)的風(fēng) 險的基礎(chǔ)和簽發(fā)保險單的依據(jù)。I/we declare that the answers given and the statements made on the Application Form and in the Schedule of Declared Risks are in every respect true and accurate and that no information has been withheld which the Insurer might reasonably consider relevant to a decision to accept this proposal.I/we understand that the Insurer is issuing the Policy