I declare that above is true to the best of my knowledge and belief, and hereby agree that the application be incorporated into the policy. I have read and understand the Company's cargo transportation insurance clauses and extensions(including the Exclusions and the applicant's or insured's Obligations).
投保人签章: Name /Seal of Proposer: 送单地址: 同上 或 Delivery address: Ditto or Copyright: 我的物流吧
联系地址: Address of Proposer: 日期: Date: Year
电话: Tel:
Month
Day
/my568 1
集装箱运输: 是 Container Load Yes
否
整船运输: 是 Yes
否 No
Full Vessel Charter
起运日期: Slg. on or abt. 至: To: 保险金额 Amount Insured: 保险费 Premium: Year Month Day
投保人兹声明上述所填内容属实, 同意以本投保单作为订立保险合同的依据; 对贵公司就货物运输险保险条款及附加条 投保人兹声明上述所填内容属实, 同意以本投保单作为订立保险合同的依据; 款及附加险条款( 括责任免除和投保人及被保险人义务部分)的内容及说明已经了解. 款及附加险条款(包括责任免除和投保人及被保险人义务部分)的内容及说明已经了解.
中国平安财产保险股份有限公司
PING AN PROPERTY & CASUALTY INSURANCE COMPANY OF CHINA,LTD
货 物 运 输 险 投 保 单
APPLICATION FOR TRANSPORTATION INSURANCE
被保险人
Insured:
本投保单由投保人如实填写并签章后作为向本公司投保货物运输保险的依据, 本投保单为该货物运输保险单的组成部分.
The Applicant is required to fill in the following items in good faith and as detailed as possible, and affix signature to this application, which shall be treated as proof of application to the Company for cargo transportation insurance and constitute an integral part of the insurance policy covering c明如下: Please state risks insured against and conditions:
装载运输工具(船名/车号) : 船龄: Per Conveyance S.S. 发票或提单号 Invoice No. or B/L No. 自: From: 发票金额 Amount Invoice: 费率 Rate: 备注:合同号: Remarks: 经: Via: Age of Vessel
兹拟向中国平安财产保险股份有限公司投保下列货物运输保险: Herein apply to the Company for Transportation Insurance of following cargo: 请将保险货物项目,标记,数量及包装注明此上. Please state items, marks, quantity and packing of cargo insured here above.