产品责任险投保单
PROPOSAL FOR PRODUCTS LIABILITY INSURANCE
投保单号
Proposal №：
尊敬的投保人：
欢迎您来本公司投保。

请您在保险人明确说明本保险的保险条款后，如实填写本投保单及《保险标的风险询问表》（如有），并特别注意保险条款及投保单中的保险责任、责任免除及投保人、被保险人义务等内容。

Before completing the Application Form and the Schedule of Declared Risks, you should understand completely the insurer’s terms & conditions of insurance. Special attention should be drawn to the insurer’s terms & conditions and those clauses dealing with exclusions and mitigations.
投保人Applicant 网址Website
投保人地址Address of Applicant 邮编Post Code
联系人Contact
电话
Telephone
电子信箱
E-mail
被保险人Insured 网址Website
被保险人地址Address of Insured 邮编Post Code
联系人Contact
电话
Telephone
电子信箱
E-mail
营业性质Nature of Business
保险期限Period of Insurance 个月自年月日时起，至年月日时止Months From at To at
投保产品情况
Information of the Insured Products
序号No. 产品名称
Name of Product
型号规格
Standard of Type
单价
Price
销售额Sales
上一年
Last year
本年
This year
明年
next year (estimate)
原料及零部件
Raw Materials
and / or Parts
名称Name 供应商Supplier
直接及间接用途
Direct &Indirect Use
质量标准
Standard of Quality
获得何种许可证
Any License（s）
销售地区
Market Area
投产时间
Put Into Production in
产品的包装
Description of the Products
产品的历史
History of The Products
以往损失索赔情况Loss And Claim in
Past Year
发生时间
Time of Occurrence
事故原因
Cause of Accident
损失金额
Loss Amount
本投保单内容以中文为准。

The interpretation of this proposal shall be subject to Chinese version.。