机器损坏险保险合同2019新

1.机器损坏险投保单

MACHINERY BREAKDOWN INSURANCE APPLICATION

保单号

Policy No.

本投保单由投保人尽可能如实地、详细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。

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.

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1.被保险人名称和地址Name and Address of the Insured: |

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2.营业性质Nature of Business: |

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3.被保险机器所在地Location of Machinery to be Insured: |

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4.保险期限: 个月, 年月日零时起至年月日二十四时止| Period of Insurance: Months, from 0:00 of to 24:00of |

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5.被保险项目及保险金额Insured Items and Sum Insured |

项目保险金额每次事故*免赔额|

Insured Items Sum Insured Deductible for Any One Accident* | 5.1 保险财产(详见背面) |

Property Insured(Look Overleaf) ------------- ----------|

5.2 附加费用Additional Expenses |

清除残骸费用|

Debris Removal Expenses ------------- ----------|

灭火费用|

Fire Extinguishment Expinses ------------- ----------|

专业费用|

Professional Expenses ------------- ----------|

其他费用|

Other Expenses ------------- ----------|

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6.总保险金额Total Sum Insured: |

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7.保险费率Premium Rate: |

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