协议编号：LX-FS-A52417 机器损坏险保险合同标准范本
After Negotiation On A Certain Issue, An Agreement Is Reached And A Clause With Economic Relationship Is Concluded, So As To Protect Their Respective Legitimate Rights And Interests.
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时间：________年_____月_____日
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机器损坏险保险合同标准范本
使用说明：本协议资料适用于经过谈判或共同协商的某个问题，在取得一致意见后并订立的具有经济或其它关系的契约条款，最终实现保障各自的合法权益的结果。资料内容可按真实状况进行条款调整，套用时请仔细阅读。
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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8.保险费premium: |
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*每次事故指不论一次事故或一个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.
被保险机器的详细说明
specification of machinery to be insured
项目型号数量主要技术参数制造商制造年份保险金额维护及保用期情况
item model qty. major tech. manufacturer year of manu. sum insured maintenance & un-