( 合同范本 )
甲方：
乙方：
日期：年月日
精品合同 / Word文档 / 文字可改
机器损坏险保险合同(合同范
本)
The clear rights and obligations of both parties facilitate the cooperation of both parties, provide a basis for resolving disputes in the future, and prevent possible risks.
机器损坏险保险合同(合同范本)
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.
1.被保险人名称和地址Name and Address of the Insured:
2.营业性质Nature of Business:
3.被保险机器所在地Location of Machinery to be Insured:
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 ofto 24:00of
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
6.总保险金额Total Sum Insured:
7.保险费率Premium Rate:
8.保险费Premium:
＊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
Item
型号
Model
数量
Qty.
主要技术参数
Major Tech. Parameter
制造商Manufacturer
制造年份
Year of Manu.
保险金额
Sum Insured
维护及保用期情况
Maintenance & Un-expiredGuarantee Perio
说明：
（1）主要技术参数指机器的输出功率、速度、容量、负荷等，如属电器设备，应说明电压、电流量、转速，如属蒸气设备，应说明燃料、压力和温度。
（2）维护情况指自行维护（A）、由指定厂家维护（B）、由生产厂家
维护（C）。
Note:
(1)Major Technical Parameter:Output, Speed, Capacity, Loading etc. and for Electrical Equipment, Voltage, Amperage, Cycles. and for Steam Equipment, Fuel, Pressure and Temperature. (2)Maintenance: By Insured(A), By Contractor(B), By Manufacturer(c).
9.以前这些机器发生是否发生过损坏？（以往5年）是否
Previous Losses Experience(Last 5 Years) Yes No
项目Item
损坏时间Breakdown Timed
损失金额Loss Amount
10.有无制定操作规程？是否
Any Operating System? If Yes, Please State.YesNo
11.操作人员Operator:
11.1 新员工上岗前是否进行岗位教育和培训？是否