机器损坏险投保单
machinery breakdown insurance application 保单号：___________________
policy no. ________________
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
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 of to 24:00of5.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 expenses6.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