出口产品责任险投保书.doc

Pageof5

出口产品责任险投保书
EXPORTPRODUCTSLIABILITYINSURANCEAPPLICATION

本公司对问卷各项填写内容，除作为核保及其它保险程序上的参考外，不另为其它用途，并予以保密。
Theinformationprovidedherewillbeusedforinsuranceunderwritingandrelatedprocessingonly,andwillbekeptconfidential.

PartI–基本信息BasicInformation1.投保人/被保险人名称及注册地址
Name&addressofapplicant/insured(includingallsubsidiaries):

2.被保险人成立形式TheLegalFormoftheInsured
□独资Individual_________□合伙Partnership_________□公司Corporation__________□合资Jointventure______3.请选出被保险人的经营性质
PleasetickthebusinessnatureoftheInsured:
□制造商Manufacturer__________□经销商Distributor_________□贸易公司TradingCompany_________
□其它(请说明)other(pleasestate)_________________
4.投保公司从事该行业几年？如果有的话，请提供公司网址
HowlonghastheInsuredbeeninthisbusiness?Pleaseprovidecompanywebaddress,ifthereisone.

5.被保险人在美国或加拿大有分支机构或代表处？如有,请提供以下资料
DoestheInsuredhaveanysubsidiaries,affiliatesorrepresentativeofficeintheUSA
and/orCanada?IfYES,pleasegivethefollowingdetails:□Yes□No

公司名称NameofCompany:_______________________________________________
公司性质BusinessNature:____________________________________________
地址Address:_______________________________________________________
与被保险人关系RelationshipwiththeInsured:________________
PARTII-产品信息PRODUCT(s)INFORMATION(请附产品说明书、产品目录、测试报告、用户使用手册。PleaseattachProductBrochures,Catalogue,TestingReports,UserManuals)1.1）请简要说明贵公司目前所生产或销售的所有产品,并说明所需承保的产品。
Pleaselistallproductsproducedand/ordistributedbyyouandspecifytheproductstobeinsured.

______________________________________________________________________________
2）贵公司从事生产或销售这些产品多长时间?Howmanyyearshaveyoubeenmanufacturingordistributingtheseproducts?

______________________________________________________________________________2.预期产品的生命期限Whatisthelifeexpectancyofyourproduct?

_______________________________________________________________________________最近五年内是否有已停止生产或销售的产品？如有，请简要说明Arethereanyproductsthatarenolongermanufacturedordistributedbyyouduringthepastfive□YES□NO
years?IfYES,pleasedescribe.

未来一年内是否预计推出新的产品？如有，请说明。
Areanynewproductsproposedfo