1.安装工程一切险投保单
ERECTION ALL RISKS 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安装工程险的
依据。本投保单为该工程保险单的组成部分。
The Applicant is required to fill in following items with utmost faith and as detailed as possi-
ble, and affix signature to this Application, which shall be the basis of application to the Company for
Erection All Risks Insurance and constitute an integral part of the Insurance Policy covering the pro-
ject.
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1.工程关系方的名称和地址 |
Name and Address of Parties to Project |
工程所有人 |
Principal ----------- |
承包人 |
Contractor ----------- |
工程分包人 |
Sub-Contractor ----------- |
其他关系方 |
Other Party(ies)Concerned ----------- |
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2.被保险人名称和地址: |
Name and Address of the Insured: |
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3.被保险工程名称 |
Title of Contract/Project: |
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4.被保险工程地点Location of Erection: |
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5.被保险项目、保险金额/赔偿限额及每次事故*免赔额 |
Insured Items、Sums Insured/Limits of Indemnity and Deductible for Any One Accident*: |
5.1 物质损失 Material Damage |
项目 投保金额 每次事故免赔额 |
Insured Items Sums Insured Deductible for Any One Accident* |
------------- ------------ ------------------------------- |
安装工程 |
Erection Works |
(1)安装工程设备价 |
(包括设备价、运费、保费、关税等) |
Value of Equipment to be Erected (including |
Value of Equipment, Freight, Insurance |
Premium and Customs Duty, etc.) ----------- |
(2)安装费 |
Cost of Erection ----------- |
土建项目 |
Civil Engineering Work ----------- |
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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 ACCIDEMT" shall mean any one accident or series of accident arising out of one event.
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工程所有人或承包人在工地上的其他财产 |
Principal"s or Contractor"s Property Existing |
on the Site ----------- |
施工用机具及设备(详见所附清单) |
Construction Plant and Equipment |
(According to the Attached List) ----------- |
清除残骸费用 |
Removal of Debris Expenses ----------- |
灭火费用 |
Fire Extinguishment Expenses ----------- |
专业费用 |
Professional Expenses ----------- |
其他费用 |
Other Expenses ----------- |
总保险金额 |
Total Sum Insured ----------- |
5.2 特种危险赔偿限额 Limits of Indemnity for Special Risks |
赔偿限额Limits of Indemnity(不超过保额80% Limit to 80% of Sum Insured) |
危险种类 Risks ------------------------------------ |
地震、海啸 |
Earthquake, Tsunami ----------- |
洪水、风暴、暴雨 |
Flood, Storm, Tempest ----------- |
每次事故免赔额(不低于损失的20%) |
Deductible for Any One Accident (Not Less than 20% of Loss) ----------- |
5.3 费率 |
Premium Rate ----------- |
5.4 总保险费 |
Total Premium ----------- |
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6. 保险期限 Period of Insurance |
6.1 安装期: 个月,自 年 月 日起至 年 月 日止 |
Erection Period: Months, From to |
6.2 试车期(可独立分开的项目单独试车) 个月,自 年 月 日起至 年 月 日止 |
Testing or Commissioning Period: Months, From to |
6.3 是否投保有限责任保证期?如是,请列明 ---是 ---否 |
| | | | |
Whether
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