机器损坏险保险合同

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 of    to 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

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