国际贸易保险责任书.doc

1、出口产品责任险投保书EXPORT PRODUCTS LIABILITY INSURANCE APPLICATION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。The information provided here will be used for insurance underwriting and related processing only, and will be kept confidential.Part I 基本信息 Basic Information1. 投保人/被保险人名称及注册地址Name & address of appl

2、icant /insured (including all subsidiaries):2. 被保险人成立形式 The Legal Form of the Insured 独资 Individual _ 合伙Partnership _ 公司Corporation _ 合资Joint venture_3. 请选出被保险人的经营性质 Please tick the business nature of the Insured: 制造商 Manufacturer _ 经销商 Distributor _ 贸易公司 Trading Company _ 其它(请说明) other (please stat

3、e) _4. 投保公司从事该行业几年？如果有的话，请提供公司网址How long has the Insured been in this business? Please provide company web address, if there is one.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 Does the Insured have any subsidiaries, affiliates or representative office in the USA and/or Canada? If YES, please give the follo

4、wing details: Yes No 公司名称 Name of Company: _ 公司性质 Business Nature: _ _ 地址 Address: _ _ 与被保险人关系 Relationship with the Insured: _ _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。Please attach Product Brochures, Catalogue, Testing Reports, User Manuals)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

5、保的产品。 Please list all products produced and/or distributed by you and specify the products to be insured. _ 2）贵公司从事生产或销售这些产品多长时间? How many years have you been manufacturing or distributing these products? _2. 预期产品的生命期限 What is the life expectancy of your product? _ 3. 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Ar

6、e there any products that are no longer manufactured or distributed by you during the past five YES NO years? If YES, please describe. 4. 未来一年内是否预计推出新的产品？如有，请说明。 Are any new products proposed for introduction during the ensuing year? If YES, please specify: YES NO *请注意：任何新增加的产品必须通知本公司, 并经本公司书面同意后才能受

7、本保险保障。 *Note: Any additional product must be reported to the Company and will be covered only upon written acceptance by the company.5. 产品是否全部由贵公司自行设计? Are all of your products designed by yourself? YES NO6. 贵公司的产品是否作为其它产品的零组件?若是，请指明 Are there any products sold as component parts for other products?

8、 If YES, please specify: YES NO 7. 1）贵公司所售的产品是否有以其它名称来销售? 如有，请说明并提供其所占比例。 Are any of your products sold under another name or label? If YES, please describe and give YES NOPercentage. _ 2）如有，请问此产品是由贵司设计还是买方设计？ YOUR COMPANYAre such products made to your specification or those of the buyer? BUYER 8. 贵

9、公司是否向他人购买原料或零组件?Do you purchase materials or components from others? YES NO9. 贵公司的产品是否用于下列项目或与其有关 Could any of your products or services be used on or in connection with: * 航空器/飞弹/太空方面 aircraft/missile/aerospace? YES NO * 水上或海上交通工具 watercraft or offshore? YES NO * 内陆交通运输 transportation/transit? YES NO * 维生、复健设备 life support service? YES NO 如有