新版机器损坏险保险合格式
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1机器损坏险投保单
machinery breakdown insurance application
保单号
policy no
投保单投保实详细填写签章作公司投保机器损坏险
投保单该机器损坏险保险单组成部分
the applicant is required to fill in the following items with utmost faith and as detailed as pos
sible and affi_ signature to this application which shall be the basis of application to the pany
for machinery breakdown insurance and constitute an integral part of the machinery breakdown in
surance policy
1保险名称址name and address of the insured
2营业性质nature of business
3保险机器location of machinery to be insured
4保险期限 月 年 月 日零时起 年 月 日二十四时止
period of insurance months from 000 of to 2400of
5保险项目保险金额insured items and sum insured
项目 保险金额 次事_免赔额
insured items sum insured deductible for any one accident_
51 保险财产(详见背面)
property insured(look overleaf)
52 附加费additional e_penses
清残骸费
debris removal e_penses
灭火费
fire e_tinguishment e_pinses
专业费
professional e_penses
费
other e_penses
6总保险金额total sum insured
7保险费率premium rate
8保险费premium
_次事指次事事件引起系列事
the words any one accident chall mean any one accident or series of accident arising out of one event
保险机器详细说明
specification of machinery to be insured
项目 型号 数量 技术参数 制造商 制造年份 保险金额 维护保期情况
item model qty major tech manufacturer year of manu sum insured maintenance & une_pired
parameter guarantee period
________________________________________________
________________________________________________
________________________________________________
保险机器详细说明
specification of machinery to be insured
项目 型号 数量 技术参数 制造商 制造年份 保险金额 维护保期情况
item model qty major tech manufacturer year of manu sum insured maintenance & une_pired
parameter guarantee period
________________________________________________
________________________________________________
________________________________________________
说明(1)技术参数指机器输出功率速度容量负荷等属电器设备应说明电压电流量转速属蒸气设
备应说明燃料压力温度
(2)维护情况指行维护(a)指定厂家维护(b)生产厂家维护(c)
note(1)major technical parameteroutput speed capacity loading etc and for electrical equipment voltage amperage
cycles and for steam equipment fuel pressure and temperature
(2)maintenance by insured(a) by contractor(b) by manufacturer(c)
9 前机器发生否发生损坏(5年) 否
previous losses e_perience(last 5 years) yes no
项目item _____________________________________
损坏时间breakdown timed _____________________________________
损失金额loss amount _____________________________________
10 制定操作规程 否
any operating system if yes please state yes no
11 操作员operator
111 新员工岗前否进行岗位教育培训 否
were the new operator trained before taking up new post yes no
112 操作员否持证岗 否
are the operator working with qualitication certificate yes no
113 均岗时间the average time of employment in this post
12 维修情况condition of maintenance
121 配置专业维修员 数 否
any trained maintenance worker yes numbers______ no
122 否进行日常维修保养 否
any daily maintenance yes no
123 修隔____月进行次ovrhaul every______months
124 否生产厂家求规定进行维修保养 否
procedures ply with the requirement of manufacturer yes no
13 特条款specila provisions
14 备注remarks
投保保险兹声明填述容属实贵公司安装工程切险条款附加容(包括责免部
分)说明已解意该条款附加容投保安装工程切险
iwe(the applicant & the insured) to hereby declare that the above contents are truly filled in and that iwe
have understood the panys e_planation on the clauses of erection all risks insurance and its additional
contents (including e_clusions) and that iwe agree to apply for erection all risks insurance subject to the
abovementioned clauses and its additional contents
投保保险(签章) 电话
signatures of the applicant & the insured ____________ telephone ____________
址 日期
address _____________________________ date_______________
________________________________________________________
容保险公司填写for office use only
办日期___________________________ 核保日期____________
2中国太洋保险公司机器损坏险条款
责范围
保险期保险单明细表中列明保险机器附属设备列原引起构成突然预料意外事造成物质损坏灭失(简称损失)公司保险单规定负责赔偿
()设计制造安装错误铸造原材料缺陷
(二)工技术员操作错误缺乏验技术善疏忽失恶意行
(三)离心力引起断裂
(四)超负荷超电压碰线电弧漏电短路气放电感应电电气原
(五)条款中二外责规定外原
二外责
公司列原直接间接引起损失费责负责赔偿
()机器设备运行必然引起果然磨损氧化腐蚀孔蚀锅垢等物理性变化化学反应
(二)种传送带缆绳金属线链条轮胎调换代钻头钻杆刀具印刷滚筒套筒活动道玻璃磁陶钢筛网筛毛毡制品切操作中媒介物(润滑油燃料催化剂等)种易损易耗品
(三)保险代表已知道应该知道保险机器附属设备保险开始前已存缺点缺陷
(四)根法律契约供货方制造安装修理负责损失费
(五)公设施部门限制性供应意行非意外事引起停电停气停水
(六)火灾爆炸
(七)震海啸雷电飓风台风龙卷风风暴暴雨洪水冰雹崩山崩雪崩火山爆发面陷沉然灾害
(八)飞机坠毁飞机部件飞行物体坠落
(九)机动车碰撞
(十)水箱水爆裂
(十)保险代表意行重失
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