財(cái)產(chǎn)險(xiǎn)投保單(2009版) 英 V1

14位單證流水號(hào)14位單證流水號(hào)中國(guó)人民財(cái)產(chǎn)保險(xiǎn)股份有限公司財(cái)產(chǎn)××險(xiǎn)（2009版）投保單PICCPropertyandCasualtyCompanyLimitedProposalFormfor××Insurance(2009)ProposalFormNO.：**********************投保人Applicant單位名稱Name通訊地址CorrespondingAddress郵編：Postalcode:組織機(jī)構(gòu)代碼OrganizationCode聯(lián)系人Contactperson聯(lián)系電話Telephoneno.被保險(xiǎn)人Insured單位名稱Name通訊地址CorrespondingAddress郵編：Postalcode:組織機(jī)構(gòu)代碼OrganizationCode聯(lián)系人Contactperson聯(lián)系電話Telephoneno.行業(yè)類別：行業(yè)代碼：Industryclassification：IndustryCode：保險(xiǎn)標(biāo)的地址個(gè)數(shù)：共個(gè),詳見(jiàn)《財(cái)產(chǎn)××險(xiǎn)（2009版）投保標(biāo)的項(xiàng)目清單》NumberofLocation(s)ofinsuredproperty：Fordetails,pleaserefertotheListofInsuredPropertyfor××Insurance(2009)保險(xiǎn)標(biāo)的地址：郵編：Location(s)ofInsuredProperty：Postalcode:被保險(xiǎn)人資產(chǎn)及營(yíng)業(yè)額狀況注冊(cè)資本：總資產(chǎn)：上一年度實(shí)際營(yíng)業(yè)額：AssetsandturnoveroftheInsuredregisteredcapital:totalAssets:actualturnoveroflastyear:投保主險(xiǎn)險(xiǎn)種：□基本險(xiǎn)□綜合險(xiǎn)□一切險(xiǎn)TypeofInsurance:□FireInsurance□PropertyInsurance□PropertyAllRisksInsurance有關(guān)保險(xiǎn)標(biāo)的投保信息，請(qǐng)見(jiàn)《財(cái)產(chǎn)××險(xiǎn)（2009版）投保標(biāo)的項(xiàng)目清單》；有關(guān)附加險(xiǎn)條款投保信息，請(qǐng)見(jiàn)《財(cái)產(chǎn)××險(xiǎn)（2009版）附加險(xiǎn)條款投保清單》。上述投保清單為本投保單的組成部分。FordetailsaboutPropertyInsured,pleasefillintheListofItemsInsured;FordetailsaboutExtensionClause,pleasefillintheListofExtensionClause;TheaforementionedListsareeffectivepartsofthisProposalForm.除另有約定本保險(xiǎn)合同的每次事故免賠額為元，或損失金額的%，二者以高者為準(zhǔn)Unlessotherwiseagreed,theDeductibleofthisInsuranceContactshallbeor%ofloss,whicheveristhegreater.是否有其他有關(guān)保險(xiǎn)合同：□有□無(wú)Doyouhaveanyotherrelevantinsurancecontact(s)?□YES□NO如有，請(qǐng)說(shuō)明標(biāo)的項(xiàng)目、保險(xiǎn)金額、免賠額、保險(xiǎn)公司名稱以及其他相關(guān)信息：IfYES,pleaseprovidedetailsofPropertyInsured,SumInsured,Deductible(s),Insurer’snameandanyotherrelevantinformation.是否為續(xù)保合同Isthisarenewalinsurancecontract□是□否□YES□NO總保險(xiǎn)金額：人民幣(大寫)（小寫）:TotalSumInsured:RMB保險(xiǎn)期間：月，自年月日零時(shí)起至年月日二十四時(shí)止PeriodofInsurance:months,from00:00to24:00總保險(xiǎn)費(fèi)：GrossPremium人民幣(大寫):（小寫）:RMB保險(xiǎn)費(fèi)交付時(shí)間：年月日Duedateofpremiumpayment:保險(xiǎn)合同爭(zhēng)議解決方式：□訴訟□提交仲裁委員會(huì)仲裁SolutionofDispute:□Litigation□submittoarbitrationcommitteeforanarbitration特別約定：Specialtermsandconditions:投保人聲明DeclarationoftheApplicant保險(xiǎn)人已向本人提供并詳細(xì)介紹了《中國(guó)人民財(cái)產(chǎn)保險(xiǎn)股份有限公司財(cái)產(chǎn)××險(xiǎn)條款（2009版）》及其附加險(xiǎn)條款（若投保附加險(xiǎn)）內(nèi)容，并對(duì)其中免除保險(xiǎn)人責(zé)任的條款（包括但不限于責(zé)任免除、投保人被保險(xiǎn)人義務(wù)、賠償處理、其他事項(xiàng)等），以及本保險(xiǎn)合同中付費(fèi)約定和特別約定的內(nèi)容向本人做了明確說(shuō)明，本人已充分理解并接受上述內(nèi)容，同意以此作為訂立保險(xiǎn)合同的依據(jù)，自愿投保本保險(xiǎn)。WeherebydeclarethattheInsurerhas

providedandexplainedindetail<>anditsextensionclauses(ifany).TheInsurerhas

alsospecifiedtheexclusionclauses(includingbutnotlimittothe

exclusions,obligationoftheApplicant,

treatmentoftheclaims

andotheritems),aswellaspaymentagreementandspecialtermsandconditions.

Theundersignedhas

fullyunderstoodandacceptedthecontentmentionedabove,thusagreedto

concludethe

Policyonthebasisofthisdeclaration,andappliedforthisinsurancevoluntarily投保人簽章：年月日（以下公司內(nèi)部作業(yè)欄，客戶無(wú)須填寫）初審情況業(yè)務(wù)來(lái)源：□直接業(yè)務(wù)□個(gè)人代理□專業(yè)代理□兼業(yè)代理□經(jīng)紀(jì)人□網(wǎng)上業(yè)務(wù)代理（經(jīng)紀(jì)）人名稱：業(yè)務(wù)員簽字：年月日核保意見(jiàn)核保人簽字：年月日中國(guó)人民財(cái)產(chǎn)保險(xiǎn)股份有限公司財(cái)產(chǎn)××險(xiǎn)（2009版）投保標(biāo)的項(xiàng)目清單PICCPropertyandCasualtyCompanyLimitedListofItemsInsuredfor××Insurance(2009)本清單為財(cái)產(chǎn)××險(xiǎn)（2009版）投保單的有效組成部分。ThisListshallbeaneffectivepartoftheProposalFormfor××Insurance(2009)投保單號(hào)碼：共頁(yè)第頁(yè)P(yáng)roposalFormNo.:Pageof1.保險(xiǎn)標(biāo)的地址：郵編：Location(s)ofPropertyInsured:Postalcode:2.保險(xiǎn)標(biāo)的地址內(nèi)被保險(xiǎn)人所從事的生產(chǎn)經(jīng)營(yíng)活動(dòng)的簡(jiǎn)要描述：PleasedescribethebusinessoperationinLocation(s)ofPropertyInsuredbriefly:*國(guó)民經(jīng)濟(jì)行業(yè)分類代碼：（此信息由保險(xiǎn)人填寫）IndustryCode:(filledbytheInsurer)3.保險(xiǎn)標(biāo)的項(xiàng)目投保信息DetailsoftheItemsInsured序號(hào)No.保險(xiǎn)標(biāo)的名稱NameofItemInsured單位Unit數(shù)量Quantity保險(xiǎn)金額/賠償限額SumInsured/LimitofIndemnity以何種方式確定保險(xiǎn)價(jià)值CalculationofInsuredValue備注Remarks12345678910111213注：投保標(biāo)的為特約標(biāo)的時(shí)，請(qǐng)?jiān)趥渥谥凶⒚鳌疤丶s”字樣。Note:IfanItemInsuredshallbespeciallyagreedbytheInsurer,pleasestate“speciallyagreed”intheRemarks.投保人（蓋章）SignatureofApplicant(Stamped)年月日Date:

年月日Date:中國(guó)人民財(cái)產(chǎn)保險(xiǎn)股份有限公司財(cái)產(chǎn)××險(xiǎn)（2009版）附加險(xiǎn)條款投保清單PICCPropertyandCasualtyCompanyLimitedListofExtensionClausesfor××Insurance(2009)本清單為財(cái)產(chǎn)××險(xiǎn)（2009版）投保單的有效組成部分。ThisListshallbeaneffectivepartofProposalFormfor××Insurance(2009)投保單號(hào)碼：ProposalFormNo.:共頁(yè)第頁(yè)P(yáng)ageof1.保險(xiǎn)標(biāo)的地址：郵編：Location(s)ofPropertyInsuredPostalcode2.附加險(xiǎn)條款投保信息DetailsofExtensionClauses序號(hào)No.附加險(xiǎn)條款名稱NameofExtensionClauses保險(xiǎn)金額/賠償限額SumInsured/LimitofIndemnity每次事故免賠額/免賠率Deductible備注Remarks123456789101112131415注：對(duì)于需明確保險(xiǎn)價(jià)值、地域范圍等信息的附加險(xiǎn)條款，請(qǐng)?jiān)凇皞渥ⅰ睓趦?nèi)填寫相關(guān)信息。Note:IftheInsuredValue,territoryorotherinformationshallbespecifiedintheExtensionClauses,pleasefillinsuchinformationinRemarks.投保人（蓋章）Applicant’sSignature(Stamped)年月日Date:中國(guó)人民財(cái)產(chǎn)保險(xiǎn)股份有限公司財(cái)產(chǎn)××險(xiǎn)（2009版）風(fēng)險(xiǎn)問(wèn)詢表－－生產(chǎn)性企業(yè)PICCPropertyandCasualtyCompanyLimitedQuestionnairefor××Insurance(2009)Manufacturingrisk基本概況1.BasicInformation企業(yè)名稱：Nameofenterprise:詳細(xì)地址：郵政編碼：Address:Postalcode:國(guó)有企業(yè)□私有企業(yè)□合資企業(yè)□其他□□State-ownedenterprises□Privateenterprise□JointVenture□Others保險(xiǎn)財(cái)產(chǎn)處于河（海、湖、水庫(kù)）邊，相距米□ 山坡上□山腳下□低洼處□平原□ThePropertyInsuredislocated□attheriverside(seasideorsidebylakeorreservoir),withdistancebetweenofM□onthehillside□atthefootofthehill□inlow-lyingareas□ontheplain保險(xiǎn)財(cái)產(chǎn)的周圍環(huán)境SurroundingsofthePropertyInsured東：距離米，East：;Distance:M西：距離米，West：;Distance:M南：距離米，South：;Distance:M北：距離米，North：;Distance:M投產(chǎn)時(shí)間年月Productioninitiatingdate:yearmonth生產(chǎn)過(guò)程2.Procedure產(chǎn)成品：Products主要原料：Majormaterials:主要產(chǎn)品及年產(chǎn)量：Majorproductsandannualoutput:主要生產(chǎn)設(shè)備的制造年份及制造商：（有投保項(xiàng)目清單的可不填）ManufacturingDateandManufacturerofthemajormachineryandequipments.(youcanignorethis,ifsuchinformationisavailableintheListofPropertyInsured)設(shè)備名稱Nameofmachineryandequipment設(shè)備型號(hào)Type制造商或廠地Manufacturerandplaceofproduction制造年份Manufacturingyear工藝流程圖隨件附上□無(wú)法提供□ProcedureChartis□Attachedor□N/A生產(chǎn)工藝采取常溫□高溫，最高溫度為度□常壓□高壓，最高壓力為MPa□Whichofthefollowingisusedintheprocedure?□Normaltemperature□Hightemperature,withhighesttemperatureof℃□Normalpressure□Highpressure,withhighestpressureofMPa主要生產(chǎn)過(guò)程自動(dòng)化□機(jī)械操作□手工操作□MajorProcedureis□automatic,□mechanizedor□manual.帶明火操作烤爐□熔爐□干燥機(jī)□加熱器□其他□Ifthemanufacturingprocedureiswithfire,whichofthefollowingmachineryorequipmentisused?□oven□smelter□drier□heater□others易燃易爆品液體□氣體□氣霧劑□其他□IfanyInflammableandexplosivematerialisused,pleasestatewhetheritis□liquid,□airor□aerosol.無(wú)塵室無(wú)□有□Isthereanydust-freeworkshop?□YES□NO等級(jí)100,000□10,000□1,000□100□其他□IfYES,thedustinessdegreeis□100,000,□10,000,□1,000,□100,or□others.存貨物資3.Stock儲(chǔ)存方式倉(cāng)儲(chǔ)□露堆□罩棚□其他□Thestockisstored□inthewarehouse□intheopenair□undertheawning□inotherplaces存儲(chǔ)地點(diǎn)如多個(gè)地點(diǎn)，需列明1. 2.3.PleasestatetheLocation(s)ofStorage:1. 2.3.易燃易爆物質(zhì)無(wú)□有□名稱獨(dú)立的符合防火防爆要求的倉(cāng)庫(kù)內(nèi)無(wú)□有□IsthereanyInflammableandexplosivematerial?□YES□NOIfYES,pleasestatethename:IfYES,isitstoredinanindependentfire-proofandexplosion-proofwarehouse?□YES□NO主要倉(cāng)儲(chǔ)物品名稱易燃□、可燃□、難燃或不燃□名稱易燃□、可燃□、難燃或不燃□名稱易燃□、可燃□、難燃或不燃□Pleaseprovideinformationaboutthemajorstock:Nameofstock:Itis□flammable

,□combustible,

□noncombustible.Nameofstock:Itis□flammable

,□combustible,

□noncombustible.Nameofstock:Itis□flammable

,□combustible,

□noncombustible.液體儲(chǔ)罐所儲(chǔ)存的可燃物質(zhì)名稱體積Combustiblematerialstoredinliquidstoragetank.Name:Volume:防滅火設(shè)施防雷電口防靜電口防明火口自動(dòng)滅火裝置口Fireprotectionfacilitiesforthestocks:□lightningprotectionfacility□electrostaticpreventionfacility□firepreventionfacility□automaticfireextinguishingequipment上年度存貨量最大值平均值Valueofstocklastyear:Maximumvalue:Averagevalue:建筑物情況4.Building(s)自有□租用□□ownedor□rented.有無(wú)共用單位有□無(wú)□Is/arethebuilding(s)usedwithothers?□YES□NO廠區(qū)平面圖隨件附上□無(wú)法提供□Thelayoutofthefactoryis□attached□N/A.主體建筑物結(jié)構(gòu)Structureofthemainbuilding(s):名稱Nameofbuilding結(jié)構(gòu)Structure高度m或?qū)訑?shù)heightorstorey占用性質(zhì)Occupation說(shuō)明:Note:1.建筑物結(jié)構(gòu)：A鋼筋混凝土結(jié)構(gòu)B鋼結(jié)構(gòu)C磚砌/石頭D木材E其他，請(qǐng)注明；1.Structure:A.reinforcedconcretestructure,B.steelstructure,C.Brickorstonestructure,D.Woodenstructure,E.others,pleasestatehere:2.占用性質(zhì)：A辦公B宿舍C倉(cāng)儲(chǔ)D生產(chǎn)(要注明類別:如機(jī)器加工、熱處理、噴漆、裝配、電鍍、焊接、注塑、印刷、粉碎等)；2.Occupation:A.Office;B.Dormitory;C.Warehouse;D.Plant(Pleasespecifythetypeofwork,forexample,machining,heattreating,spray-painting,assembling,electroplating,welding,injectionmolding,printing,pulverizing,etc.)3.對(duì)于非單一用途的多層建筑物要說(shuō)明每一層次的使用情況。Ifamulti-storeybuildingisusedformulti-purpose,pleasestatetheoccupationforeachstorey.避雷設(shè)施無(wú)□有□套Isthereanylightningprotectionfacility□YES□NOIfYES,howmany?散熱、排煙裝置無(wú)□有□套Isthereanycoolingandventilationsystem□YES□NOIfYES,howmany?防火墻、門無(wú)□有□耐火時(shí)間小時(shí)Isthereanyfire-resistant

wallanddoor?□YES□NOIfYES,howlongwillit/theyresistthefire?hours.動(dòng)力設(shè)備5.Power廠區(qū)能源燃油□天然氣□液化氣□煤□電□其他□Thepowerofthefactoryisproduced/providedby□fuel□naturalgas□liquefiedgas□coal□electricity□others變壓器進(jìn)線1□2□臺(tái)數(shù)油浸式□干式□Transformer(s)進(jìn)線1□2□NumberoftransformerTypeoftransformer(s):□Oil-immersed□Drytype功率＃1KVA＃2KVA＃3KVAPower＃1KVA＃2KVA＃3KVA鍋爐臺(tái)數(shù)Numberofboiler:類型蒸汽□熱水□其他□Typeofboiler(s):□Steam□Hotwater□others工作壓力額定壓力Workingpressure:Ratedpressure:燃料柴油□煤□其他□Fuel:□Diesel□Coal□Others防護(hù)設(shè)施6.Protectiveandpreventivefacilities自動(dòng)水噴淋系統(tǒng)無(wú)□有□Isthereanyautomaticsprinklersystem?□YES□NO濕式□干式□預(yù)作用□雨淋□IfYES,pleaseprovidethefollowinginformation:Type:□Wettype□Drytype□Pre-acting□Deluge系統(tǒng)采用標(biāo)準(zhǔn)NFPA□GB□其他□Standardappliedforthesystem:□NFPA□GB□□Others面積覆蓋率噴頭型號(hào)噴頭孔徑Ratioofareacovered:Typeofsprinklerheads:Holediameterofsprinklerheads:相鄰噴淋管間距相鄰噴頭間距Spacebetweenneighboringsprinklerpipes:Spacebetweenneighboringsprinklerheads:設(shè)計(jì)噴水強(qiáng)度作用面積Designedsprinklingintensity:Areacovered:豎管底部流量豎管底部壓力Flowatthebottomofthestandpipe:Pressureatthebottomofthestandpipe:市政消防供水：主管直徑壓力靜壓殘壓Municipalfire-fightingwatersupply:Diameterofmainpipe:Pressure:HydrostaticpressureResidualvoltage:消防水箱數(shù)量?jī)?chǔ)存量M其他Fire-fightingwatertank(s):Quantity:Volume:MOthers消防水泵總數(shù)柴油□電力□自動(dòng)□手動(dòng)□Fire-fightingwaterpump(s):Quantity:Type:□Diesel□Electrical□Automatic□Manual消防泵＃1□2□出水量揚(yáng)程Firepump(s):1□2□Wateroutflow:Pumphead:噴淋泵＃1□2□出水量揚(yáng)程Sprinklingpump(s):1□2□Wateroutflow:Pumphead:室外消防栓數(shù)量Quantityofoutdoorfirepumps:室內(nèi)消防栓數(shù)量Quantityofindoorfirepumps:滅火器干粉□二氧化碳□泡沫□其他□數(shù)量Typeoffireextinguisher:□Drypowder□Carbondioxide□Foam□OthersQuantityofeach:_____________________________________________特殊消防系統(tǒng)無(wú)□有□Isthereanyspecialfire-fightingsystem?□YES□NO二氧化碳系統(tǒng)□煙烙系統(tǒng)□水噴霧系統(tǒng)□泡沫滅火系統(tǒng)□□carbondioxidesystem□INERGENsystem□watersprayingsystem□foamfire-fightingsystem煙霧抽取系統(tǒng)□自動(dòng)噴淋系統(tǒng)□其他□□Smokeextractsystem□automaticsprinklingsystem□others火災(zāi)探測(cè)系統(tǒng)無(wú)□有□Istherefiredetectionsystem?□YES□NO感煙型□感溫型□采樣型□其他□□Smokedetectionsystem□Temperaturedetectionsystem□Samplingbaseddetectivesystem□Others報(bào)警信號(hào)送至警衛(wèi)室□控制中心□其他□Thefirealarmissentto□guardhouse□controlcentre□others現(xiàn)有消防設(shè)施是否取得由消防部門簽發(fā)的《建筑工程消防驗(yàn)收意見(jiàn)書(shū)》或其它消防合格證書(shū)：是（）否（）HaveyougotFirePreventionInspectionReportonConstructionsorotherfirepreventioncertificationissuedbythefiredepartmentontheexistingfire-fightingfacilities?□YES□NO《建筑工程消防驗(yàn)收意見(jiàn)書(shū)》內(nèi)說(shuō)明的廠房或倉(cāng)庫(kù)使用等級(jí)為：丙類及以下危險(xiǎn)等級(jí)（）；超過(guò)丙類的危險(xiǎn)等級(jí)（）Whatistheclassificationoftheplantand/orthewarehousestatedintheFirePreventionInspectionReportonConstructions?RiskclassequaltoorbelowCRiskclassaboveC防盜警報(bào)系統(tǒng)無(wú)□有□Isthereanyburglaryalarmsystem?□YES□NO紅外線□錄像監(jiān)控□門磁□其他□□Infrared□Closed-circuittelevision□Magneticswitch□Others警衛(wèi)人數(shù)公司雇員□保安公司□NumberofGuardsTheguardsareemployeeof□theInsured□securitycompany?巡邏無(wú)□有□頻率記錄有□無(wú)□Dotheguardspatrolthefactory?□YES□NOIfYES,howfrequentdotheguardspatrol?IfYES,arethepatrolsrecorded?□YES□NO廠內(nèi)全職消防隊(duì)無(wú)□有□隊(duì)員人數(shù)Aretherefull-timefirefightersinthefactory?□YES□NOIfYES,howmanyfirefighters?

離廠最近之消防隊(duì)距離反應(yīng)速度Whatisthedistancebetweenthefactoryandthenearestfirestation?Howlongwillittakeforthefirefightersfromthefirestationtothefactory?防洪設(shè)施 與市政雨水管網(wǎng)(河、溝、渠)相連的排雨水系統(tǒng)□防洪墻□高度米防洪閘門□沙袋數(shù)量袋汛期堆放位置 防洪抽水機(jī)□數(shù)量臺(tái) 倉(cāng)儲(chǔ)物品加墊板□高度厘米Measurestakentocontrolorpreventfloodrisk:□Drainagesystemconnectingwithmunicipaldrainagesystem(orriver,raceway,oraqueduct)□Floodwall,(height:)□Floodgate□Sandbags,(quantity:,pilinglocationinfloodseason:)□Waterpumpforfloodprevention,(quantity:)□Platformboardforstocks,(height:) 管理7.Management禁煙措施 全廠禁煙□固定吸煙點(diǎn)□無(wú)禁煙條例□Isthereanysmoke-freemeasuretakeninyourfactory?□YES,thewholefactoryissmoke-free□YES,butthereissmokingareainthefactory□NO防滅火措施禁止吸煙和使用明火□良好的靜電接地□ 使用防爆型的電器設(shè)備和照明燈具□裝有可燃?xì)怏w濃度檢測(cè)報(bào)警裝置□ 防火分區(qū)□保持工作場(chǎng)所整潔□ 電氣設(shè)備和熱工設(shè)備周圍禁止堆放易燃或可燃物品□Firepreventionmeasures:□Prohibitiononfireandsmoking□Staticelectricityearth□Usageofexplosion-proofelectricalequipmentandlights□Detectionandalarmsystemtodetectthedensityofcombustiblegas□Firecompartment□Goodhousekeeping□Prohibitiononputtingcombustibleorflammablematerialsaroundtheelectricalequipmentorhotworkingequipment動(dòng)火許可制度無(wú)□有□書(shū)面記錄有□無(wú)□Doyouhavehotworkpermit?□YES□NOIfYES,doyouhavewrittenrecord?□YES□NO定期消防設(shè)施維護(hù)無(wú)□有□書(shū)面記錄有□無(wú)□Doyoucheckandmaintainthefire-fightingfacilities?□YES□NOIfYES,doyouhavewrittenrecord?□YES□NO防火安全責(zé)任制無(wú)□有□Haveyoumadefirepreventionresponsibilityplan?□YES□NO防火安全管理機(jī)構(gòu)無(wú)□有□動(dòng)火許可制度無(wú)□有□風(fēng)險(xiǎn)控制預(yù)案無(wú)□有□消防管理制度無(wú)□有□名稱Haveyouorganizedafirepreventionmanagementteam?□YES□NOHaveyougothotworkpermit?□YES□NOHaveyoumaderiskcontrolplan?□YES□NOHaveyousetupFire-fightingmanagementsystem?□YES□NO廠內(nèi)自檢程序無(wú)□有□書(shū)面記錄有□無(wú)□Isthereanyself-testprocedure?□YES□NOIfYES,doyouhavewrittenrecord?□YES□NO廠內(nèi)應(yīng)急編組無(wú)□有□人數(shù)訓(xùn)練頻度Doyouhaveanyinneremergencyteam?□YES□NOIfYES,howmanypeople?IfYES,onwhatfrequencyarethetrainingsprovidedforsuchteam?保安措施圍墻防護(hù)設(shè)施□防盜報(bào)警裝置□監(jiān)控?cái)z像頭□數(shù)量個(gè)專職保安□人數(shù)人門衛(wèi)□出入大門登記制度□夜間、公休日和節(jié)假日均有人值班□Securitymeasures□Defensivehedge□Burglaryalarm□Closed-circuittelevision,quantity:□Fulltimeguards(quantity:)□Gatekeeper□Registrationforentranceandexit□Rotasystematnight,onweekendsandholidays自然災(zāi)害8.Naturehazards地震災(zāi)害記錄Earthquakerecord地震帶地震等級(jí)Seismicbelt:Earthquakeintensity(Metcalli)andmagnitude(Richer):建筑物特殊抗震設(shè)計(jì)Specialdesignfortheearthquakeresistanceofthestructure:暴雨、洪水災(zāi)害記錄Rainstormandfloodrecord附近水系及離廠距離Distanceawayfromnearestriver,lake,seaorotherwatersystem:風(fēng)暴災(zāi)害記錄Windstormrecord:每年風(fēng)暴發(fā)生次數(shù)Frequencyofwindstormperyear:其他Otherhazards:出險(xiǎn)理賠記錄9.Claimsrecord:列明以前曾發(fā)生的索賠事例Pleasestateclaimshappenedinthepast.日期Date出險(xiǎn)情況Lossordamage索賠金額Claimamount1234投保人聲明：上述陳述及詳細(xì)資料均屬真實(shí)，未錯(cuò)報(bào)或隱瞞任何資料的實(shí)情。本人（本公司）同意以本調(diào)查表連同投保人提供的其他資料成為保險(xiǎn)合同成立的基礎(chǔ)。WeherebydeclarethatthestatementsmadebyusintheQuestionnaireandProposalFormare,tothebestofourknowledgeandbelief,completeandtrue,andweherebyagreethatthisQuestionnaireandProposalFormconstitutethebasisandarepartofanypolicyissuedinconnectionwiththeaboverisks.投保人（簽章）SignatureoftheApplicant(Stamped)年月日Date

中國(guó)人民財(cái)產(chǎn)保險(xiǎn)股份有限公司×××分公司財(cái)產(chǎn)××險(xiǎn)（2009版）風(fēng)險(xiǎn)問(wèn)詢表－－商業(yè)性企業(yè)PICCPropertyandCasualtyCompanyLimitedQuestionnairefor××Insurance(2009)Commercialrisk一、基本概況1.BasicInformation企業(yè)名稱：Nameofenterprise:詳細(xì)地址：郵政編碼：Address:Postalcode:國(guó)有企業(yè)□私有企業(yè)□合資企業(yè)□其他□□State-ownedenterprises□Privateenterprise□JointVenture□Others保險(xiǎn)財(cái)產(chǎn)處于河（海、湖、水庫(kù)）邊，相距米□山坡上□山腳下□低洼處□平原□市區(qū)□郊區(qū)□ThePropertyInsuredislocated□attheriverside(seasideorsidebylakeorreservoir),withdistanceofM□onthehillside□atthefootofthehill□inlow-lyingareas□ontheplain□intheurbanarea□inthesuburb保險(xiǎn)財(cái)產(chǎn)的周圍環(huán)境SurroundingsofthePropertyInsured東：距離米，East：;Distance:M西：距離米，West：;Distance:M南：距離米，South：;Distance:M北：距離米，North：;Distance:M開(kāi)業(yè)時(shí)間年月平均日營(yíng)業(yè)額Businessinitiatingdate:yearmonthAverageturnoverperday:主要經(jīng)營(yíng)項(xiàng)目現(xiàn)有員工人數(shù)Generaloperations:Numberofemployees:營(yíng)業(yè)時(shí)間每天小時(shí)Businesstime:_____hoursperday.二、存貨物資2.Stock儲(chǔ)存方式倉(cāng)儲(chǔ)□露堆□罩棚□其他□Thestockisstored□inthewarehouse□intheopenair□undertheawning□inotherplaces存儲(chǔ)地點(diǎn)如多個(gè)地點(diǎn)，需列明1. 2.3.PleasestatetheLocation(s)ofStorage:1. 2.3.易燃易爆物質(zhì)無(wú)□有□名稱IsthereanyInflammableandexplosivematerial?□YES□NOIfYES,pleasestatethename:可燃液體的防滅火設(shè)施防雷電口防靜電口防明火口自動(dòng)滅火裝置口Fireprotectionfacilitiesforcombustibleliquid:□lightningprotectionfacility□electrostaticpreventionfacility□firepreventionfacility□automaticfireextinguishingequipment上年度存貨量最大值平均值Valueofstockoflastyear:Maximumvalue:Averagevalue:三、建筑物3.Building(s)建筑物概況Basicinformationofthebuilding(s)名稱占地面積(m2)高度(m)層數(shù)層投入使用時(shí)間年月自有□租用□有無(wú)共用單位有□無(wú)□Name:Area:m2Height:MStorey:Thedateofcommercialuse:Thebuilding(s)is/are□owned□rented.Is/arethebuilding(s)usedwithothers?□YES□NO使用情況：（填A(yù)BC）建筑物名稱Nameofbuilding結(jié)構(gòu)Structure層次（包括地下室）Storey(includingbasement)用途Occupation保險(xiǎn)財(cái)產(chǎn)項(xiàng)目PropertyInsured說(shuō)明:Note:1.建筑物結(jié)構(gòu)：A鋼筋混凝土結(jié)構(gòu)B鋼結(jié)構(gòu)C磚砌/石頭D木材E其他，請(qǐng)注明；1.Structure:A.reinforcedconcretestructure,B.steelstructure,C.Brickorstonestructure,D.Woodenstructure,E.others,pleasestatehere:2.建筑物用途：A辦公B住宿C飲食D商場(chǎng)E娛樂(lè)場(chǎng)所F銀行G郵局H倉(cāng)庫(kù)I車庫(kù)J小商品批發(fā)市場(chǎng)、K建材城(市場(chǎng))、L其他（要注明）；2.Occupation:A.Office;B.Dormitory;C.FoodanddrinkD.ShopE.EntertainmentF.BankG.PostofficeH.WarehouseI.GarageJ.WholesalemarketforsmallcommoditiesK.ConstructionmaterialsmarketL.Others裝修:Decoration電氣線路有無(wú)穿套保護(hù)套管有□無(wú)□Aretheelectricalwireswithprotectivesleeves?□YES□NO有無(wú)可靠的保險(xiǎn)裝置 有□無(wú)□Aretherereliablesafetydevices?□YES□NO 有無(wú)亂拉亂接電線？有□無(wú)□Aretheelectricalwiresingoodorder?□YES□NO電線是否老化？是□否□Aretheelectricalwiresaging?□YES□NO裝飾完工時(shí)間年月Completiondateofthedecoration:yearmonth有無(wú)足夠?qū)挾鹊南劳ǖ? 有□無(wú)□Istherefireescapewithenoughspace?□YES□NO消防通道有無(wú)被堵塞或占用有□無(wú)□Isthefireescapekeptclear?□YES□NO裝修工程是否經(jīng)過(guò)當(dāng)?shù)毓蚕辣O(jiān)督機(jī)構(gòu)的審批是□否□Havethedecorationworkbeenapprovedbythelocalfiredepartment?□YES□NO建筑物內(nèi)有無(wú)使用明火 有□無(wú)□Isthereanyusageoffireinthebuilding?□YES□NO所在位置用途IfYES,pleasestatethelocationandpurposeofthefire.四、防護(hù)設(shè)施Protectiveandpreventivefacilities自動(dòng)滅火裝置水噴淋滅火口二氧化碳滅火口鹵代烷滅火口泡沫滅火口Automaticfireextinguishingsystem:□Sprinklingsystem□Carbondioxidefireextinguishingsystem□Halonfireextinguishingsystem□Foamfire-fightingsystem市政消防供水：主管直徑壓力靜壓殘壓Municipalfire-fightingwatersupply:Diameterofmainpipe:Pressure:HydrostaticpressureResidualvoltage:消防水箱數(shù)量?jī)?chǔ)存量M其他Fire-fightingwatertank(s):Quantity:Volume:MOthers消防水泵總數(shù)柴油□電力□自動(dòng)□手動(dòng)□Fire-fightingwaterpump(s):Quantity:Type:□Diesel□Electrical□Automatic□Manual消防泵＃1□2□出水量揚(yáng)程Firepump(s):1□2□Wateroutflow:Pumphead:噴淋泵＃1□2□出水量揚(yáng)程Sprinklingpump(s):1□2□Wateroutflow:Pumphead:室外消防栓數(shù)量室內(nèi)消防栓數(shù)量Quantityofoutdoorfirepumps:Quantityofindoorfirepumps:滅火器干粉□二氧化碳□泡沫□其他□數(shù)量Typeoffireextinguisher:□Drypowder□Carbondioxide□Foam□OthersQuantityofeach:_____________________________________________特殊消防系統(tǒng)無(wú)□有□二氧化碳系統(tǒng)□煙烙系統(tǒng)□水噴霧系統(tǒng)□泡沫滅火系統(tǒng)□煙霧抽取系統(tǒng)□自動(dòng)噴淋系統(tǒng)□其他□Isthereanyspecialfire-fightingsystem?□YES□NO□carbondioxidesystem□INERGENsystem□watersprayingsystem□foamfire-fightingsystem□Smokeextractsystem□automaticsprinklingsystem□others火災(zāi)探測(cè)系統(tǒng)無(wú)□有□Istherefiredetectionsystem?□YES□NO感煙型口感溫型口采樣型口其他口□Smokedetectionsystem□Temperaturedetectionsystem□Samplingbaseddetectivesystem□Others現(xiàn)有消防設(shè)施是否取得由消防部門簽發(fā)的《建筑工程消防驗(yàn)收意見(jiàn)書(shū)》或其它消防合格證書(shū)：是（）否（）HaveyougotFirePreventionInspectionReportonConstructionsorotherfirepreventioncertificationissuedbythefiredepartmentontheexistingfire-fightingfacilities?□YES□NO《建筑工程消防驗(yàn)收意見(jiàn)書(shū)》內(nèi)說(shuō)明的使用等級(jí)為：丙類及以下危險(xiǎn)等級(jí)（）；超過(guò)丙類的危險(xiǎn)等級(jí)（）Whatistheclassificationoftheplantand/orthewarehousestatedintheFirePreventionInspectionReportonConstructions?Riskclassequaltoorbelow丙類Riskclasshigherthan丙類防盜警報(bào)系統(tǒng)無(wú)□有□紅外線□錄像監(jiān)控□門磁□其他□Isthereanyburglaryalarmsystem?□YES□NO□Infrared□Closed-circuittelevision□Magneticswitch□Others警衛(wèi)人數(shù)公司雇員□保安公司□NumberofGuardsTheguardsareemployeeof□theInsured□securitycompany?組建義務(wù)消防隊(duì)無(wú)□有□隊(duì)員人數(shù)一般員工是否會(huì)使用滅火器材是□否□Haveyouorganizedpart-timefirefightingteam?□YES□NOIfYES,howmanymembers?

Doyounormalemployeesknowhowtousethefirefightingfacilities?□YES□NO最近之消防隊(duì)距離反應(yīng)速度Whatisthedistancebetweenthefactoryandthenearestfirestation?Howlongwillittakeforthefirefightersfromthefirestationtothefactory?防洪設(shè)施 與市政雨水管網(wǎng)(河、溝、渠)相連的排雨水系統(tǒng)□ 防洪墻□高度米防洪閘門□ 沙袋數(shù)量袋汛期堆放位置 防洪抽水機(jī)□數(shù)量臺(tái) 倉(cāng)儲(chǔ)物品加墊板□高度厘米Measurestakentocontrolorpreventfloodrisk:□Drainagesystemconnectingwithmunicipaldrainagesystem(orriver,raceway,oraqueduct)□Floodwall,(height:)□Floodgate□Sandbags,(quantity:,pilinglocationinfloodseason:)□Waterpumpforfloodprevention,(quantity: