条码： 机构代码: 0210000114 业务员姓名: 业务员代码: 投保日期: 货 运 险 投 保 单 MARINE CARGO INSURANCE APPLICATION FORM 0.01 投保险种：0603出口×0606进口0607国内 欢迎您到民安保险（中国）有限公司投保！ Welcome to Ming An Insurance Co.(China) Ltd. for your Insurance Application ! 在您填写投保单之前，请您仔细阅读保险条款，尤其是免除保险人责任的内容，并听取本保险公司业务人员的说明，如对本保险公司业务人员的说明不明白或有异议的，请在填写本投保单之前向本保险公司业务人员进行询问。待您在充分理解条款后，请如实填写投保单中的各项内容（请在需要选择项目前或对应列的“”内划X），应确保内容真实可靠。 Before your filling in this Application Form, please assure to have a careful reading on insurance terms, conditions, especially our exclusions and to listen carefully to our certified employee’s explanation on your Application as well. If you still feel unclear or have understanding discrepancies, please be sure to make an inquiry with our employee before starting to fill in this noted Application Form. After your fully understanding of our insurance terms and conditions, then you may proceed to fill in each and every item of this Form Fully and Honestly to fulfill your duty to disclose material facts. (Cross where “”is required ) 请照下列细节缮发×保单/Please grant us a * 被保险人名称: Assured: Policy/暂保单正本 Cover Note in 张及副本 Original(s) 3 张 Copie(s) to cover the following shipment:- 过 户: Held to the order of: 运输工具: Conveyances: *Vessel Name & Voy. No./Flight No./Parcel Post/By Truck/By Train 信用证号码: L/C No.: (if any) 发票号码： Invoice No.: 开航日期*Sailing/Flying/Mailing/Leaving Date (on/about) 至 To 经/转船地点: *Via/with Transhipment at: 提单号*AWB/P.O. Receipt No./B/L No.: 保险货物包装、数量及名称 Packing, Quantity and Description of Goods 航 程: 由 Voyage: From 保险金额: Amount Insured: 唛头及号码 Marks & Numbers 要保条款: KEPC003 KEPC014 FE06027 FE06028 FE06026 FE06196 Terms & Conditions Required: 国内水路、陆路运输保险条款 基本险 综合险 协会货物条款1982.1.1 ICC(A) ICC(B) 海洋运输货物保险条款 战争险条款 协会×人保 罢工险条款 协会 人保 ICC(C) F. P. A.平安险W. A.水渍险×ALL RISKS一切险 铁路货物运输保险条款 ICC(AIR)协会航空货物运输保险条款 基本险综合险 TPND 扩展全程公路运输盗抢险特别约定 陆上运输货物保险（火车、汽车） 陆运险陆运一切险 国内航空货物运输保险条款 公路货物运输保险条款 航空运输货物保险 其他 特别约定： 赔款地点: Claims Payable at: 取代暂保单号码: Replacing Cover Note No.: 声明Declaration 本保险合同由保险条款，投保单，保险单， 批单和特别约定组成。 This Insurance Contract is composed of Insurance Terms & Conditions, Insurance Application, Policy, Endorsement and Special Provision(s). 投保人声明：本人已收到并仔细阅读了投保险种所对应的保险条款，贵司已对保险条款中各项内容尤其是免除保险人责任的内容作了明确说明和提示，本人对保险条款中各项内容及贵司的说明与提示内容完全理解，没有异议。上述所填写内容均属事实，同意以此投保单作为订立保险合同的依据。 Applicant’s Declaration: I (we) have already received, read and understood the given terms & condition. The insurer has explicitly instructed and demonstrated the policy terms & conditions, clauses and the application including exclusions. I (we) hereby declare to have fully understood and agreed all the foresaid contents without any discrepancy . I (we) hereby also declare that the particulars and statements given on my behalf in this noted Form are to the best of my knowledge, true and complete. I (we) formally agree that this Application shall be legally deemed to be the basis of the Insurance Contract between the Insured and Insurer. 除持有贵公司签发的临时保单外，保障需在贵公司复核、接纳投保单及已收妥保费后才能生效。 The insurance will not be in force until the application form has been accepted by the Company and the premium has been paid, except to the extent of any official cover note which may be issued. 保单请邮寄/送出 Please *post/deliver the policy to our office. 保单到取 Contact Person: 联系人： E-mail: Tel: 电话： Address: Mobile: 手机： Fax: 传真： I will collect the policy at your office. ＊ ★ 请删去不适用之处Delete whichever is inapplicable 请加√号在适用处Tick whichever is applicable. 邮箱： 地址： 603. 收到保险公司出具的保单后，请尽快拨打我司24小时客服热线与我司核对保单信息，以保障您的权益。 To protect your interests, please call our 24-hours hotline to check the Policy information when receiving Policy. 投保人签署/公司盖章 Co. Chop & Signature of Applicant 保险公司填写 业务来源：□直接业务□其他业务 客户代码： 098001222549 协议号码： 是否风险查勘：□是 □否 报价单号： 初核人意见： 初核人签名： CLAIMS, IF ANY, SUBJECT TO AN EXCESS OF USD500 OR 10% ON ADJUSTED LOSS WHICHEVER IS THE HIGHER. 本文来源：https://www.wddqw.com/doc/b67ba821a5e9856a5612604e.html