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 ofto 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
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