出口產(chǎn)品責(zé)任險(xiǎn)投保書(shū)(文件)
【正文】 the last 5 years:年度Year損失金額Incurred Loss Amount事故描述Incident DetailsPART VI – 保險(xiǎn)要求 INSURANCE REQUIREMENT 1. 以往有無(wú)保險(xiǎn)公司退?；蚓鼙ＹF司產(chǎn)品責(zé)任險(xiǎn)? 若有，請(qǐng)說(shuō)明Has any insurer ever cancelled or declined your products liability? If YES, please explain.2. 請(qǐng)?zhí)峁┵F公司目前產(chǎn)品責(zé)任險(xiǎn)承保情況（之前已投保）Please provide current product liability insurance information:(1) 保險(xiǎn)公司: 保險(xiǎn)期限 Insurer: Policy Period (2) 責(zé)任限額 每次事故限額 保單期限累計(jì)限額 Limits of Liability: Any one occurrence _________________ Aggregate per Policy Period_________________ (3) 免賠額 Deductible_________________ (4) 保單形式 事故發(fā)生制 索賠發(fā)生制 （追溯日） Coverage Form: □ Occurrence □ Claimsmade (Retroactive Date)___________3. 最新/續(xù)保需要的產(chǎn)品責(zé)任保險(xiǎn)要求 New /Renewal requested product liability insurance (1) 保險(xiǎn)期限 Policy Period ______ (2) 責(zé)任限額 每次事故限額 保單期限累計(jì)限額 Limits of Liability: Any one occurrence _________________ Aggregate per Policy Period_________________ (3) 免賠額 Deductible_________________ (4) 保單形式 事故發(fā)生制 索賠發(fā)生制 （追溯日） Coverage Form: □ Occurrence □ Claimsmade (Retroactive Date) ___________PART VII. –投保人/被保險(xiǎn)人聲明 THE INSURED/APPLICANT DECLARATION，保險(xiǎn)人已就本投保單及所附保險(xiǎn)條款的內(nèi)容，尤其是就保險(xiǎn)人免除及減輕責(zé)任的條款、投保人和被保險(xiǎn)人義務(wù)條款及本投保單中的特別約定條款向本人作了明確說(shuō)明，本人對(duì)該保險(xiǎn)條款及保險(xiǎn)條件已了解并同意接受。 *Note: Any additional product must be reported to the Company and will be covered only upon written acceptance by the pany.5. 產(chǎn)品是否全部由貴公司自行設(shè)計(jì)? Are all of your products designed by yourself? □ YES □ NO6. 貴公司的產(chǎn)品是否作為其它產(chǎn)品的零組件?若是，請(qǐng)指明 Are there any products sold as ponent parts for other products? If YES, please specify: □ YES □ NO
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