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O. OF ORIGINALS ISSUED.中國平安保險股份有限公司PING AN INSURANCE COMPANY OF CHINA,LTD.進(jìn)出口貨 物 運(yùn) 輸 險 投保單APPLICATION FOR IMP/EXP TRANPORTATION INSURANCE 被保險人Insured:本投保單由投保人如實填寫并簽章后作為向本公司投保貨物運(yùn)輸保險的依據(jù),本投保單為該貨物運(yùn)輸保險單的組成部分。Please state items, marks, quantity and packing of cargo insured here above.請將投保的險別及條件注明如下:Please state risks insured against and conditions:( ) PICC (.) Clause ( ) .( ) ICC Clause ( ) W/W( ) All Risks ( ) TPND( ) . ( ) FREC( ) . ( ) IOP( ) ICC Clause A ( ) RFWD( ) ICC Clause B ( ) Risk of Breakage( )ICC Clause C ( ) Risks during( ) Air TPT All Risks ( ) transshipment( ) Air TPT Risks( ) O/L TPT All Risks( ) O/L TPT Risks( ) War Risks( 裝載運(yùn)輸工具(船名/車號): 船齡: 集裝箱運(yùn)輸: 是□ 否□ 整船運(yùn)輸: 是□ 否□per conveyance . Age of Vessel Container Load Yes No Full Vessel Charter Yes No發(fā)票或提單號 開航日期: 年 月 日 Invoice No. or B/L No. Slg. On or abt. Year Month Day自: 國 港/地 經(jīng): 港/地 至: 國 港/地From: Country Port Via: Port To: Country Port發(fā)票金額 保險金額Invoice Value: Amount Insured:費(fèi)率 保險費(fèi)Rate: Premium:備注Remarks:投保人茲聲明上述所填內(nèi)容屬實,同意以本投保單作為訂立保險合同的依據(jù);對貴公司就貨物運(yùn)輸保險條款及附加險條款(包括責(zé)任免除和投保人及被保險人義務(wù)部分)的內(nèi)容及說明已經(jīng)了解。This Policy of Insurance witnesses that PING AN INSURANCE COMPANY OF CHINA,LTD.,at the request of the Insured and in consideration of the agreed premium paid by the Insured,undertakes to i