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保险类译文案例


出口产品责任险投保书

Application for Export Products Liability Insurance

                                                                                                                                                                                                                   

* 本公司对问卷各项填写内容,除作为核保及其它保险程序上的参考外,不另为其它用途,并予以保密。

* The information provided here will be used for insurance underwriting and related processing only, and will be kept confidential.

* 随卷请检附资料如下:

* Please attach the following information:

产品说明书、产品目录、测试报告、用户使用手册。

Product Brochures, Catalogue, Testing Reports, User Manuals.

Part I – 基本信息 Basic Information

1. 投保人/被保险人名称及注册地址

Name & address of applicant /insured (including all subsidiaries):

 

 

电话Telephone:

2.  被保险人成立形式 The Legal Form of the Insured

 

 

 

 

 

       独资 Individual _________        合伙Partnership _________      公司Corporation __________       合资Joint venture________

3.  请选出被保险人的经营性质

     Please tick the business nature of the Insured:

 

 

 

        制造商 Manufacturer __________        经销商 Distributor _________          贸易公司 Trading Company _________

 

        其它(请说明) other (please state) _________________

4. 投保公司从事该行业几年?如果有的话,请提供公司网址

How long has the Insured been in this business? Please provide company web address, if there is one.

 

5.  被保险人在美国或加拿大有分支机构或代表处? 如有, 请提供以下资料

     Does the Insured have any subsidiaries, affiliates or representative office in the USA and/or Canada?  If YES,  please give the following details:

     公司名称 Name of Company: _______________________________________________

     公司性质 Business Nature: _________________________         ___________________

     地址 Address: ______________________________________________       _________

     员工人数 No. of Employees:                                                                     ________

     与被保险人关系 Relationship with the Insured: _____________                                  ___

 

 

 

YES

 

 

NO

Part II - 产品销售额 TURNOVER *

        请列出五年(包括未来一年的)各种产品在各地区的营业额 (美元)
  Please give five years(including the coming year’s) turnover by product lines in each region (in US Dollars)

        * 如果选择指定经销商投保,请列出该经销商的名称及其销售额。

        Please state only the turnover and names for your particular buyers if you choose to insure selectively buyers only.

a. 美加地区  USA/Canada

年度Year  

产品 Product

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. 澳洲和新西兰 Australia & New Zealand

年度Year  

产品 Product

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. 欧洲 Europe

年度Year  

产品 Product

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

    d.   其它地区 Rest of the World

年度Year  

产品 Product

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PARTIII - 产品信息 PRODUCT(s) INFORMATION

1.   1)请简要说明贵公司目前所生产或销售的所有产品 

2)贵公司从事生产或销售这些产品多长时间。
Please list all products produced and/or distributed by you. How many years have you been manufactory?

2.    预期产品的生命期限
      What is the life expectancy of your product?

最近五年内是否有已停止生产或销售的产品? 如有,请简要说明
Are there any products that are no longer manufactured or distributed by you during the past five years? If YES, please describe.      

 

YES

 

 


NO

3.       未来一年内是否预计推出新的产品?如有,请说明

       Are any new products proposed for introduction during the ensuing year? If YES, please specify:
       *
请注意:任何新增加的产品必须通知本公司,并自本公司书面同意之日起受本保险保障。
       *Note: Any additional product must be reported to the Company and will be covered only from the date on which it is accepted by the company.

 

 

YES

 

 


NO

4.       产品是否由贵公司自行设计?若否,请解释
Are all of your products designed by yourself? If NO, please explain:

 

YES

 

 


NO

5.       贵公司的产品是否作为其它产品的零组件?若是,请指明
Are there any products sold as component parts for other products? If YES, please specify:

 

YES

 

 


NO

6.       1)贵公司所售的产品是否有以其它名称来销售? 如有,请说明并提供其所占比例。
2
)如有,请问次产品是由贵司设计还是买方设计?

 Are any of your products sold under another name or label?  

 If YES, please describe and give percentage. Are such products made to your specification or those of 

 buyer.

 

    YES

 

 

 

     NO

       YOUR COMPANY

BUYER

7.       贵公司是否向他人购买原料或零组件?
 Do you purchase materials or components from others?

 

YES

 

 


NO

贵公司是否与出口商或经销商签订超出一般商品买卖协约中免除对方赔偿条款的协约?  如有,请提供相关文件
 Are there any contractual e.g. hold harmless agreements entered into with importers or product purchasers that go beyond the typical purchase order agreement? If YES, please describe and provide a copy. 

 

 

YES

 

 


NO

10.  贵公司的产品是否用于下列项目或与其有关
        Could any of your products or services be used on or in connection with:
        *
航空器/飞弹/太空方面 aircraft/missile/aerospace?
       *
水上或海上交通工具 watercraft or offshore?
       *
内陆交通运输 transportation/transit?
       *
维生、复健设备 life support service?

       如有,请说明:If YES, please specify:

 

 

 

 

 

            YES      NO

 

 

            YES      NO

 

 

            YES      NO

 

            YES      NO

PART IV – 产品质量及安全控制 PRODUCT QUALITY AND SAFETY CONTROL

1.       贵公司是否有书面的产品质量控制措施?

Is there a written Quality Control Procedure in place?

 

YES

 

 


NO

2.       产品是否达到或超过美国政府与美国工业所订的标准? 如是,请列举适用的标准及其影本
Are your products designed to meet or exceed U.S. government and U.S. industry standards? If YES, please list all applicable standards and attach copies.

 

YES

 

 


NO

3.     产品测试  Product Testing

      1)  有无书面的产品测试程序?
           Are written testing procedures in place for your products?

      2)  产品是否经过专业机构监测合格。如有, 请附复印本

           Do you apply any third-party laboratories/testing centers? If yes, please attach copy of the reports.    

 

 

 

       YES      NO

 

 

 

        YES      NO

 

4.  关于产品的潜在危险、误用或滥用,贵公司是否警告最终消费者? 如有,说明以下何种方式

     Are hazards inherent in the final product, and warnings against foreseeable misuse and abuse made       

known to the ultimate user? If YES, please specify how:

l    在产品危险部位标示警告事项
warning labels at the point of hazard?_______________________________________________

l    提供文字说明     
written instructions?_____________________________________________________________

l    其它方式(请说明)
other means (attach details)?________ _____________________________________________  

 

 

YES

 

 


NO

5.   对已售产品,贵公司能否能确定:
Can you determine based on available records for all products you have sold:

l          产品的制造日期?
When any given product item was manufactured?

l          产品销售的对象及出售日期?
To whom it was sold, and the date of sale?

l          零件及材料的供货商?
Suppliers of the parts and materials?

 

 

 

       YES      NO

 

 

 

        YES      NO

 

 

 

        YES      NO

6.       贵公司是否留存有关产品的旧的使用说明,操作手册或广告资料?

       Do you maintain copies of old instruction or operation manuals and advertising material?

 

YES

 

 


NO

Part V -  损失纪录 LOSS EXPERIENCE

1.       贵公司是否曾因产品可能不安全而将产品收回? 若有,请说明并告知回收比率
Have you ever recalled products because of a potential product safety hazard? If YES, please attach details and indicate percent of recovery.

 

 

 

YES

 

 


NO

2.       贵公司产品 (无论是否被承保)是否曾造成他人的医疗费,身体伤害或财产损失?如果有, 请提供公司最近五年的损失纪录。

    Has anyone ever requested payment of damages for medical expense, bodily injury or property     

    damage caused by your product (whether insured or uninsured)? If YES, please provide your  

    company’s loss history for the last 5 years:

 

 

YES

 

 


NO

年度

Year

损失金额

Incurred Loss Amount

事故描述

Incident Details

 

 

 

 

 

 

PART VI – 保险要求 INSURANCE REQUIREMENT 

1.       以往有无保险公司退保或拒保贵司产品责任险? 若有,请说明

Has any insurer ever cancelled or declined your products liability? If YES, please explain.

 

YES

 

 


NO

2.       请提供贵公司目前产品责任险承保情况
Please provide current product liability insurance information:

(1)    保险公司:                                                               保险期限
               Insurer:                                                                 
Policy Period     

 (2)    责任限额                      每次事故限额                             保单期限累计限额                                                                                                                                                                                

          Limits of Liability:     Any one occurrence _________________ Aggregate per Policy Period_________________  

 (3)    保费                                           免赔额
          Premium: ______________     Deductible_________________  

(4)    保单形式                            事故发生制                     索赔发生制  追溯日

 

          Coverage Form:                Occurrence                 Claims-made (Retroactive Date)___________

3.       最新/续保需要的产品责任保险需求
 New /Renewal requested product liability insurance

(1)   保险期限
               
Policy Period                                                                                                                                                     

 (2)    责任限额                    每次事故限额                                               保单期限累计限额                                                                                                                                                                                

         Limits of Liability:       Any one occurrence _________________ Aggregate per Policy Period_________________  

(3)   免赔额
               Deductible_________________    

(4)    保单形式                          事故发生制             索赔发生制  追溯日

         Coverage Form:           Occurrence         Claims-made (Retroactive Date) ___________

4.    是否 需要增加经销商责任? 如需要,请提供经销商的名称及地址
       Do you require “Vendors Liability” ? If YES, please provide the list of vendor(s) and address(es)
:   

 

YES

 

 


NO

 

 
 
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