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货物运输保险投保单

 

                                            PICC中国人民保险公司南京分公司

                              The People's Insurance Company of China,Nanjing Branch

                                                                             

货物运输保险投保单

APPLICATION FORM FOR CARGO TRANSPORTATION INSURANCE

被保险人

INSURED:                                                                 

发票号(INVOICE NO.)________________

合同号(CONTRACT NO.)_______________

信用证号(L/C NO.)__________________

发票金额(INVOICE AMOUNT)                投保加成(PLUS)                

兹有下列货物向________投保。(INSURANCE IS REQUIRED ON THE FOLLOWING COMMODITIES:)

标记

MARKS&NO.

数量及包装

QUANTITY

保险货物项目

DESCRIPTION OF GOODS

保险金额

AMOUNT INSURED

 

 

 

 

 

 

启运日期:                                装载运输工具:

DATE OF COMMENCEMENT:                    PER CONVEYANCE:                 

                                                                        

FROM                     VIA                 TO                             

提单号:                           赔款偿付地点                                

B/L NO.                          CLAIM PAYABLE AT                          

投保险别:(PLEASE INDICATE THE CONDITIONS &/OR SPECIAL COVERAGES:)  

请如实告知下列情况:(如“是”在[  ]中打“√”,“不是”打“×”)IF ANY,PLEASE MARK“√”OR“×”

1.货物种类:袋装[  ]散装[  ]冷藏[  ]液体[  ]活动物机器/汽车[  ]危险品等级[  ]

  GOODS:BAG/JUMBO BULK REEFER LIQUID LIVE ANIMAL MACHINE/AUTO DANGEROUS CLASS

2.集装箱种类:普通[  ]开顶[  ]框架[  ]平板[  ]冷藏[  ]

CONTAINER:ORDINARY OPEN FRAME FLAT REFRIGERATOR

3.转运工具:海轮[  ]飞机[  ]驳船[  ]火车[  ]汽车[  ]

    BY TRANSIT:SHIP PLANE BARGE TRAIN TRUCK

4.船舶资料:船籍[  ]船龄[  ]  

 PARTICULAR OF SHIP:REGISTRY  AGE

                                                                               

 

备注:被保险人确认本保险合同条款和内容已经完全了解。投保人(签名盖章)APPLICANT'S

SIGNATURE THE ASSURED CONFIRMS HEREWITH THE

TERMS AND CONDITIONS OF THESE INSURANCE                       

CONTRACT FULLY UNDERSTOOD                                                  电话:(TEL)__________________

投保日期:                                                                 DATE地址:(ADD)_____________

 

 

 

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