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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
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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:)
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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 |
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启运日期： 装载运输工具：
DATE OF COMMENCEMENT __________________________PER CONVEYANCE: ______________
自 经 至
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 CONVERAGES:)
请如实告知下列情况：(如“是”在[ ] 中打“√”，“不是”打“X”) IF ANY, PLEASE MARK“√”
OR “X”
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
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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）
地址：（ADD） |
