公众责任保险风险问卷调查-公共场所.doc

公众责任保险 Public Liability Insurance 风险调查问卷 Risk Evaluation Questionnaire 本表适用于公共场所的场所公众责任险投保。This form shall be applied to on premise cover of Public Liability Insurance for public place. 概 况General Information 1．投保人名称Name of Insured _________________________________________________________________________ 2．总部地址Address of Head Office in P.R.China _________________________________________________________________________ 3．企业性质Nature of Enterprise □国营state-owned □集体collective □私营private-owned □股份制shared □机关事业government 中外合资joint □外商独资，请告知外方的国籍：foreigner-owned, please advise nationality of the owner 4．保险地址Location under Cover (连锁店请附地址清单Please attach list if you are operating a chain firm) _________________________________________________________________________ 5．请在左栏选择被保险人所经营管理的场所的主要性质，然后选择或回答对应的右栏中的有关问题。 Please make choice on the left handside first, then, if applicable, choose Yes or No or answer the relevant question on the right handside. □大卖场/超市/百货商场shopping mall/supermarket/department store： 是否设有儿童游乐区Are pleasure ground for children included？ □是Yes □否No 是否有铺位或柜台向第三方出租 Are there any business areas leased to third parties？ □是Yes □否No □商务楼/公寓business office/apartment □公园/游乐场park/amusement centre □医院/诊所hospital/clinic □宾馆hotel：是否是星级宾馆，多少星级No. of Stars if you are qualified？_______ 若上述场所含有以下服务内容，则也须选择和回答Please complete the rest part if you provide the services as described below: □饭店/餐厅restaurant/snack bar □旱地溜冰场skating rink：请告知何种地面 please advise what kind of ground :____________________________________ □舞厅、卡拉OK disco room, karaoke private： 是否供应酒精度超过15的饮料Do you provide beverage with alcohol level above 15 degree？ □是Yes □否No □酒吧pub □影剧院、放映厅cinema/theatre □游泳馆/池swimming pool ：换水频度frequency of changing water？_______；值班救生员人数No. of life guard？_____ 采用何种措施保证水质way to guarantee quality of