产品责任险问卷.doc

Questionnaire for Products Liability Insurance 产品责任险 风险调查问卷 INSTRUCTIONS 填写说明 Please ... Print clearly or type 请清楚填写或打印本表 Answer all questions completely 请完整地回答本表的全部问题 If space is insufficient to answer any question fully, continue on a separate sheet of your firm’s letterhead indicating the number of the question. 如果空格不够您完整的回答某些问题，请您继续用贵公司的信纸另外填写，并标明问题的序号。 If the answer to any question is ”none” state ”NONE”. 如果某个问题的答案是“无”，请填“无”。 Application must be signed and dated by owner, partner or officer. 此表必须由雇主、合伙人或有关负责人填写并注明日期。 IMPORTANT NOTICE 重要提示 It is your duty to disclose all material facts to Company. A material fact is one that is likely to influence an Underwriter’s judgement and acceptance of your proposal. If your proposal is a renewal, it should also include any change in facts previously advised to Underwriters. If you are in any doubt about facts considered material, disclose them. FAILURE TO DISCLOSE could prejudice your rights to recover in the event of a claim or allow Underwriters to void the Policy. 您有责任将所有重要的信息告知我们公司。重要的信息是影响承保者判断和接受您投保的一个可能的因素。如果您是续保，也应该告知一些原来承保者考虑过但改变的情况。如果您对一些重要的信息不能确定也告知我们。告知上的疏忽可能会导致如果发生索赔，您将损失获得赔偿的权利，或者让承保人注销保单。 Section A - General Information 基本信息 NAME OF COMPANY: 公司名称 2. Principal Adress: 总公司地址 3. Does applicant have subsidiaries or divisions? YES NO 申请人是否还有其他附属机构? ( ( ( If ”YES”, please specify. 如果有，请详细说明 Please tick the business nature of Applicant and its subsidiaries and associated companies. 请在申请人及其附属公司的营业性质上打√ Applicant 申请人 Sub./Assoc. 附属机构 Manufacturer 制造商 Distributor 经销商 Importer 进口商 Other (please specify) 其他（请详细说明） How long has the Insured been in business? 被保险人从事该行业多久 Other detailed background information of the Insured, is there any website ？ 被保人的详细背景资料，是否有网址可查阅？ Has any insurer ever cancelled or declined your products liability? YES NO 以往是否有保险公司取消或降低贵司的产品责任保险？ ( ( ( If ”YES”, please explain. 如果有，请详细解释 Does the Insure