产品责任险投保单(涉外）.doc

产品责任险情况调查表及投保单 Questionnaire and Proposal for Products Liability Insurance No. 1.投保人名称/地址Name and Address of Applicant: 2.被保险人名称/地址Name and Address of the Insured: 3.被保险人营业性质Nature of Business of the Insured: 制造商( ) 零售商( ) 批发商( ) 进口商( ) 出口商( ) Manufacturer Retailer Wholesaler Importer Exporter 如非以上所列, 请注明如下If not as above-mentioned, please state: 4. 附加被保险人Additional Insured(s): 全称 Full Name 所属国家 Country 成立日期 Date of Establishment 与被保险人关系 Relationship to Insured 1 □经销商 □其他 Distributor Other 2 □经销商 □其他 Distributor Other 3 □经销商 □其他 Distributor Other (如果有附加被保险人要求贵公司投保本产品责任保险，请附上其与贵公司的书面协议。If anyone require you to have this product liability insurance, please attach a copy of their agreement.) 5. 投保产品信息（请提供关于列明产品的简介、使用手册、样品图片） INSURED PRODUCTS’ INFORMATION (Please attach brochures, instruction manuals, pictures of samples etc of all products listed) (1)生产的产品或分销的产品（非被保险人生产的产品） Products Manufactured / Products Distributed (not own manufacture) 请列出过去及未来年度贵公司生产的产品在世界范围的年销售额。 Please provide the expected/previous sales to worldwide. 产品名称 期限 国内销售 出口美加 出口欧洲 出口其他 Products Period Domestic Sales USA/Canada Sales Europe Sales Others Sales 20 20 20 20 20 20 （2）新产品New Products 请提供被保险人在保险期内拟推向市场的新产品的