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CONTRACTOR’S ALL RISKS INSURANCE QUESTIONAIRE 建筑工程一切险查询表
Producer Code
(Internal U Only)
—
Producer Name
(Internal U Only)
Policyholder Information 投保单位基本信息 投保单位基本信息
Name of Policyholder 投保单位: Licen number 营业执照编号: _________________________爱的死心塌地
__
(Remark: If policy premium over RMB200,000 or US$20,000, plea provide copy of operation licen) (说明: 如保费超过 RMB200,000 或 US$20,000，请提供营业执照复印件)
Business Address 办公地址: Contact Person 联络人: Fax No 传真号码: Contact Tel. No 联系电话: Email Address 电子邮件:
Postcode 邮政编码:
Risk Information 投保资料 投保资料
1. Name of Principal 业主名称 2. Name(s) of Contractor(s) 承包商名称 3. Name of supervisor 工程监理 4. Location of site 工地地点 5. Title of contract 工程名称 6. Period of Insurance 保险期限
Commencement of work 工程起始日期 Duration of construction 工程期限 months 月 months 月
Testing and Commissioning included 其中调试期 Maintenance period 保证期 7. Description of contract work (plea give detailed technical information) 工程情况描述 (请提供详细的技术情况) months 月
Occupancy (workshop, office, lab, boiler hou, power station, residential building, etc) 用途（生产车间、办公楼、实验室，锅炉房，供电站，居民楼，其它）
Dimensions (length, height, depth, spans, number of floors) 规模（长、高、深、宽、楼层数）
Building s马云创业经历
tructure (R.C. frame, R.C. & brick, steel structure, etc) 建筑物结构形式（钢筋混凝土框架、砖混、钢结构、其它）
Foundation (describe what kind of pile adopted, if piling) 基础形式（如为桩基，请描述桩基类型）
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8. Give details of similar projects he carried out previously 列举以前做过的类似工程 9. Will blasting be ud, if yes, indicate type envisaged and max. any one charge 是否使用爆炸，如用，请说明 爆炸类型和单次最大爆炸量 10.Subsoil conditions 底土条件 Other 其他 11.Name and distance of nearest river 最近的河流名称和距离 Name 名称 Distance 距离 12. Are existing buildings and/or stru年会暖场音乐
ctures on or adjacent to the site, owned by or held in care, custody or control of the Contractor(s) or the Principal, to be insured against loss or damage arising out of or in connection with the contract work? 是否投保因施工原因造成的承包商 或业主拥有照管或控制的建筑物及 工地邻近地区建筑的损失？ No. Yes If yes, indicate the following informat销售技巧和话术
ion： 否 是 如果是，请给出以下信息： _______________________________________________________________________________ Limit of indemnity 赔偿限额 _________________________________________________________
______________________ Value of the buildings 这些建筑物价值 _______________________________________________________________________________ Exact description of the buildings/ structures (occupancy, buil孜然炒面
ding structure, floors, etc.) 这些建筑物/结构的精确描述（占用性质，结构形式，楼层数等） rock 岩石
No. 否 gravel 碎石
Yes 是 sand 沙一打一个成语
clay 沙土 filled ground 填土地
13. Plea state hereunder the amounts you wish to insure and the limits of indemnity required 请在下面注明您希望的保险及赔偿限额
Currency 币种： Section I Sum insured 第一部分 投保额 Items to be insured 投保项目 1. Contract work 合同项目 (permanent and temporary work, including all materials to be incorporate herein 永久及暂时的项目包括所有的材料) 1.1 Contract price 合同价 1.2 Material or items supplied by the Principal(s) 由业主提供的项目及物料 2. Other insured item required 其它要投保的项目 Total sum to be insured for works 工程总投保金额： Section II Third Party Liability 第二部分 第三者责任 Items to be insured 投保项目 Bodily injury/Property damage 人身伤害/财产损失 Each & every Loss 每次事故限额 Aggregate in insured period 保险期限内总限 额 Limits of Indemnity 赔偿限额 Sums to be insure
d 投保金额
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Remarks: Enclo copies of following document and files: 备注： 备注： 请附以下材料： Insurance clau of tender and/or works contract 工程招标或合同中的保险条款 Breakdown of price 工程造价明细 General layout, elevation plan 工程总图、工程平面图 Work progress chart 工程进度图
We hereby declare that the statements made by us in this Questionnaire is complete and true to the best of our knowledge and belief, and we hereby agree that this Questionnaire shall form the basis and part of any 钢琴简谱入门
policy issued in connection with the above risk or risks. It is agreed that the Insurers shall be liable in accordance with the terms of the Policy only and that the Insured will not lodge any other claims of whatever nature. 特此声明就我方所知及所信，在本查询表中所作的陈述是完整的和真实的。我们同意此 查询表作为就以上有关风险出具的任何保单的基础，并构成保单的一部分。兹经双方同意，保险人仅根据保单条款承担责任巧克力饼干
，被保险 人不能提出其他任何性质的索赔。 The Insurers Undertake to deal with this information in strict confidence.保险人负责对此信息严格保密。
Signature of propor: 投保人签名: Phone No: 电话: Fill-in date: 填写日期：
Signature of producer: 销售人员签名: Phone No: 电话: Confirm date: 确认日期：
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