中国太平洋保险公司深圳分公司.doc

中国太平洋保险公司深圳分公司
China Pacific Insurance Co., Ltd. Shenzhen Branch
中国广东省深圳市深南中路2号新闻大厦1号楼20、21层。邮政编码:518027
电话:0755-2096888- 传真:0755-2091245
20、21/F, No. 1 Bldg. News Mansion 2 Shennan Rd, Central Shenzhen P. R. China
Tele: 0755-2096888- Fax: 0755-2091245
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船舶建造险投保申请书
Proposal for Builders’ Risks Insurance
投保单号:
No.:
本申请书由投保人如实地、尽可能详尽地填写并签章后作为向承保人投保船舶建造险的依据,本申请书为该船舶建造保险单的组成部分。
The Applicant required to fill in the following items in good faith and as detailed as possible and affix signature to this proposal, which shall be treated as proof of application to the underwriter for Builders’ Risks Insurance and constitute an integral part of the Insurance Policy.
1. 建造合同关系方姓名和地址是否被保险人
(Parties to Contract) (Name and Address) (Whether he is the Insured)
所有人:
(Principal)
承包人:
(Contractor)
分承包人:
(Sub-Contractor)
其他关系方:
(Other Parties Contract Value)
2. 建成价格或合同最后价格:
(Building Cost or Final Contract Value)
3. 保险期限(Period of Insurance):
月自年月日时起至年月日止
( months from at to at )
4. 建造地点(Site of Shipyard or Dock of Building):
5. 交船地点(Site of Delivery):
6. 建造期限(Building Period)
动工日期(Date mencement): 年月日
上船台日期(Date of Staging): 年月日
下水日期(Date of Launching): 年月日
试航日期(Date of Trial ): 年月日
交船日期(Date of Delivery ): 年月日
7. 被建造成船舶的情况
Descriptions of the Vessel to be Built)

(Vessel Type) (Dead Weight Tonnage) (Gross Ton