出口产品责任险投保书

出口产品责任险投保书EXPORTPRODUCTSLIABILITYINSURANCEAPPLICATION本公司对问卷各项填写内容，除作为核保及其它保险程序上的参考外，不另为其它用途，并予以保密。Theinformationprovidedherewillbeusedforinsuranceunderwritingandrelatedprocessingonly,andwillbekeptconfidential.PartI–基本信息BasicInformation1.投保人/被保险人名称及注册地址Name&addressofapplicant/insured(includingallsubsidiaries):2.被保险人成立形式TheLegalFormoftheInsured□独资Individual_________□合伙Partnership_________□公司Corporation__________□合资Jointventure______3.请选出被保险人的经营性质PleasetickthebusinessnatureoftheInsured:□制造商Manufacturer__________□经销商Distributor_________□贸易公司TradingCompany_________□其它(请说明)other(pleasestate)_________________4.投保公司从事该行业几年？如果有的话，请提供公司网址HowlonghastheInsuredbeeninthisbusiness?Pleaseprovidecompanywebaddress,ifthereisone.5.被保险人在美国或加拿大有分支机构或代表处？如有,请提供以下资料DoestheInsuredhaveanysubsidiaries,affiliatesorrepresentativeofficeintheUSAand/orCanada?IfYES,pleasegivethefollowingdetails:□Yes□No公司名称NameofCompany:_______________________________________________公司性质BusinessNature:____________________________________________地址Address:_______________________________________________________与被保险人关系RelationshipwiththeInsured:________________PARTII-产品信息PRODUCT(s)INFORMATION(请附产品说明书、产品目录、测试报告、用户使用手册。PleaseattachProductBrochures,Catalogue,TestingReports,UserManuals)1.1）请简要说明贵公司目前所生产或销售的所有产品,并说明所需承保的产品。Pleaselistallproductsproducedand/ordistributedbyyouandspecifytheproductstobeinsured.______________________________________________________________________________2）贵公司从事生产或销售这些产品多长时间?Howmanyyearshaveyoubeenmanufacturingordistributingtheseproducts?______________________________________________________________________________2.预期产品的生命期限Whatisthelifeexpectancyofyourproduct?_______________________________________________________________________________3.最近五年内是否有已停止生产或销售的产品？如有，请简要说明Arethereanyproductsthatarenolongermanufacturedordistributedbyyouduringthepastfive□YES□NOyears?IfYES,pleasedescribe.4.未来一年内是否预计推出新的产品？如有，请说明。Areanynewproductsproposedforintroductionduringtheensuingyear?IfYES,pleasespecify:□YES□NO*请注意：任何新增加的产品必须通知本公司,并经本公司书面同意后才能受本保险保障。*Note:AnyadditionalproductmustbereportedtotheCompanyandwillbecoveredonlyuponwrittenacceptancebythecompany.5.产品是否全部由贵公司自行设计?Areallofyourproductsdesignedbyyourself?□YES□NO6.贵公司的产品是否作为其它产品的零组件?若是，请指明Arethereanyproductssoldascomponentpartsforotherproducts?IfYES,pleasespecify:□YES□NO7.1）贵公司所售的产品是否有以其它名称来销售?如有，请说明并提供其所占比例。Areanyofyourproductssoldunderanothernameorlabel?IfYES,pleasedescribeandgive□YES□NOPercentage.__________________________________________________________________2）如有，请问此产品是由贵司设计还是买方设计？□YOURCOMPANYAresuchproductsmadetoyourspecificationorthoseofthebuyer?□BUYER8.贵公司是否向他人购买原料或零组件?Doyoupurchasematerialsorcomponentsfromothers?□YES□NO9.贵公司的产品是否用于下列项目或与其有关Couldanyofyourproductsorservicesbeusedonorinconnectionwith:*航空器/飞弹/太空方面aircraft/missile/aerospace?□YES□NO*水上或海上交通工具watercraftoroffshore?□YES□NO*内陆交通运输transportation/transit?□YES□NO*维生、复健设备lifesupportservice?□YES□NO如有，请说明：IfYES,pleasespecify:___________________________________PartIII-产品销售额TURNOVER请列出投保产品下一年度预期销售额及过去四年的实际销售额(美元)Pleaseprovideestimatedturnoverfortheproductstobeinsuredandpast4yearsactualturnoverineachregion(inUSDollars)a.美加地区USA/Canada年度Year产品Product20102009200820072006b.澳洲和新西兰Australia&NewZealand年度Year产品Product20102009200820072006c.欧洲Europe年度Year产品Product20102009200820072006d.其它地区RestoftheWorld年度Year产品Product20102009200820072006PARTIV–产品质量及安全控制PRODUCTQUALITYANDSAFETYCONTROL1.1)贵公司是否有书面的产品质量控制措施？□YES□NOIsthereawrittenQualityControlProcedureinplace?2)是否有书面的产品回收计划？□YES□NOIsthereawrittenproductrecallplan?2.产品是否达到或超过相关国家政府与行业所订的标准?如是，请列举适用的标准及其影本Areyourproductsdesignedtomeetorexceedtherespectivegovernmentandindustry’sstandards?□YES□NOIfYES,pleaselistallapplicablestandardsandattachcopies.__________________________________________________________________________3.产品测试ProductTesting1)有无书面的产品测试程序?□YES□NOArewrittentestingproceduresinplaceforyourproducts?2)产品是否经过专业机构监测合格。如有，请附复印本□YES□NODoyouapplyanythird-partylaboratories/testingcenters?Ifyes,pleaseattachcopyofthereports.____________________________________________________________________________4.关于产品的潜在危险、误用或滥用，贵公司是否警告最终消费者？如有，说明以下何种方式Arehazardsinherentinthefinalproduct,andwarningsagainstforeseeablemisuseandabusemade□YES□NOknowntotheultimateuser?IfYES,pleasespecifyhow:在产品危险部位标示警告事项warninglabelsatthepointofhazard?_______________________________________________提供文字说明writteninstructions?_____________________________________________________________其它方式(请说明)othermeans(attachdetails)?_____________________________________________________5.对已售产品，贵公司能否能确定：Canyoudeterminebasedonavailablerecordsforallproductsyouhavesold:产品的制造日期?□YES□NOWhenanygivenproductitemwasmanufactured?产品销售的对象及出售日期?□YES□NOTowhomitwassold,andthedateofsale?零件及材料的供货商?□YES□NOSuppliersofthepartsandmaterials?6.贵公司是否留存有关产品的旧的使用说明，操作手册或广告资料?Doyoumaintaincopiesofoldinstructionoroperationmanualsandadvertisingmaterial?□YES□NOPartV–经销商责任Vendor’sLiability1.您是否需要“经销商责任”（是否作为附加被保险人）？若是，请填写以下信息：DoyourequireanyVendorLiabilitycover（tobeadditionalinsuredorn