雇主责任险风险问卷调查表

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1、雇主责任保险Employer’sLiabilityInsurance风险调查问卷RiskEvaluationQuestionnaire概况GeneralInformation1．投保人名称NameofInsured____________________________________________________________________________________________________________2．总部地址AddressofHeadOfficeinP.R.China_______________________________________

2、_____________________________________________________________________3．工作地点Work-place(若包含多个附地址清单Ifmorethanoneplaceareincluded,pleaseattachlist)____________________________________________________________________________________________________________4．企业性质NatureofEnterprise□国营state-owned□

3、集体collective□私营private-owned□股份制shared□中外合资joint□外商独资，请告知外方的国籍：foreigner-owned,pleaseadvisenationalityoftheowner____________________________________________________________________________________________________________5．行业性质与经营范围Nature&ScopeofBusiness是否属于危险品生产Isyourbusinesstomanufactureh

4、azardousproducts？□是Yes□否No请详述：Pleasedescribe____________________________________________________________________________________________________________6．普通汽车数量Numberofregularautomobiles：___________________________________________________________________________是否拥有特种工程车？Doyoupossessengine

5、eringvehiclesforspecializedoperation□是Yes□否No若有，请说明：Ifso,pleasespecify车辆类型type数量quantity__________________________________________________________________雇员情况conditionofemployee1．员工人数No.ofEmployee:___________其中，人事/人力资源部员工数Amidstabove,No.ofEmployeesinthepersonnel/humanresourcedepartment:___

6、______________女性员工占比PercentageofFemaleEmployee：________%30岁以下员工占比PercentageofEmployeebelow30：________%30~50岁员工占比PercentageofEmployeebetween30and50：________%50岁以上员工占比PercentageofEmployeeover50：________%2．是否为本单位雇员缴纳四金？Doyoupaytolegalwelfarefundsforallofyouremployees□是Yes□否No除本保险外，是否还为雇员购买其他商

7、业保险？Isthereanyotherwelfarecommercialinsurancepolicypurchasedforyouremployeebesidesthisinsurance□是Yes□否No请简单评述本单位的福利和收入水平在同行业中的所处地位：Pleasegivecommentinrespectofyouremployee’swelfareandsalary□领先superior□高于平均水平aboveaverage□一般水平average□低于平均水平belowaverage3．请按下表填写雇员