宾馆公众责任险投保书

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1、TRUSOURCEJI—JPUBLICLIABILITYPROPOSALFORMFORHOTEL宾馆公众责任险投保书Pleasenotethattheinformationyouprovideisusedtodetermineyourinsurancerequirementsandtoassessthepremiumyouwillneedtopay,therefore,pleasegivefullestinformation.Thankyou.请注意您所提供的资料将用于决定您的投保屮请是否被接受以及如被接受您必须缴付的保险费，因此，请给

2、了最详细的资料。谢谢。1.NameofApplicant投保人姓名2.CorrespondentAddrcss/Tcl.No.通讯地址及电话3.TheApplicantis:投保人是：□Individual□Partnership□CorporationDJointVenture□Other独资合伙股份公司合资其他4.ThePremisestobeinsuredis:被保险场所是：□aHotelCanApartmentBuildingOaCondominiumBuilding宾馆公寓房个人公寓房5.BusinessAddress:营业地

3、址:Telephone:电话：6.PeriodofInsurance保险期限From由To到7.LimitofInsuranceLiability:需保险金额：PerAccident每次意外事故PerPeriodofInsurance保险期限8.Amountofexcessyourfirmpreparedtocarryforeachpropertydamageaccident:每次财物损毁事故的自负额：PerAccident每次意外事故9.HowlonghasInsuredbeeninbusinessashotelieratthispr

4、emises?被保险人在该保险场所从事宾馆业有多久？10.1)Enterchecknexttoconstructioncomponentsinthefollowingspaces.Ifmixedconstruction,indicatepercentageineachcategorytoaddupto100%ordescribeinspaceprovided:in在下列建筑结构处打勾。如是混合结构，诸在每个类别上写上比例数，或在空格处详细描述。StructureExteriorFloorWallsRoofA.Protectedsteel

5、frameorreinforcedconcrete被保护的钢架或钢盘混凝土B.Unprotectedsteelorhollowconcreteblock未保护钢架或空心混凝土板C.Brickormasonry砖瓦结构A.Wood木结构B.Other(Describe)其他(请详述)rf~lTRUSOURCEJ1—JIstheApplicant5sMaintenanceofthePremises投保人对保险场所的维修□Good好dFair般口卩00「差2)HowoldistheoldestpartoftheElectricalWiring

6、systems?电线系统最旧的部分有多少年？Whenwastheinstallationlasttestedandcertifiedbyanindependentelectricalengineer?独立工程师最近作的测试及证明是在何时？3)A.WhatFireProtectiondoesthePremiseshave:被保险场所的防火措施：PortableExtinguisher便携式灭火器材□Yes有ClNo无Ifyes,howmany如是，请问多少andwhattype型号是FireHosesandHydrants消防水管及龙头□

7、Yes有ClNo无Ifyes,inwhatareas如有，请问所在地区Fire/SmokeAlarms火灾/烟雾报警系统□Yes有ONo无Ifyes,inwhatareas如有，请问所在地区□Allareasincludingguestrooms所有地区包括房间□Commonareasonly只在公共地区SprinklerSystem喷淋系统□Yes有ClNo无Ifyes,inwhatareas如有，请问所在地区□Allareasincludingguestrooms所有地区包括房间□Commonareasonly只在公共地区B.How

8、manyemergencyexitsarethereperfloor?请问每一楼面有多少紧急出口？C.DoesInsuredhaveawrittencrowdcontrolandevacuationplan