外銷產(chǎn)品責任險要保書

1、Page1of5出口產(chǎn)品責任險投保書出口產(chǎn)品責任險投保書EXPTPRODUCTSLIABILITYINSURANCEAPPLICATION本公司對問卷各項填寫內(nèi)容，除作為核保及其它保險程序上的參考外，不另為其它用途，并予以保密。Theinfmationprovidedherewillbeusedfinsuranceunderwritingrelatedprocessingonlywillbekeptconfidential.PartI–

2、基本信息基本信息BasicInfmation1.投保人被保險人名稱及注冊地址Name&addressofapplicantinsured(includingallsubsidiaries):2.被保險人成立形式TheLegalFmoftheInsured□獨資Individual_________□合伙Partnership_________□公司Cpation__________□合資Jointventure______3.請選出被保

3、險人的經(jīng)營性質(zhì)PleasetickthebusinessnatureoftheInsured:□制造商Manufacturer__________□經(jīng)銷商Distribut_________□貿(mào)易公司TradingCompany_________□其它(請說明)other(pleasestate)_________________4.投保公司從事該行業(yè)幾年？如果有的話，請?zhí)峁┕揪W(wǎng)址HowlonghastheInsuredbeenint

4、hisbusinessPleaseprovidecompanywebaddressifthereisone.5.被保險人在美國或加拿大有分支機構或代表處？如有請?zhí)峁┮韵沦Y料DoestheInsuredhaveanysubsidiariesaffiliatesrepresentativeofficeintheUSACanadaIfYESpleasegivethefollowingdetails:□Yes□No公司名稱NameofCompa

5、ny:_______________________________________________公司性質(zhì)BusinessNature:____________________________________________地址Address:_______________________________________________________與被保險人關系RelationshipwiththeInsured:________

6、________PARTII產(chǎn)品信息產(chǎn)品信息PRODUCT(s)INFMATION(請附產(chǎn)品說明書、產(chǎn)品目錄、測試報告、用戶使用手冊。請附產(chǎn)品說明書、產(chǎn)品目錄、測試報告、用戶使用手冊。PleaseattachProductBrochuresCatalogueTestingReptsUserManuals)1.1）請簡要說明貴公司目前所生產(chǎn)或銷售的所有產(chǎn)品并說明所需承保的產(chǎn)品。Pleaselistallproductsproduceddi

7、stributedbyyouspecifytheproductstobeinsured.______________________________________________________________________________2）貴公司從事生產(chǎn)或銷售這些產(chǎn)品多長時間Howmanyyearshaveyoubeenmanufacturingdistributingtheseproducts_________________

8、_____________________________________________________________2.預期產(chǎn)品的生命期限Whatisthelifeexpectancyofyourproduct_______________________________________________________________________________3.最近五年內(nèi)是否有已停止生產(chǎn)或銷售的產(chǎn)品？如有，請簡要說明Are

9、thereanyproductsthatarenolongermanufactureddistributedbyyouduringthepastfive□YES□NOyearsIfYESpleasedescribe.4.未來一年內(nèi)是否預計推出新的產(chǎn)品？如有，請說明。AreanynewproductsproposedfintroductionduringtheensuingyearIfYESpleasespecify:□YES□NO請注意

10、：任何新增加的產(chǎn)品必須通知本公司并經(jīng)本公司書面同意后才能受本保險保障。Note:AnyadditionalproductmustbereptedtotheCompanywillbecoveredonlyuponwrittenacceptancebythecompany.Page3of5d.其它地區(qū)其它地區(qū)RestoftheWld年度Year產(chǎn)品Product20122011201020092008PARTIV–產(chǎn)品質(zhì)量及安全控制產(chǎn)品質(zhì)量

11、及安全控制PRODUCTQUALITYSAFETYCONTROL1.1)貴公司是否有書面的產(chǎn)品質(zhì)量控制措施？□YES□NOIsthereawrittenQualityControlProcedureinplace2)是否有書面的產(chǎn)品回收計劃？□YES□NOIsthereawrittenproductrecallplan2.產(chǎn)品是否達到或超過相關國家政府與行業(yè)所訂的標準如是，請列舉適用的標準及其影本Areyourproductsdesig

12、nedtomeetexceedtherespectivegovernmentindustry’sstards□YES□NOIfYESpleaselistallapplicablestardsattachcopies.__________________________________________________________________________3.產(chǎn)品測試ProductTesting1)有無書面的產(chǎn)品測試程序□YES□

13、NOArewrittentestingproceduresinplacefyourproducts2)產(chǎn)品是否經(jīng)過專業(yè)機構監(jiān)測合格。如有，請附復印本□YES□NODoyouapplyanythirdpartylabatiestestingcentersIfyespleaseattachcopyoftherepts.______________________________________________________________

14、______________4.關于產(chǎn)品的潛在危險、誤用或濫用，貴公司是否警告最終消費者？如有，說明以下何種方式Arehazardsinherentinthefinalproductwarningsagainstfeseeablemisuseabusemade□YES□NOknowntotheultimateuserIfYESpleasespecifyhow:?在產(chǎn)品危險部位標示警告事項warninglabelsatthepointof

15、hazard_______________________________________________?提供文字說明writteninstructions_____________________________________________________________?其它方式(請說明)othermeans(attachdetails)_____________________________________________

16、________5.對已售產(chǎn)品，貴公司能否能確定：Canyoudeterminebasedonavailablerecdsfallproductsyouhavesold:?產(chǎn)品的制造日期□YES□NOWhenanygivenproductitemwasmanufactured?產(chǎn)品銷售的對象及出售日期□YES□NOTowhomitwassoldthedateofsale?零件及材料的供貨商□YES□NOSuppliersofthepar

17、tsmaterials6.貴公司是否留存有關產(chǎn)品的舊的使用說明，操作手冊或廣告資料Doyoumaintaincopiesofoldinstructionoperationmanualsadvertisingmaterial□YES□NOPartV–經(jīng)銷商責任經(jīng)銷商責任Vend’sLiability1.您是否需要“經(jīng)銷商責任”（是否作為附加被保險人）？若是，請?zhí)顚懸韵滦畔ⅲ篋oyourequireanyVendLiabilitycover

18、（tobeadditionalinsurednot）Ifyespleaseprovidethefollowinginfmation:經(jīng)銷商名稱地址產(chǎn)品名稱使用品牌名稱銷售額Vend’sNameAddressProductNameBrSales___________________________________________________________________________________________________