新華保險顧問有限公司
Sun Flower Insurance Brokers Limited
香港專業保險經紀協會會員
A MEMBER OF PROFESSIONAL INSURANCE BROKERS ASSOCIATION
電話 Tel: 2521-1881 傳真 Fax: 2521-1919
致To
由From
電話Phone
電子郵件E-mail
日期Date

Application For Marine Open Cover

(All Questions Must Be Answered Fully & Concisely 請完整準確回答所有問題)


1. (a) Open Cover to be in the name of 投保戶名稱
 (b) Address 地址
 (c) Phone No. 電話 Fax No. 傳真 Attention 致

2. Period of insurance required 投保期限 From 由 To 至
3. Nature of Merchandise to be covered
投保貨物
4. The type of packing employed
使用的包裝種類
5. Please state voyage(s) to be covered
請註明投保航程
From 由 To 至 Via 轉
6. Means of Transport
Please tick () where applicable
運輸工具
請在適當處 ()
  (a) Ocean-going vessels 遠洋輪船
  (b) Airfreight 貨運飛機
  (c) Parcel Post 郵包
  (d) Others 其他
7. Maximum amount at risk: 保險限額
(a) By any one vessel 每一艘船

(b) By any one land conveyance每一陸運工具

(c) By any one aircraft 每一飛機

(b) At any one location 每一地點

 ( HK$/US$ Currency 幣值 )

( HK$/US$ Currency 幣值 )

( HK$/US$ Currency 幣值 )

( HK$/US$ Currency 幣值 )
8. Basis of valuation for insurance purposes?
保險價值根據		 Invoice Cost plus all charges plus 發票價格加上 %
9. Please state the conditions of insurance
required and any other special
requirements
請註明承保條件要求以及其他特殊要求
10. Please advise any shipment sold by the assured on "FOB", CFR" or similar terms Yes   No
If yes, the following Clauses is applicable

1. Sellers Interest Clause
2. Covering frorn door to door including cover throughout all loading and unloading operations against the insured perils as per Institute Clauses & related clauses statede
11. Is the interest now insured with any other
company? If so, please state the
name of Company.
本保險標的物以前曾否向其他保險公司
投保? 如有，請列出該公司名稱
12. Please state the total value of sendings for the
last year and the estimated turnover for the
coming year
請說明去年及預計來年之貨運總金額 		            Last Year 去年          Coming Year 來年

Exports 出口          

Imports 進口          

Local Transit 本地運輸     

13. Please state the total amount of claims
paid and outstanding for the last three
years

請說明前三年已結和未結索賠的
全部金額 		Year 年份 Approx. Number of Claims
大致索賠案件數		 Amount
金額
Total 總計
Date at Hong Kong 日期於香港
On(d日)/ (m月) / (yyyy年) 		Signature 簽名

IMPORTANT NOTE

(1) You are required to disclose all material facts which you know as insurer would regard them as likely to influence the acceptance and assessment of this proposal. If you are in any doubt about facts considered
material, you should disclose them.

(2) You are reminded to keep a copy of the completed proposal for your record and future reference.

(3) A specimen copy of the policy form is available on request.