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

致To
由From
電話Phone
電子郵件E-mail
日期Date

火險申請表

FIRE INSURANCE REQUEST FORM

請以英文正楷填寫此表格及在適當方格內加 Please complete the table in English block letter and tick if applicable

保戶名稱	Name of Insured
行業	Business
聯絡電話	Contact No.		傳真 Fax :
通訊地址	Postal Address
投保地址	Risk Location
(若與通訊地址不同 if different from above)
佔用性質	Occupation
按揭公司	Mortgagee(s)
保險期	Period of Insurance (日D/月M/年Y)	由 From :	至 To :

投保項目Item	投保額Sum Insured (HK$)
1. 房屋（溝渠及地基除外）
Building/Flat Including Landlord’s Fixtures And Fittings (But Excluding Drains & Foundations)
2. 傢俬及裝修
Furniture, Fixtures & Fittings
3. 貨物
Goods & Merchandise
4. 機器及零件（工模除外）
Machinery & Accessories (Excluding Moulds Of Any Kind)
5. 衣服行李（珠寶首飾及錶除外）
Clothing & Personal Effects (Excluding Jewelry & Watches)
6. 其他（請註明）：
Clothing & Personal Effects (Excluding Jewelry & Watches)
總投保額　Total Amount Insured：
保費率Rate：
保費 Premium：

賠償記錄 Claims History	過往三年有否索償 Any Claim in the past 3 years? 有Yes 否No

自負額
Excess :

日期 Date:

投保人簽署 Applicant's Signature:

香港德輔道中282號興業商業中心11樓1108室 Room 1108, Hing Yip Commercial Centre, 282 Des Voeux Road Central, Hong Kong
電話Tel: (852) 2521-1881 傳真Fax: (852) 2521-1919 網址Website: www.sunflowerVIP.com www.sunflowerMPF.com

保障由火災、閃電及家用煱爐或氣體爆炸及下列項目造成之損毀This insurance covers loss or damage caused by Fire, Lightning and explosion of boilers or gas used for domestic purposes only or by extended Extra Perils as specified below：
	EP01A – Aircraft 飛機	EP02A - Bush Fire 山火	EP03B – Earthquake (Fire Shock & Flood) 地震（火災及水浸）
	EP04A – Explosion 爆炸	EP05A – Vehicle Impact (by third party vehicle) 汽車撞擊 (由第三者汽車引致)	EP06A – Riot & Strike 暴動或罷工
	EP06C – Malicious Damage 惡意破壞	EP07A - Spontaneous Combustion 自燃附加險	EP08A – Sprinkler Leakage 防火花灑滲漏
	EP09C – Typhoon Windstorm & Flood 颱風暴風及水浸	EP10A – Water Tanks Apparatus & Pipes 水箱及水管滲漏	EP11A - Landslip and Subsidence 山泥崩塌及地陷