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

餐飲業保險報價申請表 RESTAURANT INSURANCE REQUEST FORM

商舖綜合保險
Shop Package		 財物全險
Property-All-Risks		 火險及附加險
Fire & Allied Perils		 公衆責任保險
Public Liability		 金錢保險
Money		 其他
Others：
辦公室專用 For Office Use Only
保障範圍
Cover 		投保額
Sum Insured (HK$) 		保費率
Rate 		保費
Premium
1 營業裝置及設備 Furniture, Fixtures & Fittings
1.1 櫥窗、玻璃門及框架 Show windows, glass door and frames -
1.2. 有沒有任何霓虹燈招牌或廣告牌 Any Advertising Signs?
Please specify sizes and materials of signs/Photos for ref.
( ) 呎 x ( ) 呎 x ( ) 呎
1.3任何一件器材價值超過HK$75,000 Any one item of equipment exceeding HK$75,000.00 -
2 商品存貨    Stock in Trade
3 樓宇結構    Fabric of Building
4 金錢損失保險  Loss of Money Insurance
4.1. 在營業時間運往返銀行或辦公室途中 In transit to and from Bank (Business Hours) -
4.2. 在營業時間置於辦公室內 In Premises ((Business Hours) -
4.3. 在營業時間後置於上鎖夾萬或保險庫內 Secured in the locked safe / strong room in the Premises (After Business Hours) -
4.4. 在營業時間後置於辦公室內或收銀機或上鎖抽屜內 In Premises & secured in the cash register or locked drawer (After Business Hours)
5 公眾責任保險 Public Liability Insurance
餐廳總面積 Gross floor area：
餐廳座位數目 No. of Seats：
餐廳營業時間 Business Hours：
6 其他 Other: 餐廳成立年份 Established：
 最低保費 Min.
防盜系統 Anti-theft Device ( *請遞交防盜系統圖解作核保用途 Please attach Alarm Plan for underwriting purpose)
   自動通報撥號警報器 Auto Dialer Alarm    商品電子防盜系統 Electronic Article Surveillance    捲閘 Roller Shutter
   直線警衛監控警報器 Direct-link Monitoring Alarm   通道管理系統 Access Control System   柵欄 Grille   Other 其他:
防火系統 Fire Protection
   花灑系統 Fully Sprinklered?    煙霧探測器 Fire Alarm Smoke Detector?    滅火桶 Extinguisher?

Building Construction / Occupancy Information:
工業樓宇/商業樓宇/商住樓宇/獨立屋/村屋；樓齡：年 Please attached with Photos 請連同相片


7 僱員賠償保險 Employees’ Compensation Insurance - 請註明外出工作、海外公幹、體力勞動、操作機器或駕駛車輛類別等職務需要 Please specify “Outdoor”, “Overseas”, “Manual Work”, “Type of Machine or Vehicle” if applicable
項目
Item		 僱員人數及工作類別
No. & Description of Employee 		海外公幹
備註*
Remark 		預計全年總收入**
Estimated Annual Total
Earnings (HK$) 		條款
Warranty 		保費率
Rate 		保費
Premium
1.
2.
3.
Provide Employer's MPF contribution list 強積金供款記錄  總計Total  最低保費Min.
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

勞 保 徵 費 Levy 10.8%
附加文件 Supplementary Document -
 請提供閣下最新的續保通知書或保險單副本作核保用途
Please provide copy of latest renewal notice or policy schedule for underwriting purpose 		總保費Total Premi um

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

佣金 Comm. %
淨保費Net Premiu m