财产一切险风险问询表 Property All Risks Insurance Questionnaire

Rm 1917,Pacific Business Building，Jiabin Rd，Luohu，Shenzhen Tel:0755-82136473 Fax:0755-82136086 深圳罗湖区嘉宾路太平洋商贸大厦1917室 邮编：518001 电话：0755-82136473 传真：0755-82136086

请如实告知以下情况:

Please provide the following information to your best knowledge, complete and true:

1.投保人名称及地址

Name and Address of Proposer 2.被保险人名称及地址

Name and Address of Insured 3.经营内容 Business 4.保险财产项目和地址

Items and Respective Address(es) of Insured Property 5.保险财产价值

注：仓储物品的申报金额栏请填写最近五年的任一时点的最大存量（金额）。

Rm 1917,Pacific Business Building，Jiabin Rd，Luohu，Shenzhen Tel:0755-82136473 Fax:0755-82136086 深圳罗湖区嘉宾路太平洋商贸大厦1917室 邮编：518001 电话：0755-82136473 传真：0755-82136086

6.建筑物状况

建筑结构：1）钢筋混凝土 2）钢结构 3）钢混，砖混或钢结构 4）砖混 5）木结构或其它不明结构

Building construction: 1) reinforced concrete 2) steel framework 3) steel reinforced concrete, brick reinforced concrete or steel framework 4) brick reinforced concrete 5) timber or other framework 7.机器设备：

Machinery & Equipment

8.原材料/在产品/成品状况

Raw materials/goods in progress/finished goods

Rm 1917,Pacific Business Building，Jiabin Rd，Luohu，Shenzhen Tel:0755-82136473 Fax:0755-82136086 深圳罗湖区嘉宾路太平洋商贸大厦1917室 邮编：518001 电话：0755-82136473 传真：0755-82136086

9.周围环境 Surroundings

1） 描述周围建筑物、社区情况（方位/距离）

Describe vicinal buildings and compounds, if any

2） 最近的江、湖、海的名称、距离

Name and distance of nearest river, lake or sea, if any

3） 距最近消防队距离及所需时间

Access to the nearest fire brigade

4） 是否出于低洼地带 □是 □否

Whether it is located at low water level Yes No

5） 洪水警戒线 □以上 □以下

Flood warning line Above Below 10.主要自然灾害及通常发生季节

Major natural hazards and seasons of occurrence

□地震 □洪水 □台风 □暴雨 □其他 Earthquake Flood Typhoon Storm Others

Rm 1917,Pacific Business Building，Jiabin Rd，Luohu，Shenzhen Tel:0755-82136473 Fax:0755-82136086 深圳罗湖区嘉宾路太平洋商贸大厦1917室 邮编：518001 电话：0755-82136473 传真：0755-82136086

11.企业安全/防范情况： Security/precaution control

1）有无制作安全操作规程？ □有 □无 Is there any safety operation manual? Yes No

2）有无自己的消防队？ □有 □无 Does it have its own fire brigade Yes No If yes, please state number of staff 人(staffs)

3）有无报警系统？ □有 □无 Is there any alarm system? Yes No

4）有无设置便携式灭火器? □有 □无 Is there equipped with portable fire extinguisher? Yes No

5）有无充分水源？ □有 □无 Is there any adequacy water source Yes No

6）有无禁烟区？ □有 □无 Is there any non-smoking area? Yes No

7）有无自动喷淋装置？ □有 □无 如有，请列明数量及安装方位 Yes No Is there any automatic sprinkler If yes, please state quantity and place

8）其他消防设施情况（请列明种类/数量及安放地点） Other fire apparatus (Please state type/quantity/place)

9）以下时间内是否有值班？ □日常工作时间 □ 节假日 □夜间 Are there any employees on duty? Routine work time Holiday Night

10）其他保安措施（防盗等）：

Other security measures (e.g. anti-theft, etc.) 12．仓储物品： Storage goods

1）是否有专人看管？ □是 □否 Is there any full time guard? Yes No

2）易燃易爆物品是否存放在独立的危险仓库内？ □是 □否 Are those combustible, explosive goods kept in separate warehouses? Yes No

Rm 1917,Pacific Business Building，Jiabin Rd，Luohu，Shenzhen Tel:0755-82136473 Fax:0755-82136086 深圳罗湖区嘉宾路太平洋商贸大厦1917室 邮编：518001 电话：0755-82136473 传真：0755-82136086

3）请说明上述危险品仓库与其他建筑物的最小间距 Please indicate the minimum distance between the above warehouses and other buildings

4）是否有消防设施？ □是 □否 Is there any fire apparatus? Yes No 如有，请列明If yes, please state

5）仓储处是否有紧急报警系统？ □是 □否 Is there any emergency alarm system in the warehouse? Yes No

6）仓储处是否定期进行清理？ □是 □否 Are the warehouses cleaned regularly? Yes No 如是，请说明清理频率If yes, please state frequency

7）仓储处是否有紧急出口及安全通道？ □是 □否 Is there emergency exit and safety passageway? Yes No

8）仓储物品是否有完整出入库登记？ □是 □否 Is there complete inventory list for the storage goods? Yes No

13.生产经营中风险： Risk at operation

1）生产工艺采取的是： □常温 □常压 Production technique: Normal temperature Normal pressure

□高温 □高压 □其它 High temperature High pressure Others

2）生产过程中有无使用易燃易爆材料？ □有 □无 Any combustible, explosive materials used Yes No

in the manufacture process?

如有，请列明If yes, please state

3）生产过程中有无可燃性气体或粉尘产生？ □有 □无 Any flammable gas or powder exist in Yes No

the manufacture process?

如有，请列明If yes, please state

4) 所列能源中经常出现突然中断现象的是 Interruption possible in the supply of

□汽 □水 □电 □气 □无中断现象

Vapor Water Electricity Gas None

Rm 1917,Pacific Business Building，Jiabin Rd，Luohu，Shenzhen Tel:0755-82136473 Fax:0755-82136086 深圳罗湖区嘉宾路太平洋商贸大厦1917室 邮编：518001 电话：0755-82136473 传真：0755-82136086

14.以往五年有无损失发生？ □是 □否 Is there any loss in the past 5 years? Yes No 如有，请说明每次损失的原因、受损财产、损失金额

If yes, Please state the cause, property damaged, and loss amount.

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