货物运输保险投保单

中国人民财产保险股份有限公司

上 海 市 分 公 司

PICC Property and Casualty Company Limited, Shanghai Branch

地址:

中国上海市中山南路700号

电话（TEL ）:(021)63773000ADD:

No.700 Zhongshan Road (S) Shanghai China

邮编（Post Code ）: 200010

传真（FAX ）:

(021)63764678

货物运输保险投保单

APPLICATION FORM FOR CARGO TRANSPORTATION INSURANCE

被保险人:

INSURED:

发票号（INVOICE NO.）

LS-BRS-INV1116合同号（CONTRACT NO.）

LS-BRS-SC0930信用证号（L/C NO.）

DBS-17526发票金额（INVOICE AMOUNT ）

投保加成（PLUS ）%

兹有下列物品向中国人民财产保险股份有限公司上海分公司投保。（INSURANCE IS REQUIRED ON THE FOLLOWING COMMODITIES:）

标 记

包装及数量

保险货物项目

保险金额

MARKS & NOS.

QUANTITY

DESCRIPTION OF GOODS

AMOUNT INSURED

86 CTNS

PRINTERS

L/C ISSUING BANK: DBS BANK LTD L/C NO:17526

启运日期:

装载运输工具:

DATE OF COMMENCEMENT

PER CONVEYANCE

By sea

自

经

至

FROM

Shanghai,China VIA

TO

Singapore

提单号:

赔款偿付地点:

B/L NO.

CLAIM PAYMENT AT

singapore

投保险别:（PLEASE INDICATE THE CONDITIONS &/OR SPECIAL COVERAGES ）

特殊要求:

请如实告知下列情况:（如‘是’在[ ]中打‘X ’）IF ANY, PLEASE MARK ‘X ’:1、货物种类普通[ × ]散装[ ]冷藏[ ]液体[ ] 活动物[ ]机器/汽车[ ] 危险品等级[ ]

GOODS

ORDINARY

BULK REEFER LIQUID LIVE ANIMAL

MACHINE/AUTO

DANGEROUSE CLASS

2、集装箱种类普通[ × ]开顶[ ]框架[ ]平板[ ] 冷藏[ ] CONTAINER ORDINARY OPEN FRAME FLAY REFRIGERATOR

3、转运工具海轮[ × ]飞机[ ]驳船[ ]

火车[ ] 汽车

[ ]

BY TRANSIT SHIP PLANE

BARGE

TRAIN

TRUCK

4、船舶资料

船籍

船龄

PARTICULAR OF SHIP

REGISTRY

AGE

备注:被保险人确认本保险合同条款和内容已经完全了解

投保人（签名盖章）APPLICANT'S SIGNATURE

THE ASSURED CONFIRMS HEREWITH THE TERMS AND CONDI-TIONS OF THESE INSURANCE CONTRACT FULLY UNDER-STOOD.

投保日期:（DATE ）电话:（TEL ） 0086-21-27403417

SHANGHAI LINSHENG TRADING COMPANY LIMITED

US$ 93,807.4110%

BRS/BRS-LINSH0928/SHINGAPORE/C.NO.1-UP

US$95,625.00

Nov. 22,All risks AS PER B/L

(021)63764678