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【简介】
本投保书必须经由投保人授权的董事的确认、签名、盖章并注明日期。 This proposal must be reviewed, signed, stamped and dated by a duly authorized Director. 请回答该表中的所有问题。若填写位置不足,请另附公司信纸作答。 You must answer all the questions in this form. If more space is required to answer a question, continue on your letterhead. 签署本投保书并不代表投保人购买本保险合同 Signing this proposal does not bind the Applicant to complete this insurance. 有关投保人的资料 Details of Applicant 1. 投保人名称 Name of the Applicant _______________ 地址 Principal Address _______________ 联系人 Contact Person _______________ 电话号码 传真号码 Telephone number ________________________ Fax number ___________________________ 电邮地址 网址 E-mail address ________________________ Website ___________________________ 2. 投保人成立时间 When was the Applicant established? ___ 3. 请对投保人的业务范围提供详细的描述 Please provide full details of business activities undertaken by the Applicant ___________________________________ ___________________________________ ___________________________________ ___________________________________ 4. 投保人是否曾更名或曾收购、合并其它机构或其它业务? Has your name ever been changed, or have you purchased or merged with any other practice or business? 是Yes 否No 若有,请另附公司信纸提供详细信息,包括该被并购方的名称、并购时间、新增人员的数目及被并购业务的收入情况。 If yes, please attach details including the name of any practice of which this Practice is a successor, the date of such transaction, the number of employed and the fee income of the previous practice 5. 请说明投保人各分支机构及职责(如需要包含于承保范围中的) Please list any branch (for which cover is required) together with details of the Partner(s) responsible for each one ___________________________________ ___________________________________
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