恐怖保险投保问卷（4页）.doc

A.INFORMATION ABOUT THE APPLICANT 投保人信息

1.Company Name: 公司名称

2.Names of all subsidiary companies: 所有子公司/附属公司名称

3.Head Office Address: 总部地址

4.Ownership of the Company (e.g. public, private, government, etc.) 公司所有权性质 （如上市公司、私人所有，政府所有等）

5.Nationality of Ownership: 公司拥有人的国籍

6.Date of Commencement of operations: 开始营业日期

7.Description of Applicant’s business operations: 投保人营业活动

8.Is Business Interruption cover required?是否要投保营业中断

9.Limit of Cover required: 要求的赔偿限额(single combined limit each 

and every loss and in the aggregate during the period of insurance 

for physical damage and business interruption)

（物质损失和营业中断每次损失的限额及仔保单期限内的累积限额）

10.Has the applicant, any of its subsidiaries or any other entity 

to be insured under this policy suffered a loss, whether insured 

or not, in the past five years from an incident of terrorism 

or sabotage?  If yes, list the date, location, type of incident 

and amount of loss: 

投保人，或其子公司/附属公司，或者在本保单所承保的其他实体在过去5年内是否曾经因为恐怖袭击或者破坏活动而遭受过损失，无论过去是否投保恐怖险？如果有的话，请列出日期、地点、事件类型及损失额。