机器风险调查问卷（5页）.doc

1．企业名称及地址/NameandAddressofApplicant：

2．被保险机器地址/Locationofinsuredmachinery：

3．工厂附近是否有火车站、机场？/Istherearailwaystation/airportinthevicinityofthefactory？

□是/Yes□否/No

4．最近三年是否受到过损坏？/Whetherabreakdownsustainedinthepastthreeyears？

□是/Yes□否/No

如是，请列出机器名称、损坏时间、原因和金额/Ifso,pleasestatenameofthemachine

sustainingbreakdown,time,causeandamountoftheloss：

5．损失后是否完全修复？/Hasthemachine-sustainingbreakdownbeencompletelyrepaired？

□是/Yes□否/No

6．是否经过试车验收并取得合格证？/Whethertheacceptancetesthasbeenpastandthecertificateofqualityhasbeenobtained？

□是/Yes□否/No

7．是否有制造厂商，安装者的责任保险期？/Istheremaintenanceperiodgivenbythemanufactureandtheerector？

□是/Yes□否/No如是，请列出期限：/Ifso,pleasestatethemaintenanceperiod：

8．进口的技术合同是否有明细单价？/Whethertheunitpriceshavebeenspecifiedonthetechnicalandpurchasecontractsofimportedmachinery？□是/Yes□否/No

9．外文使用说明书及技术资料是否已全部译成中文？/HaveoperationinstructionsandtechnicalmaterialsbeentranslatedintoChinese？