产品责任险询问表.doc

PRODUCTS LIABILITY INSURANCE QUESTIONNAIRE 产　品　责　任　险　询　问　表 PLEASE TYPE OR PRINT 请以打字或正楷填写 Applicants Instructions 申请人注意事项： Answer all questions and please do it in English , if possible.请回答下列问题，并尽可能以英文回答。 If space is insufficient to answer any questions fully, attach separate sheet.若作答空间不够，请另附其它纸张回答。 If the answer to any question is none, state NONE.若回答问题的答案为无的话，请答「无」字。 Application must be signed and dated by owner, partner or officer.本问卷需公司所有人、合伙人、或部门主管签章及注明填写日期。 APPLICANT 要保人 Full Name：?????全名 Principal address：?????住所地 Website：?????网址 Subsidiaries or Divisions：????? 分支机构 If you have a subsidiary, affiliate or representative in the USA/Canada, please give names(s) and address(s)：????? 若　贵公司在美国／加拿大有分支机构／联络处请详列名称及地址Individual　独资 Partnership　合伙 Corporation　公司 Other　其它Manufacturer　制造商 Wholesaler　批发商 Retailer　零售商 Importer　进口商 Exporter　出口商 Assembler 　零件组合商  Years in business under present name：????? 　 以目前公司名称从事该行业之年数 Prior experience in this business under another name：???? 以前有无以其它之公司名称／商号从事该行业之经验 PRODUCTS AND SALES DATA 产品及销售数据 Describe your products, Include and identify, those acquired via acquisition or merger, those planned for introduction in next 12 months, and those previously discontinued. Show number of years involved with each products; indicate which products you install, service or repair：请叙述　贵公司之产品，在叙述中请包括并指明藉由并购或合并而取得之产品及在未来12个月内计划生产之产品，以及可能中止生产之产品。请按产品及年度，分项说明　贵公司所生产、装配及修理之产品。 List the turnover figures for the past 5 years as well as the estimated Turnover for the forthcoming year. Indicate the approximate percentage split in turnover per territory.列出过去五年之销售金额及预估年度预计投保之销售金额，同时依下列不同地区填写其所占之比率。 Year 年份 Turnover 销售金额(US$) 各地区比例 USA/Canada 美／加 Japan/Australia/Europe 日本／澳洲／欧洲 Other 其它地区 Est. 2014 ????? ?? ????? ????? 2013 ????? ????? ????? ????? 2012 ????? ????? ????? ????? 2011 ????? ????? ????? ????? 2010 ????? ????? ????? ????? Please indicate the approximate percentage of overall turnover for the year relating to