职业责任保险 PI Proposal

Huatai Insurance Company of China, Limited 0755bx © All rights reserved.
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11.
工种分类：专业－请提供从事以下业务的收入比例 Division of Work: Disciplines – please indicate the approximate percentage of the total fee income derived from the following areas:
13.
投保人、其负责人、合伙人、董事及高级管理人员是否为其他合伙企业或财团的成员？ Is the Applicant, principal, partner, director or officer a member of any joint venture or consortium? 是Yes 否No
政府部门 Government Department 金融公司 Financial Company 商业公司 Commercial Company 制造业/工业企业 Manufacturing / Industrial Enterprise 建筑施工/工程企业 Architectural Construction / Engineering Enterprise 商品批发/零售企业 Merchandise Wholesale / Retail Enterprise 航空航天部门 Aviation Department 卫生医疗机构 Medical Organization 其他-请说明 Other（Please Describe） 合计 TOTAL % % % % % % % % % 100%
姓名 Name 年龄 Age 职位 Position 执业资格 Qualifications 获得资格年份 Year Qualified 在现单位担任该职位的 年资 Year in this position at the Applicant
7.
请提供投保人雇员的人数 Please state the number of the employees:
本年度（预测） Current year (estimate) 上一年度 Past year
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9.
投保人本年度及上一年度涉外业务收入的比例。涉外业务指为海外机构或实体提供专业服务的业务。 就本提问而言，“海外”包括港、澳、台地区。 What are the percentages of the total fee income of the current year and the past year coming from foreign business? Foreign business means business comes from offering professional service to an overseas unit or registered entity. For the purpose this question only, “overseas” include Hong Kong, Macau and Taiwan.
负责人/合伙人/董事 Principals/Partners/Directors 具备专业资格的职员 Professional qualified staff 其他技术职员 Other technical staff 实习职员 Trainee staff 非技术行政职员 Non-technical administrative staff 文员-如打字员、招待员等 Clerical staff-typists, receptionist etc. 其他职员 Other staff 合计 Total
3.
Huatai Insurance Company of China, Limited 0755bx © All rights reserved.
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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
12.
是否有单一客户的业务超过公司业务总收入30％？ Does any one client make up more than 30% of your total fee income? 是Yes 否No
如有，请说明： If yes, please provide:
服务类型和服务区域 Type of Service and Country 收入 Fee Income 合约价值 Contract Value 起期 Date Commenced 终期 Date Finished

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 Telephone number 电邮地址 E-mail address 2. _____
职业责任保险 – 投保书
PROFESSIONAL LIABILITY INSURANCE – PROPOSAL
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.
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____________________________________________________________________ ________________________ 传真号码 Fax number ___________________________ 网址 Website
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 ________________________________________________________________________________________ ________________________________________________________________________________________ 6. 请提供投保人的负责人、合伙人、董事及高级管理人员的资历 What are the qualifications of your principals, partners, directors and officers?
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投保人成立时间 When was the Applicant established? ________________________________________________________ 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 ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________
硬件销售 Hardware Sales 硬件销售（自主研发） Hardware Sales (Own Developed)* 第三方软件销售 Third Party Software Sales 软件销售（自主研发） Software Sales(Own Developed)* 数据通信服务 Data Communication Services (ISP)* 电讯服务 Telecommunication Services 维护服务 Maintenance Services 数据处理/存储服务 Data Processing/Warehousing Services % % % % % % % % 软件测试服务 Software Testing Services 一般性咨询服务 General Consultancy 其他-请说明 Other（Please Describe） 合计 TOTAL 带*项目必填 *Addendum form to be completed % % % 1 00%
有关投保人业务的资料 Details of the Business
Huatai Insurance Company of China, Limited 0755bx © All rights reserved. 2
8.
请提供投保人本年度及上一年度的总收入 Please provide your total fee income of the current year and the past year:
本年度（预测） Current year (estimate) % 上一年度 Past year %
10.
工种分类：业务 — 请提供从事以下业务的收入比例 Division of Work: Operations – please indicate the approximate percentage of the total fee income derived from the following areas: