财产险询价单

地址：上海浦东新区东方路989号中达广场1002A 室 电话：（021）6876 3600 传真：（021） 6876 7730
投保币种
Insurance Currency
表格号码
Form Number
_________________
财 产 保 险 询 价 书
Property Insurance Application Form
上海星达保险经纪有限公司
mixture, please specify the % of
construction
如有夹心彩钢板结构,请告知夹心彩钢板结构建筑所占之______%, 以及中间之保温材料:_________
投保人声明
Declaration of the Applicant
·
我们谨此确认对投保书已充分阅读与了解。

We have completely read and understood in this application
签字人姓名:
Name of signatory:
日期:Date:
____________________________________________________________签字、盖章:
Signed and stamped:
· 我们谨此同意在保险合同完成前，将任何重要事项的变更告知保险经纪公司名称。

We undertake to inform Name of Insurance Broker of any material alteration to those facts before completion of the contract of insurance.· 经调查了解，我们谨此声明本投保书中的所有陈述、细节和信息以及所附任何资料是真实、可靠的，没有任何遗漏、隐瞒或忽略。

We declare, after inquiry, that the statements, particulars and information contained in this application and in any documents accompanying this application are true and correct in every detail and that no other material facts have been misstated, suppressed or omitted.
· 我们谨此同意本投保书及随附之相关讯息或文件，皆视同保险合同的一部份。

We agree that this proposal, together with any other information or documents supplied, will form the basis of any contract of insurance.
___________________。