通用职业责任险MiscPIProposal
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如有你有帮助，请购买下载，谢谢！ 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. 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 传真号码 Telephone number ________________________ Fax number ___________________________ 电邮地址 网址 E-mail address ________________________ Website ___________________________ 2. 投保人成立时间 When was the Applicant established? ________________________________________________________ 3. 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 ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ 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 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。 5. 6. 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 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 ________________________________________________________________________________________ ________________________________________________________________________________________ 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 < class='_1'>< class='_1'>< class='_1'>< class='_1'>< class='_1'>What are the qualifications of your principals, partners, directors and officers? 姓名 Name 年龄 Age 职位 Position 执业资格 Qualifications 获得资格年份 在现单位担任该职位的Year Qualified 年资 Year in this position at the Applicant 1页
如有你有帮助，请购买下载，谢谢！ 7. < class='_1'>< class='_1'>< class='_1'>< class='_1'>< class='_1'> 请提供投保人雇员的人数 Please state the number of the employees: 全职 兼职 Full-time Part-time < class='_1'>< class='_1'>< class='_1'>< class='_1'>< class='_1'> 有关投保人业务的资料 Details of the Business 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） 上一年度 Current year (estimate Past year 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 < class='_1'>< class='_1'>< class='_1'>< class='_1'>< class='_1'>to an overseas unit or registered entity. For the purpose this question only, “overseas” include Hong Kong, Macau and Taiwan. 本年度（预测） 上一年度 Current year (estimate Past year % % 10. 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： < class='_1'>< class='_1'>< class='_1'>< class='_1'>< class='_1'>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 11. 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 如答案为“是”，请提供详细以下信息： If yes, please attach detail in respect of: (a 该合伙企业或财团的名称 Name of joint venture or consortium (b 该合伙企业或财团所提供服务的类型 Type of services being provided by the consortium or joint venture (c 投保人公司、负责人、合伙人、董事或高级管理人员在该合伙企业或财团中所占利益份额 Percentage interest in such consortium or joint venture 12. 投保人是否执行任何质量保证体系或相关计划？ Does the Applicant operate any Quality Assurance Program(s or similar? 是Yes 否No 若答案为“是”，请提供详细资料: If yes, please provide details: ________________________________________________________________________________________ ________________________________________________________________________________________ 13. 是否与第三方签订业务分包合同？ Do you subcontract any professional services to a third party? 2页 < class='_1'>< class='_1'>< class='_1'>< class='_1'>< class='_1'>
如有你有帮助，请购买下载，谢谢！ 是Yes 否No 若答案为“是”，请另附公司信纸提供以下资料： If yes, please attach detail in respect of: (a 该分包业务是什么？ What services are subcontracted? 