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[]
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[]
["海洋货物运输保险投保单"]
["APPLICATION FORM FOR MARINE CARGO TRANSPORTATION INSURANCE"]
["被保险人ASSURED'S NAME:"]
[]
["提单号（B/L NO.)",{"$nulls":4},"发票号（INVOICE NO.)"]
["合同号（CONTRACT NO.)",null,"*",null,null,"信用证号（CREDIT NO.)"]
["发票金额INVOICE AMOUNT:",{"$nulls":5},"投保加成ADDITION OF INV.AMOUNT:",null,null,"*110"]
["保险金额AMOUNT INSURED:"]
[]
["兹有下列物品向中国人民财产保险股份有限公司投保INSURANCE IS REQUIRED ON THE FOLLOWING CONDITIONS:"]
["标记",{"$nulls":3},"包装及数量",null,"保险货物项目描述"]
["MARKS & NOS.",{"$nulls":3},"QUANTITY",null,"DESCRIPTION OF GOODS"]
{"$rows_empty":7}
["装载运输工具（PER CONVEYANCE):"]
["启运日期（DATE OF COMMENCEMENT):"]
["自(FROM):",{"$nulls":3},"经(VIA):",null,null,"到（TO)："]
["正本保单数量（ORIGINAL):",{"$nulls":3},"赔款偿付地点（CLAIM PAYABLE AT):"]
["承保险别（CONDITIONS):"]
[]
[]
["请如实告知下类情况：（如‘是’在[ ]中打√，‘不是’打X)IF ANY,PLEASE MARK‘√’OR‘X’"]
["1 货物种类：",null,"袋装[ ]    散装[ ]  冷藏[√ ]  液体[ ]  活动物[ ]    机器/车辆[√]  危险品等级[ ]"]
["  GOODS: ",null,"BAG/JUMBO    BULK     REEFER     LIQUID    LIVE ANIMAL   MACHINE/AUTO   DANGEROUS CLASS"]
["2 集装箱类型",null,"普通[ ]    开顶[ ]  框架[ ]  平板[√ ]  冷藏[ ]"]
["  CONTAINER:",null,"ORIDINARY    OPEN      FRAME     FLAT      REFRIGERATOR"]
["3 转运工具：",null,"海轮[√ ]    飞机[ ]  驳船[ ]  火车[ ]  汽车[ ]"]
["  BY TRANSIT: ",null,"SHIP         PLANE     BARGE     TRAIN     TREUCK"]
["4 船舶资料",null,"PARTICULAR OF SHIP: ",null,null,"船籍RIGISTRY[                    ] ",{"$nulls":3},"船龄AGE[         ]"]
["投保人声明：保险人已向本人提供并详细介绍了《海洋运输货物保险条款》，并对其中免除保险人责任的条款（包括但不限于责任免除、投保人被保险人义务、赔偿处理、其他事项等），以及本保险合同中付费约定和特别约定的内容向本人做了明确说明，本人已充分理解并接受上述内容，同意以此作为订立保险合同的依据，自愿投保本保险。上述所填写的内容均属实。    "]