保险专业资源下载网站

投保人：
联系地址：                                       邮政编码：
电话：                                           传真：
1.被保险人名称：
联系地址：                         邮政编码：
  电话：                             传真：                       
  网址：
2.被保险人性质：
  □国家机关  □事业单位  □社会团体  □学校  □企业  □个体工商户  
请说明所在行业：                                                                
3.被保险人营业范围：
                                                                                  
4.被保险人工作人员总人数：                                                        
  其中高级职员姓名，职务，健康情况，请说明：
                                                                                  
                                                                                  
                                                                                  
                                                                                  
  其他类型工作人员说明（如工作类型、人数、健康情况）：
                                                                                  
                                                                                  
                                                                                  
                                                                                  
  注：如必要，请附工作人员基本情况清单。
5.过去三年是否投保过与雇主责任相关的保险？□是  □否
过去三年损失情况如何？□有  □无
如果有，请说明：
保险期间        保险人数                损失情况                获赔情况
                                                                                
                                                                                
                                                                                
6.是否按照《工伤保险条例》参加工伤保险？□是  □否
  如果是，过去三年被保险人参加工伤保险的情况：
保险期间        保险人数                损失情况                 获赔情况
                                                                                
                                                                                
                                                                                      
7.工作人员上岗前，是否经过岗位培训？ □是  □否
  培训时间一般多长？                                                                 
8.是否拥有专职医疗人员？□有  □无
  如果有，请列明数量：                                                            
9.与最近的医院的距离：                                                            
  请提供医院名称：                                                                 
10.是否全部工作人员参加医疗保险？□是  □否
如果否，请说明情况：
                                                                                
11.劳动合同中对被保险人工作人员伤、残或死亡及职业性疾病等规定的赔偿原则及限额：
                                                                                   
                                                                                   
                                                                                   
注：经保险人要求，被保险人应将与