中 國 人 民 保 險 公 司

The People's Insurance Company of China

總 公 司 設 于 北 京

Head Office: BEIJING

Invoice No.

國際運輸保險憑證

Insurance Certificate

No.

被保險人：

Assured's Name

茲依照本公司正式運輸保險單內所載全部條款及本承保憑證所特訂之條款承保下列貨運物資，但保險單之條款與特訂條款如有抵觸者應以特訂條款為準。

We have this day noted a risk as hereunder mentioned in your favour, subject to all clauses and conditions of the Company's printed form of Policy and to the special terms outlined herein (which latter shall override the policy terms in so far as they may be inconsistent therewith).

標　　　記

Marks & Nos.

包裝及數量

Quantity

保險貨物項目

Descriptions of Goods

保 險 金 額

Amount Insured

總保險金額：

Total Amount Insured:

保  費

Premium

as arranged

費  率

Rate

as arranged

裝載運輸工具

Per Conveyance S.S.

開航日期

Slg. on or abt.

自

From

至

To

承保險別：

Conditions

& / or

Special Coverage

所保貨物，如遇出險，本公司憑本憑證及有關證件給付賠款。

Claims, in any, payable to the Holder of the appertaining documents and on surrender of this Certificate.

所保貨物，如發生損失事故，應立即通知本公司下述就近代理人查勘。

In the event of accident whereby loss or damage may result in a claim under this Certificate immediate notice must be given to the nearest Company's Agent as mentioned hereunder.

中 國 人 民 保 險 公 司

THE PEOPLE'S INSURANCE CO. OF CHINA

賠款償付地點

Claim payable at

日期

DATE

北京

Beijing