我處下列貨物擬向你處投保國(guó)內(nèi)貨物運(yùn)輸保險(xiǎn)： 編號(hào)：___ ------------------------------------------------------- |被保險(xiǎn)人                                                                                                  | |-----------------------------------------------------| |    標(biāo)記或發(fā)票號(hào)碼    |    保險(xiǎn)貨物名稱    |件    數(shù)|    提單或通知單號(hào)次    |    保  險(xiǎn)  金  額      | |-----------|----------|----|------------|------------| |                      |                    |        |                        |                        | |                      |                    |        |                        |                        | |                      |                    |        |                        |                        | |----------------------------------------|------------| |運(yùn)  輸  工  具|                  |    約                  啟                  |賠款償|                ||              |                  |          年    月    日                    |      |                | |(及轉(zhuǎn)載工具)|                  |    于                  運(yùn)                  |付地點(diǎn)|                | |-------|---------|-----------------------------------| |              |                  |  轉(zhuǎn)載  |                                                            | |運(yùn)  輸  路  線|  自    經(jīng)    到  |  地點(diǎn)  |                                                            | |-----------------------------------------------------| |要保險(xiǎn)別：基本險(xiǎn)    附加險(xiǎn)別      基本險(xiǎn)費(fèi)率    ‰    附加險(xiǎn)費(fèi)率    ‰                                    | |----------------------------------------------------  | |                                                                    |  投保單位簽章                      | |                                                                    |                                    ||                                                                    |      年    月    日                | ------------------------------------------------------- 頒布 單 位: 國(guó)家工商管理局經(jīng)濟(jì)合同司 頒布 日 期: