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TY BAo HIEM BUU TPHCM

.
in,ur"nce
Dja chi: 6-8-10 La C7, Phan Xich Long, P.7, Q.Phu Nhufn, TpHCM
Ngl1lJj b(;m dich-thl/c DT: (08) 35174797 Fax: (08) 35174798 Web: www.pti.com.vn
? A ? A. X. A 1. ? a
BAN CAU HOI KIEM GIAY YEU CAU BAO HIEM
BAa HIEM TAl SAN
(ap d\Ing vo; bao chay va cac nii ro bao mQi nii ro tai san)
(dung 9ho khach himg ke khai)
I. Thong tin chi tiet nguoo yeu cAu bio
h
x
lem
1: Nguai duqc bao (dAy'du)
2. Dja chi
3. cong trioo dU<;Jc yeu cAu bao
4. Nganh nghe kiOO doanh cua Ngtrai dU<;Jc
bao
5. Thai bao
6. Nguai duqc th\l huang (neu c6)
II. BfC di@m rie"'g cua tai sin duClc bio
h

x
lem
1: Cong triOO nay dU<;Jc xay d(mg b!ng
nguyen gi ?
2. Cong triOO duqc bao c6 gdn cong
triOO khac khong ?
Niu co, d nghj noi ro
a. Nhtlng cong triOO gdn ke dang sir d\lng
OOu.the nao ?
b. Nguyen 'xay d\lllg cae cong triOO
gdn ke?
Neu khong, de nghi n6i ro khoang cach
giua cong triOO gdn ke va cong triOO dU<;Jc
bao
I- (
eJ, 1\tt\1t /1\UN6 11En Pit 1\T
Van phong Nha may Nha kho J2S1
Nha rieng b khac 0 (ghi ro)
!. p
aevv f U<U QI .. '
Tir den
o C6 [if Khong
Tuangbao:
Mai:
- .
. I Quy trinh khai thdc bOo hidm tai san- BMPTI.TS.Ol.OlB
1/4
3. C6 OOUng d{>ng nguy dugc 0 C6 dKhong
th\lc gdn cong triOO OOUng tiOO Nu c6, nghi neu chi tit .
hu6ng lam tang rui ro chay khong?
4. Tu6i cua cong triOO?
5. da th\lc d{>ng kiOO doaOO
cong triOO nay dugc bao lau?
III. vi bao
c6 yeu cAu b{lO
(1) Chay & rui ro dic
B. N6 D C. Cac phuong tren
c6 mu6n bao OOUng'rlii ro khong dam vao 0 D. Bai cong dinh
sau day khong ? cong, 6(>ng 0 .
E. Hanh d{>ng c6 y 0 F. DQng dAt,
dQng nlii lira 0
6. Giong, bao 0 H. Giong, bao, l\lt 0
I. Nuac tran ra til chua 0 J.
do dam va 0
o (2) MQi rui ro
IV. Chi v@ tii san dtrQ'c bao (Niu khong ghi ro, xin kern theo bemg danh rnyc
.
S6 bao Tai san
1. trir

(VM -: )C. J,., .l' )
fOG. 000 ,GOO
2. May'm6c, thiet bi
3. Thit bi van phong
4. D6 c6 diQh
cJ t)O .000.aoa r
5. Kho
6: NhUng khoan khac
7. DQn wang (nu yeu cAu)
T6ng so tien hiem A .O()O ,0(\(\ ,(\\)O
Quy trinh kha; thOc bao h;im to; scm- BMPTI.TS.OI.OIB 2/4
v. Nhihlg thong tin khac
1. C6 hQ"P d6ng bllO tai san wong W 0 C6 IiKhong .
con l\lc v6i PTI cac Cong ty
bao khac khong?
N u c6, d nghi n6i ro t6ng gia tri va ten
Cong ty bao 'hiern .
2. dil tirng c6 rnQt yeu cAu rnQt tai
l\1c bi til ch6i chua quy Mc bao 0 C6 g Khong
bi huy bo, S\l tai t\lC duqc yeu
cAu atY cao hon?
N u c6, d nghi n6i ro ten COl)g ty bao /
d6 va tit cua rn6i truOng hQ"P. 0 C6 IS1 Khoog
3. Dil timg xay ra t6n til nhiing
hQa rna yeu cAu bao chua?
. N u c6, ghi chi tit
CAMKET
Chung toi dam bao nhUng ke khai tren day la hoan toan dAy du, dUng S\l va
khong gidu di rn bdt kY S\l th\lc t nao. Chung toi d6ng y Gidy yeu cAu nay va
ban ke khai se la co so cua hQ"P d6ng giua chung toi va PTI. ChUng toi chdp
nhiing nQi dung cua Quy bao nhiing di u diu khoan, nhiing trir
duqc ghi.ro trong Quy .
. HQ"P d6ng chi h.rc yeu cAu bao dil duQ'c PTI chdp
Quy trinh khai thOc bOo hiim toi san- BMPTI.TS.Ol.OIB 3/4
. .

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