中国平安财产保险股份有限公司无人机风险问答单

 Unmanned Aerial Vehicle QUESTIONAIRE

1、 投保人（被保险人）名称、地址及联系人

Name, Address and Contacts of Insured

                                                                           

2、 被保险人主营业务及资质

Main Business scope and Qualifications of Insured

                                                                           

3、 是否有附加被保险人要求，如果有，请说明详细情况，包括但不限于与被保险人或保险标的的关系

   Any additional insureds are required? If yes, please provide details (including but not limited to the relationship between the additional insured and the insured subject).

                                                                             

4、 投保飞机/零备件详细情况

Details of the aircraft or spares:

保险标的 Subject	无人机品牌及型号 Brand & type	生产序列号 Manufacturing Serials Numbers	起飞重量 Weight	机身价值  Value of Hull or spares	购买日期 Date of Purchase
类型 Type	固定翼 □     直升机□       多旋翼□        （旋翼数量） Fixed Wing   Helicopter     Multi Rotor      (amount of rotors)

5、 保险期限

Period of Insurance

保险期限为一年，自20年  月   日0:00 至20   年  月   日24:00止。

12 months， From    to   ， both days inclusive， Local Standard Time (Beijing)

6、保险保障、赔偿限额及免赔额

Coverage, Limit and Deductible

(A) 保单责任

Policy Coverage

                                                               

(B)每次事故免赔额

Deductible any one occurrence

                                                               

(C)赔偿限额（包括免赔额）

　Compensation Limit (Deductible Included)

                                                               

7、主要的作业用途和作业区域。是否有在城市或者其他非自然环境区域上空的飞行？

Uses and work area of the UAV (Would a UAV fly over city or other non-natural zone?)

                                                               

8、 投保飞机的年均小时数

The average using hours of the insured UAV

                                                               

9、 飞行员/操作人员信息

Details of Pilots / Operators

操作员 Pilots/ Operators	序号 No.	姓名 Name	执照号码 License number	技术等级 Technical grade	操作小时数 Operated hours
	1
	2

10、 投保飞机飞行地域范围(请选择)

Geographical Limited (please mark)

　　□中国大陆境内，不含香港、澳门、台湾

Mainland China （excluding Hong Kong, Macao and Taiwan）

　　□  中国全境及领海，含香港、澳门、台湾

　　　The whole territory and territorial waters of China (including Hong Kong, Macao and Taiwan)

　　□  中国及周边国家、亚太地区，不含美国、日本

　　　 China, the neighboring countries of China, and the Asia-Pacific region (excluding the U.S and Japan)

　　□  全球，含美国、日本、欧洲   

　　　　Global (including the U.S and Japan)

11、投保飞机日常维修服务的提供人和提供地点：

   　Maintenance providers and places:

                                                               

12、 投保人以往经营飞机是否出过事故？或者所列飞手以往飞行任务中是否出过事故？

如有，请写明出险时间、出险原因、飞机损失金额、人员伤亡情况以及保险赔偿金额

 Is there any accident occurred in relation with the insured or the pilots set forth on the

 list? If yes, please provide the time, cause, amount of loss, damage and claims arising

 therefrom.  

                                                               

13、 动力情况如何，如燃油驱动还是电力驱动，动力装置的飞行小时数…

Dynamic characteristics (fuel-driven or electric-driven, and hours of flight)   

                                                               

14、 飞机起飞重量和载荷重量

Take-off weight and payload weight of the UAV

                                                               

15、 起飞着陆方式

Take-off and landing performance

                                                               

16、 基本的飞行性能（失速速度，静稳定性等）

    Basic performances (stall speed, static stability)

                                                               

17、 所用飞控设备和软件的基本情况（飞控厂家，是否自主飞行，是否设计了备份的控制和通信系统）

Basic information on flight control equipment and software (manufacturer of flight control equipment, Self-controlling flight or not? Is there any backup of controlling and communication system in the UVA)

                                                               

18、 对飞机的起降场所的基本情况和天气情况是否有约束？

Is there any restriction or confines on places or weather conditions for take-off and landing?  

                                                               

19、 这些机载储存设备容量多大，实时数据能记录多长时间？

    Capacity of the onboard storage equipment，How long can the real-time data be recorded?

                                                               

20、这些数据是否能够进行外部读取或修改？

Whether these data could be read or modified by external?

                                                               

21、是否有自主飞行能力，还是始终需要人工进行外部控制？

Self-controlling fly or always manually controlled?

                                                               

22、一旦发生故障（如发动机、通信、机械、飞控程序故障），能够采取何种措施以保证飞机的安全?

When occurs any failure or breakdown (e.g. engine, communication unit, mechanical unit or flight control system), what measures can be taken to secure the safety of the insured UVA?

                                                               

23、该无人机是原型机还是某系列量产的产品之一？

Is the UAV a Prototype or a series of mass production?

                                                               

24、该型号飞机已经完成的飞行小时数是多少？如果是量产的机型，全球累计飞行小时数是多少？

是否有成熟的机队？

How many flight hours does this type of UAV have already? What is the global cumulative flight hour? Is there a fleet?

                                                               

25、发动机的大修小时数和最大寿命小时数是多少？

Time interval between two overhauls and maximum service hour of engine?

                                                               

26、是否和会在能见度较低或者夜晚环境中进行起降？

Take-off or landing in Poor visibility or at night?

                                                               

27、请提供相似机型的损失记录及细节（若有）

Please provide details of claims from similar type of UAV (if available).

                                                               

28、预计投保飞机数量

Quantity of the UAV insured

                                                               

29、飞机使用寿命及发动机使用寿命

    Designed service lifetime of the UVA and Engine (if applicable)

                                                               

30、该机抗风能力

   Wind resistant ability of the UAV.

                                                               

声明 Declaration

我代表拟投保的所有各方承诺，我们已在自己最了解的范围内，对上述投保单进行了真实和完备的陈述，所有重要信息及重要情况都已完全告知保险人。我们承诺并同意，将上述投保单及其他所提供的信息作为后续保险合同的基础，并将保险合同完成之前的重要信息变化告知保险人。

The undersigned declares on behalf of all parties proposing for insurance that to the best of their knowledge and belief the statements provided herein are true and complete and all material facts or circumstances have been fully disclosed. The undersigned declares and agrees that the proposal form together with any other information supplied shall form the basis of any subsequent contract of insurance and undertakes to inform the Insurer of any material alteration to those facts occurring before completion of the contract of insurance.

 

投保人签章：

日期：

Signed by the proposer’s authorized individual:               Date