FIDELITY GUARANTEE INSURANCE
RISK ASSESSMENT FORM
雇员忠诚保证保险风险评估表
Name of Insured Entity:
被保险人名称:
_____________________________________________________________________
Address:
地址:
_____________________________________________________________________
1. GENERAL
总则
1. (a) Nature of Applicant’s business
申请人营业范围
___________________________________________________________
(b) Date of business established
企业成立时间
__________________________________________________________
2. Audit:
审计:
(a) Name of outside auditor
审计员姓名
__________________________________________________________
(b) Frequency of audits
审计频率
_________________________________________________________
(c) When was such an examination last made?
最近一次审计在何时?
__________________________________________________________
(d) Was it in every respect correct?
最近一次审计的结果是否为各方面均不存在问题?
□Yes □No
是 否
If not, please give the details.
若否，请告知问题详情
__________________________________________________________
3. Do you sell exclusively to overseas markets with no local sales whatsoever?
是否只在国外市场销售?
□Yes □No
是 否
4. If you sell mainly to the local markets, do you handle sales
如果主要在国内市场销售, 销售渠道为：
□exclusively with or through wholesalers? 仅通过批发商
□exclusively with or through retailers? 仅通过零售商
□with or through both wholesalers and retailers? 通过零售商及批发商
□through own sale force? 通过自有销售渠道
5. If you handle retail sales, how many sale stores do you have?
如果开展零售业务的, 有多少零售点?__________________________
6. Are duties of the cashier entirely separate from the recording of notes and
accounts receivables?
出纳工作是否与票据和应收帐款的记录完全分离?
□Yes □No
是 否
7. State the largest sum the cashier is likely to hold:
出纳经手最高金额:
(a) on non-payroll days
非发薪日
_________________________________________________________
(b) on payroll days
发薪日
_________________________________________________________
8. Are cheques required to be countersigned? □Yes □No
支票需要连署吗? 需要 不需要
9. Please state the number of employees:
请列出雇员人数:
(a) those who handle cash
经手现金人数
_________________________________________________________
(b) those who do not handle cash
不经手现金人数
__________________________________________________________
10. (a) How often will cash be deposited in the bank?
现金存入银行频率?
__________________________________________________________
(b) Name the position of the person responsible for taking the cash to the
bank for deposit
负责将现金存入银行的人员：
__________________________________________________________
11. Please state name and position of all persons who are authorised to sign cheques:
请列出有权签署支票的所有人员的姓名及职位:
__________________________________________________________
12. (a) Is the practice of drawing cheques to “cash” or to “bearer” prohibited?
是否允许开现金支票或将支票开给持票来人的行为?
□Yes □No
是 否
(b)If not, are cheques so drawn limited to payroll and/or petty cash reimbursement?
若不允许, 那么这种支票是否仅限于发放工资及(或)小额现金偿付?
□Yes □No
是 否
13. (a) Who is responsible for reconciling the monthly bank statements?
写出配合处理银行月报的人员?
_________________________________________________________
(b)Does this person also keep the cash records? □Yes □No
此人是否会保存现金记录? 是 否
14. Are the vouchers or other supporting documents impressed with a paid
stamp or other mark so as to prevent their re-use?
凭证或其他证明是否有已用邮票或其他记号表明其不可再使用?
□Yes □No
是 否
2. CASH RECEIPTS&DISBURSEMENTS
现金收付
15. Are the receipts of Cash relatively significant in your kind of operation?
现金交易对企业运作是否比较重要?
□Yes √No
是 否
If so, please list the main sources of receipts.
若是, 请列出获取现金的主要来源.
____________________________________________________________
16. Are receipts recorded by cash registers or other mechanical devices?
收据是否由现金登记员或其他技术工具登记?
□Yes □No
是 否
If so, are the machine totals checked independently by the accounting
department?
若是, 所有技术工具是否都由会计部独立检验?
□Yes □No
是 否
17. Are receipts pre-numbered? □Yes □No
收据是否事先编过号? 是 否
18. What is the maximum amount of cash that is generally inside your office
safe?
以下几种时段公司保险箱所有的最高现金额度为多少?
□for petty cash alone:
提取小额现金时:
____ _______________________
□for on non-payroll days and excluding petty cash:
非发薪日(不包括小额现金)
____ _______________________
□for on payroll days and excluding petty cash:
发薪日(不包括小额现金)
____ _______________________
19. Please state the name and position of all persons with access to the safe.
请列出所有掌管保险箱的人员的姓名和职位.
Name Position
姓名 职位
____ _______________________
20. Are all disbursements, except from petty cash, made by cheques?
除了小额现金外的所有放款是否都通过支票的形式?
□Yes □No
是 否
Please state circumstances when exception is made.
请列出特殊情况.
3. SALES
销售
21. Are pre-numbered shipping advices prepared for all goods shipped?
是否所有的船运货物都有已编号的出运建议?
□Yes □No
是 否
22. Are sales invoices pre-numbered? □Yes □No
售货发票是否事先编了号? 是 否
23. Are all your salesmen authorized to collect payments? □Yes □No
是否所有的销售人员都有权收费? 是 否
If so, do they issue pre-numbered temporary receipts on which is printed the notation that an official receipt will be mailed to the payee within a week or less?
若是, 他们是否出具已编号的临时收据(该收据上印有如下注意事项:
正式收据将于一周内寄至收款人处)?
□Yes □No
是 否
24. What is the average amount of cash collection in the hands of a salesman
with authority to collect at any one time?
在任何时候都有权收费的销售人员所持有的平均现金数额为多少?
____ _______________________
25. Are the salesmen required to surrender all proceeds of collection and
receipts before closing each day to the responsible officer?
销售人员是否要将所有收到的款项在每天下班前上交给负责人?
□Yes □No
是 否
4. PURCHASES
采购
26. Are purchases made only on the basis of purchase requisitions signed by
the respective department heads?
采购是否一定要出具由各部门经理签字的采购申请表?
□Yes □No
是 否
27. Are purchase prices approved by responsible officials?
负责人是否同意采购价格?
□Yes □No
是 否
5. PAYROLLS
工资
28. Are payroll receipts obtained from employees?
是否由雇员提供工资收据?
□Yes □No
是 否
6. PREVIOUS LOSSES
历史出险状况
29. Have you ever sustained any loss through fraud or dishonesty of any
employee irrespective of whether at the time of loss you have or have no
fidelity bond?
不管你司曾经有无信用保险, 你司是否由于雇员的欺诈或不诚实遭受
损失?
□Yes □No
是 否
If so, please state the circumstances, amount involved and date of each loss
in detail, as well as the means you have adopted to prevent recurrence of
such loss.
若曾有, 请具体列出地点、相关数额、日期以及你司采用的防止措施.
