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B Insurance of a Short Term Export Supplier Credit against the Risk of Non Payment Insurance of a Short Term Export Supplier Credit against the Risk of Non Payment

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APPLICATION
for insurance of a short-term export supplier credit against the risk of non-payment
GIC type B

Applicant:

Export Contract

Subject:

To the Country:
Purchase price:

Manufacturer:

Importer

Country:

I. Applicant

Commercial name of the applicant:
Company Identification No.:
Tax registration No.:
Address:
City:
Postcode:
Legal form:
Number of employees of the company:

Annual turnover for the last accounting period:
Balance sum for the last accounting period:

Banking connection:
Account number:
Name and position of the statutory body:
Responsible person:
Phone:
Fax:
E-mail:

Applicant's bank financing export:
Address:
City:
Postcode:
Name of the bank employee:
Phone:
Fax:
E-mail:
Assignment of the indemnification required:	yes no
(If yes, state the identification of the subject and bank connection including the account number.)

Applies for:	conclusion of the insurance promise
	conclusion of the insurance contract

II. Export Contract:

Subject of the Export Contract (goods and services):

Expected:

Date of signing of the Export Contract:
Starting date of deliveries:
Finishing date of deliveries:
Number of partial deliveries:

Total amount of the Export Contract (in currency of the Export Contract):

Delivery clause

(according to INCOTERMS) from:

Advance Payment		%, i.e. in currency of the Export Contract:
Cash Payment		%, i.e. in currency of the Export Contract:
Credit (Payment Deferral)		%, i.e. in currency of the Export Contract:

Credit payment terms:

Payment deferral of credit until:		number of years:
number and periodicity of instalments:
interest rate:

Please attach the schedule of invoicing of deliveries and repayment of the supplier credit by the foreign importer (Attachment No. 1).

a) Obligations of the Exporter and penalties for their breach arising from the Export Contract

b) Obligations of the Importer and penalties for their breach

c) Collaterals for settlement of the purchase price (state guarantee, bank guarantee, acceptance of a bill of exchange, and such)

Purchase price:	thous.	(in currency of the Export Contract)
Calculated profit:	thous.	(in currency of the Export Contract)
Credit amount:	thous.	(in currency of the Export Contract)
Interest amount:	thous.	(in currency of the Export Contract)

National contents:

Main suppliers (manufacturers):

1. Czech Republic, commercial name:

Delivery value:		thous.		(in currency of the Export Contract)
		% from the total amount of the Export Contract

2. State:

Commercial name:

Delivery value:		thous.		(in currency of the Export Contract)
		% from the total amount of the Export Contract

3. State:

Commercial name:

Delivery value:		thous.		(in currency of the Export Contract)
		% from the total amount of the Export Contract

III. Importer

Commercial name of the importer:
Address:
City:
Postcode:
Identification No.:
State:
Legal form of the importer:
Predominant ownership form (state, private):
Bank of Importer:
Address:
City:
Postcode:
State:
Relations of importer to other subject:

(capital group, parent company, subsidiary, other relation)

Names of other subjects which are in capital relations to the importer:

1.
2.
3.
4.
5.

Experience with the importer until now:

Total amount of receivables from the importer (in CZK thousand):

Of which overdue:

Mention all data known to you regarding the requested insurance which could be related with assessment of the risk of the business transaction and with the importer including your experience with fulfilment of contracts and compliance with payment terms.

Inseparable parts of this form are attachments:
Attachment No.1 - Schedule of invoicing of receivables and repayment of supplier credit by the foreign importer
attachment No.2 - Declaration of the Exporter on the share in the value of export

Please attach available commercial and other information (forms) related to the importer.

All information has confidential character and serves the Export Guarantee and Insurance Corporation for processing of the draft of the insurance contract (insurance promise contract).

Declaration of applicant for insurance

I declare herewith that I am acquainted with General Insurance Conditions "B" and confirm that data entered in this form are truthful, complete and no important data known as on day of submission of this application for insurance have been omitted or withheld.

I obligate myself to inform the insurer without delay on other circumstances and changes related to the requested insurance which could occur after the submission of this application.

I take notice of my duty to reimburse the insurer all expenses accrued in connection with verification of the insurance risk also in case the insurance contract (insurance promise contract) will be prepared on the basis of data entered in this form and the contract will not be signed.

Insurance of export credit risks with state support cannot be given to exports which were negotiated by way of bribery in international trade in the sense of the § 160 and subsequent of the Criminal Code. For these purposes, I declare on behalf of our company and on behalf of persons representing our company that there has been and there will be no breach of rules against bribery in international trade 1). In this relation I further declare that persons acting on behalf of our company or representing our company were not charged by the criminal offence of bribery and they had not been convicted of such criminal offence in last 5 years. Furthermore, I declare that that our company has not been mentioned in the publicly accessible debarment list of the World Bank Group.

I accept that the insurer has the right to verify truthfulness of the above-mentioned declaration and obligate myself to submit all information and documentation the insurer may request in this regard.

According to Art. IX Of the GIC B, the insurer has the right to refuse indemnification if it has been proven that the applicant entered into the application for insurance incomplete or untruthful data with regard to bribery in international trade.

1) Communication of the Ministry of Foreign Affairs No. 25/2000 Coll. of international treaties) on acceptance of Convention on Combating Bribery of Foreign Public Officials in International Business Transactions (part 13/2000 of the Collection of international treaties circulated on March 29, 2000).

Commercial name of the applicant:

Name and position of the statutory body:

Date:

Signature: .......................................................................................

Attachment No.1:

Schedule of invoicing of deliveries and repayment of the supplier credit by foreign importer
(in currency of the Export Contract):

Invoicing of deliveries*			Repayment
Date	Amount of principal	Amount of interest	Date	Amount of principal	Amount of interest

*state the amount lowered by the value of paid advance payment

Attachment No.2
Declaration of Exporter on share in the value of export

Exporter:

Commercial name:

Company Identification No.:

with seat:
represented by:

declares,

that the share of goods and services of Czech origin in the total value of export1), which is subject to insurance of export credit risks, shall be is at least % from the value of the export which is CZK and

accepts obligation

to inform the Export Guarantee and Insurance Corporation (hereinafter "export insurance company") on decrease in the share of goods and services of Czech origin in the total value of the export which has been stated in this declaration in case this decrease would be more than 5 % and to explain reasons for this change,
in case the share of goods and services of Czech origin in the total value of the export falls under 50%, to ask the export insurance company for a subsequent approval of the exception,
reimburse the export insurance company for damages by an amount equal to the indemnification paid as a result of non-fulfilment of mentioned criteria in case the Exporter has given untruthful data in the above-mentioned declaration or if it has been discovered later that in realization of the Export Contract the above-mentioned share was by more than 5 % lower than the share assumed by the insurance contract.

This declaration is an inseparable part of the application for insurance from ,

submitted (Applicant for insurance)

Signature: .......................................................................................

Full name, signature and position of the person authorized to act on behalf of the Exporter:

Date:

1) the share of the export is calculated according to instruction for calculation of the share of goods and services of Czech origin in the total value of the export which is a part of this Declaration

Instruction for calculation of the share of goods and services of Czech origin in the total value of the export

The share of goods and services of Czech origin has to represent at least 50 % of the value of the export unless stated otherwise below.
Goods and service, which are subject of the export are considered as goods and services of Czech origin if following conditions are fulfilled:
1. Export Contract has been negotiated by the exporter who is a legal person with seat or a natural person with permanent residence on the territory of the Czech Republic or a foreign company who is controlled by a legal person having its registered seat on the territory of the Czech Republic and participating - directly or indirectly - in the basic capital of the foreign company by more than 50 %, or controlling the majority of voting rights related to the participation in the basic capital of the foreign company, or can appoint a majority of members of the Board of Directors, Supervisory Board or other similar managing body of the foreign company,
2. goods and services, which are subject of the export are invoiced by the Exporter (defined according to letter a) to a foreign buyer (importer),
3. a sub-delivery for the export is considered to be Czech if it has been delivered and invoiced to the Exporter by a sub-supplier who is a legal person with seat or a natural person with permanent residence on the territory of the Czech Republic (hereinafter Czech sub-supplier),
4. sub-deliveries (components, parts, material and such), bought by the Exporter or his Czech sub-supplier from abroad, are considered to be Czech ones only in case the Exporter or his Czech sub-supplier added value to these sub-deliveries in production (it cannot be pure re-export of goods in an unchanged state and the Exporter cannot be a mere trader whose share in the export is made by trade margin only); the Exporter and/or his Czech sub-supplier have to be able to prove (way of proving - e.g. comparison of payment for a sub-delivery with calculation of the final price of product in which the sub-delivery is included),
5. a sub-delivery from abroad which is a part of the Export Contract and for which EGAP obtained reinsurance from a foreign credit insurance company, is excluded entirely from the calculation of the Czech share,
6. in case of insurance of an export credit and if the credit is financed from several sources, the sub-delivery from abroad which is a part of the Export Contract and which is financed without Czech state export support (i.e. without insurance by EGAP or without financing/refinancing by CEB is excluded entirely from the calculation of the Czech share according to the Article 2,
7. in case of insurance of a bank guarantee and when the foreign sub-delivery is covered by a counter guarantee, it has the same character as the Czech sub-delivery for purposes of the calculation even if it does not comply with criteria under letter d).
Sub-deliveries bought by the Exporter or his Czech sub-supplier from abroad which do not comply with conditions mentioned under par. 2, are considered for purposes of the calculation of the share of goods and services as foreign sub-deliveries.
Provisions on foreign sub-deliveries according to par. 2 letters d) through g) do not apply on sub-deliveries whichthe Exporter has bought from sub-suppliers in the country of final destination of the export. Such sub-deliveries represent local costs ; extent of insurance with state support for them is restricted by international rules.

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