(capital group, parent company, subsidiary, other relation)
Names of other subjects which are in capital relations to the importer:
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:
No.1 - Schedule of invoicing of receivables and repayment of supplier credit by the foreign importer
No.2 - Declaration of the Exporter on the share in the value of export
No.3 - Declaration of the Exporter on compliance with legal provisions against bribery in international trade
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 "Bf" 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.