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C Страхование среднесрочного и долгосрочного экспортного кредита поставщика Application for conclusion of an insurance contract

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APPLICATION
for insurance of a medium- and long-term export supplier credit against the risk of non-payment
GIC type C
  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:
  (If yes, state the identification of the subject and bank connection including the account number.)
  Applies for:  
 
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.Sub-deliveries from companies in the country of importer
thous. (in currency 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
  4. 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:
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 - Questionnaire for assessment of environmental impact of the export including the declaration of the Exporter
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 "C" 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. X of the GIC C, 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,  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
  1. 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.
  2. 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).
  3. 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.
  4. 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.
Annex No. 5
to the application for Insurance of a Medium and Long Term Export Supplier Credit
against the Risk of Non Payment - product "C"

Questionnaire to assess the environmental and social impact of the export and the exporter's statement

Part A
I. Basic information
  1. Name of the export project, its capacity (range) and location (facility address and GPS coordinates)
  2. Value (i.e., the principal) of the export credit
  3. Is it modernization of an existing facility or new construction?
  4. In the case of modernization, please specify the original size or capacity of the original facility.
  5. A brief description of the technical and technological solutions to the export project.
  6. Expected date of commencement of the implementation of the export and its completion.
  7. Is the export contract for which you are requesting insurance of export credit risks part of a project secured
by another entity?
  8. Has the Environmental and Social Impact Assessment (ESIA) of the export or of the project which includes the export
been conducted?
II. Information about the current state of the environment in the area where
the export project is to be implemented
  1. Are there any sensitive locations in the area or are there any sensitive locations affected by the export?
national parks or other protected areas identified by national or international law, and other sensitive locations of international, national or regional importance, such as wetlands, forests with high biodiversity value, areas of archaeological or cultural significance, and areas of importance for indigenous peoples or other vulnerable groups
III. Information on potential impacts to human rights in the country where
the export project is to be implemented
  1. Is there a high probability of severe impacts to human rights in the country where the export project
is to be implemented?
e.g., impacts that are particularly severe (e.g., a threat to life, child labour, forced labour and human trafficking), extensive (e.g., massive relocation and working conditions across the industry), irreparable (e.g., torture, loss of health, destruction of indigenous peoples' land), or related to the operation of the project (e.g., in conflict and post-conflict areas)
Part B

Applies to:

  • all projects for which their share is equal to or above SDR 10 million,
  • all projects in or near sensitive areas irrespective of their share,
  • all existing operations and projects, irrespective of their share, where the screening has identified that there is a high likelihood of severe project-related human rights impacts occurring.
IV. Information about the inputs
  1. Land – specify the total area of land occupation after the implementation of the project and how much of it is
"green field".
  2. Water – specify annual water consumption
  3. Primary raw-material and energy sources (type, annual consumption).
  4. Does the export involve construction or the upgrading of the supporting transport or other infrastructure
(e.g., power lines)?
V. Information about the outputs
  1. Air (type and quantity of emissions)
  2. Waste water (amount of waste water, type and amount of pollutants discharged)
  3. Waste (categorization and quantity of waste)
  4. Other (e.g., noise and vibration, radiation, odours, other outputs, amount of emissions)
Exporter's statement
to the binding application for insurance under the GIC C
I hereby declare that:
  1. the facts stated in this questionnaire, in negotiations and in related written correspondence have been provided to the best of my knowledge and are true,
  2. I have not distorted or withheld anything that could affect the assessment of the impact of the export, including the project, on the environment, social environment or human rights,
  3. I acknowledge and agree with the possibility of sanctions in the event that the insured event occurred in breach of the conditions arising from the assessment of the impact of the export/project on the environment and social environment or its authorization,
  4. I will provide the necessary assistance in the insurance of the risk of default of the buyer's credit / bank financed supplier credit for the financing of the export and the credit for financing the investment to the insured bank when submitting data to assess the impact of the export, including the project, on the environment, social environment and human rights.
  Place and date:
  Name and registered office of the
  exporter/investor:
[Signature of the person authorized to act for the exporter]
  Name and title:
Illustrative list of ESE (environment and social environment)
category A projects
The following is an illustrative list containing examples of the types of new ŽSP projects and major expansion ESE projects that may be classified as Category A
  1. Crude oil refineries (excluding undertakings manufacturing only lubricants from crude oil) and installations for the gasification and liquefaction of 500 tonnes or more of coal or bituminous shale per day.
  2. Thermal power stations and other combustion installations (including cogeneration) with a heat output of not less than 300 megawatts (equivalent to a gross electrical output of 140 MWe for steam and single cycle gas turbines power stations) and nuclear power stations and other nuclear reactors, including the dismantling or decommissioning of such power stations or reactors (except research installations for the production and conversion of fissionable and fertile materials, whose maximum power does not exceed 1 kilowatt of continuous thermal load).
  3. Installations designed for the production, or enrichment of nuclear fuels, the reprocessing, storage or final disposal of irradiated nuclear fuels, or for the storage, disposal or processing of radioactive waste.
  4. Integrated works for the initial smelting of cast-iron and steel, e.g. installations for the production of primary steel by blast furnace route or direct reduction; installations for the production of non-ferrous crude metals from ore, concentrates or secondary raw materials by metallurgical, chemical or electrolytic processes.
  5. Installations for the extraction of asbestos and for the processing and transformation of asbestos and products containing asbestos: for asbestos-cement products, with an annual production of more than 20,000 tonnes finished product; for friction material, with an annual production of more than 50 tonnes finished product; and for other asbestos utilisation, of more than 200 tonnes per year.
  6. Installations for the manufacture and/or recovery of chemicals (including but not limited to petrochemicals, fertilisers, pesticides & herbicides, health care products, detergents, paints, adhesives, agro-chemicals, pharmaceuticals, explosives) on an industrial scale using physical, chemical and/or bio chemical processes and for the large-scale distribution of such chemicals via pipelines/terminals and associated facilities.
  7. Construction of airports with a basic runway length of 2,100 metres or more.
  8. Construction of motorways and express roads.
  9. Construction of a new road, or realignment and/or widening of an existing road, where such a new road, or realigned and/or widened section of road, would be 10 km or more in a continuous length.
  10. Construction of railway lines that go beyond urban areas and of long-distance railway lines.
  11. Sea ports and also inland waterways and ports for inland-waterway traffic which permit the passage of vessels of over 1,350 tonnes; trading ports, piers for loading and unloading connected to land and outside ports (excluding ferry piers) which can take vessels of over 1,350 tonnes.
  12. Waste-processing and disposal installations for the incineration, chemical treatment or landfill of hazardous, toxic or dangerous wastes.
  13. Large1 dams and other impoundments designed for the holding back or permanent storage of water.
  14. Groundwater abstraction activities or artificial groundwater recharge schemes in cases where the annual volume of water to be abstracted or recharged amounts to 10 million cubic metres or more.
  15. Industrial plants for the production of pulp, paper and board from timber or similar fibrous materials.
  16. Operations that involve large scale extraction, via underground or open-pit mining, solution mining, or marine or riverine operations to obtain precious metals, base metals, energy and industrial minerals, or construction materials. It may also include the processing of the extracted material.
  17. Greenfield cement plants where the project includes a greenfield quarry.
  18. Large scale oil, gas, or liquefied natural gas development that may include any or all of:
    • exploration (seismic and drilling);
    • field development and production activities;
    • transport activities, including pipelines/terminals, pump stations, pigging stations, compressor stations and associated facilities; or
    • gas liquefaction facilities.
  19. Installations for the storage of petroleum, petrochemical, or chemical products with a capacity of 200,000 tonnes or more.
  20. Large-scale logging.
  21. Municipal waste water treatment plants with a capacity exceeding a 150,000 population equivalent.
  22. Municipal solid waste-processing and disposal facilities.
  23. Large-scale tourism and retail development.
  24. Construction of overhead electrical power transmission lines with a length of 15 km or above and a voltage of 110 kV or above.
  25. Large-scale land reclamation.
  26. Large-scale primary agriculture/sylviculture involving the intensification or conversion of natural habitats.
  27. Plants for the tanning of hides and skins where the treatment capacity exceeds 12 tons of finished products per day.
  28. Installations for the intensive rearing of poultry or pigs with more than: 85,000 places for broilers and 60,000 places for poultry; 3,000 places for pigs (over 30 kg); or 900 places for sows.
  29. Projects which are planned to be carried out in sensitive locations or are likely to have a perceptible impact on such locations, even if the project category does not appear in the above list.
  30. Projects that can lead to significant negative social impacts to local communities or other projects of the affected parties, including those involved in the construction or operation of the project.
  31. Projects involving land acquisition and the involuntary resettlement of a significant number of affected people.

Note:
Where boundary limits are not set for individual types of sensitive sectors, limits stipulated by Act No. 100/2001 Coll., on environmental impact assessment, can be tentatively used as follows:

  • installations for large-capacity transport over 800 millimetres (p. 8),
  • extraction of metal ores or coal over 1 million tons annually (p. 14),
  • large-scale logging with a clear-cut area over 25 hectares (p. 17),
  • municipal solid waste-processing and waste dumps exceeding 30,000 tons annually (p. 19),
  • large-scale tourism facilities over 200 beds (p. 20),
  • large-capacity transmission of electricity over 110 kilovolts (p. 21).

1 As per the definition of the International Commission on Large Dams (ICOLD), ICOLD defines a large dam as a dam with a height of 15m or more from the foundation. Dams that are between 5 and 15m high and have a reservoir volume of more than 3 million m3 are also classified as large dams.

Attachment No.4
Declaration of the Exporter on compliance with legal provisions against bribery in international trade.

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. X of the GIC C, 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.

  Commercial name of the Exporter and Seat:
  Name and position:
  Place and date:
Signature of a person authorized to act on behalf of the Exporter:   .......................................................................................
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).
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