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D Страхование экспортного кредита покупателя Application for Insurance of an Export Buyer Credit against the risk of non payment (GIC type D)

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APPLICATION
for insurance of an export buyer credit against the risk of non payment
GIC type D
pursuant to Act No. 58/1995 Coll.1
Insurer:
Exportní garanční a pojišťovací společnost, a.s.
(Export Guarantee and Insurance Corporation)

registered office Prague 1, Vodičkova 34/701, zip code 111 21
ID No. 45279314/ VAT ID No. CZ45279314

1 Act No. 58/1995 Coll., on the Insurance and Financing of Exports with State Support and on the Supplement to Act No. 166/1993 Coll., on the Supreme Audit Office, as amended, as amended

  Credit Contract
  Applicant for insurance2:
  Debtor:
  Amount (principal) of the credit:
  Length of loan repayment (in years):
  Export Contract
  Subject:
  To country/Country of final destination
  of export:
  Total export value3:

2 bank, branch of a foreign bank or a financial institution

3 price agreed in the Export Contract

I. Applicant for insurance
  Name:
  Company registration number:
  VAT ID No.:
  Legal form:
  Registered office4:
  Address for postal service:  
     Street
     City
     Post code
  Applicant's bank5:
  A/C No.:
  Persons authorized to sign for the company:
  Contact person:
  Telephone:
  Fax:
  E-mail:
  Applies for:
  

4 head office – full address of the registered office in accordance with a public register

5 name of the bank – financial institution which keeps the account

II. Information about the exporter
  Name:
  Company registration number:
  VAT ID No.:
  Legal form:
  Registered office4:
  Address for postal service:  
     Street
     City
     Post code
  Exporter's bank5:
  A/C No.:
  Persons authorized to sign for the company:
  Number of employees6:
  Annual turnover for the last accounting
  period6:
  Equity at the end of the last accounting
  period:
  Balance sheet total for the last accounting
  period:6:
  Is the exporter a member of the financial group7
  of the debtor, the importer or the guarantor?
  Member of a consolidation unit:
  Name of company that performs
  consolidation for the consolidation unit:

4 head office – full address of the registered office in accordance with a public register

5 name of the bank – financial institution which keeps the account

6 fill out in accordance with the definition of small and medium-sized enterprises listed in Annex I to the Commission Regulation (EC) No. 800/2008 of 6 August 2008 declaring certain categories of aid compatible with the common market in the application of Articles 87 and 88 of the Treaty (General block exemption Regulation)

7 Financial group of an entity is a group of natural or legal persons, where:

  1. two or more natural or legal persons that, unless proven otherwise, constitute a single risk since one of them has direct or indirect control over the other person(s);
  2. two or more natural or legal persons between which there is not a relationship of control referred to in (a) but that must be seen as persons constituting a single risk because they are interconnected to such an extent that if one of them got into financial difficulties, mainly difficulties with funding or payback, the other person or all other persons would probably also get into difficulties with funding or payback,
    control is understood as a relationship between the parent company and a subsidiary company (persons) where the controlling person (parent company):
    1. has a majority of voting rights of shareholders or members in the other company; or
    2. has the right to appoint or remove a majority of the members of the administrative, managing or supervisory body of the other company and is concurrently a shareholder or member of the company; or
    3. has the right to exercise a dominant influence on any company it is a shareholder or member of within the meaning of a contract concluded with it or pursuant to its constitution or memorandum of association where the law which governs the company allows that it is subjected to such contracts, constitution or memorandum of association; or
    4. is a shareholder or member of any other company and
      1. a majority of members of the administrative, managing or supervisory body of this company who were members of these bodies during the current and previous accounting period until the time of the preparation of the consolidated financial statements, were appointed solely using their voting rights, or a share in any other company is at least 20%; or
      2. exercises, based on an agreement concluded with other shareholders or members of this company, a majority of voting rights of shareholders and members in this company.
      A group of natural or legal persons consisting of central government and all natural or legal persons directly or indirectly controlled by it or interconnected as referred to in (b) are not considered a financially linked group.
    The existence of a financially linked group made of a central or regional government or local bodies ("central bodies") and other natural or legal persons may be assessed separately for each person directly controlled as referred to in (a) or directly interconnected as referred to in (b) or all natural and legal persons that are controlled by this person as referred to in (a) or interconnected with this person as referred to in (b), including central bodies.
III. Credit Contract
   number    dated 
concluded with the debtor on:
  Name8:
  Company registration number9:
  Legal form:
  Registered office:
  Address for postal service:  
     Address
     City
     Post code
     Country
  Predominant form of ownership
  (state, private):
  Is the debtor a member of the financial group7
  of the exporter, the importer or the guarantor?
  Member of a consolidation unit:
  Name of company that performs
  consolidation for the consolidation unit:
Entities that are financially linked groups7 with the debtor, or the direct or actual owner of the debtor10, unless the debtor is a bank:
Name Company registration number Country Member of a consolidation unit Type of Connection11 Percentage of direct/indirect property connection
1.
2.
3.
4.
  Credit amount  in currency  represents  % of the total export value3 
The value of local deliveries funded by the credit  (amount), i.e.   % of Export Contract Value12 in the amount of   (amount).
  Expected length of credit drawdown in months:  
  Expected length of credit repayment:  
  Expected final date of loan repayment:  
  Postponement of instalments (in months):  
  Number of instalments:  
  Principal:   (in the currency of the Credit Contract)
  Interest:   (in the currency of the Credit Contract)
  Interest rate13:   %
  Commitment fee14:   (in the currency of the Credit Contract)
Total  insured value (in the currency of the Credit Contract)15
Attach a schedule of the drawdown and repayment of the principal and interest required for insurance. (Annex 2)
  Conditions precedent to credit drawdown:
Documents for credit drawdown:




  Form of assurance and securing of return of the credit (instalments, transfer) including valuation of securing instruments:
  How did the applicant for insurance verify the suitability of the proposed securing documentation/instruments for the
  specific legal environment?
  Other proposed conditions to the Credit Contract, namely the debtor's liability to submit documents necessary for its
  financial evaluation and the financial evaluation of the guarantors, i.e. mainly financial statements of the debtor and
  guarantor, and the documents necessary for the valuation and revaluation of the hedging instruments including the
  necessary legal opinion and due diligence, and covenants.
Guarantor:
  Name8:
  Company registration number9:
  Legal form:
  Registered office:
  Address for postal service:  
     Address
     City
     Post code
     Country
  Predominant form of ownership
  (state, private):
  Is the guarantor a member of the debtor's
  financial group7?
  Member of a consolidation unit:
  Name of company that performs
  consolidation for the consolidation unit:
Entities that are financially linked groups7 with the guarantor, or the direct or actual owner10 of the debtor, unless the guarantor is a bank:
Do not fill in if this is the same financial group as the debtor's.
Name Company registration number Country Member of a consolidation unit Type of connection11 Percentage of direct/indirect property connection
1.
2.
3.
4.

3 price agreed in the Export Contract

7 Financial group of an entity is a group of natural or legal persons, where:

  1. two or more natural or legal persons that, unless proven otherwise, constitute a single risk since one of them has direct or indirect control over the other person(s);
  2. two or more natural or legal persons between which there is not a relationship of control referred to in (a) but that must be seen as persons constituting a single risk because they are interconnected to such an extent that if one of them got into financial difficulties, mainly difficulties with funding or payback, the other person or all other persons would probably also get into difficulties with funding or payback,
    control is understood as a relationship between the parent company and a subsidiary company (persons) where the controlling person (parent company):
    1. has a majority of voting rights of shareholders or members in the other company; or
    2. has the right to appoint or remove a majority of the members of the administrative, managing or supervisory body of the other company and is concurrently a shareholder or member of the company; or
    3. has the right to exercise a dominant influence on any company it is a shareholder or member of within the meaning of a contract concluded with it or pursuant to its constitution or memorandum of association where the law which governs the company allows that it is subjected to such contracts, constitution or memorandum of association; or
    4. is a shareholder or member of any other company and
      1. a majority of members of the administrative, managing or supervisory body of this company who were members of these bodies during the current and previous accounting period until the time of the preparation of the consolidated financial statements, were appointed solely using their voting rights, or a share in any other company is at least 20%; or
      2. exercises, based on an agreement concluded with other shareholders or members of this company, a majority of voting rights of shareholders and members in this company.
      A group of natural or legal persons consisting of central government and all natural or legal persons directly or indirectly controlled by it or interconnected as referred to in (b) are not considered a financially linked group.
    The existence of a financially linked group made of a central or regional government or local bodies ("central bodies") and other natural or legal persons may be assessed separately for each person directly controlled as referred to in (a) or directly interconnected as referred to in (b) or all natural and legal persons that are controlled by this person as referred to in (a) or interconnected with this person as referred to in (b), including central bodies.

8 exact name as in the entity's country of registration and in the language in which it will be stated in the Credit Contract

9 if the registration number is maintained in a public or similar register in the country of the entity's registered office; if not available, the VAT number

10 Direct owner means another legal or natural person that has a property interest in a business corporation – entity.
    Actual owner of an entity means

  1. a legal or natural person that factually or legally exercises, directly or indirectly, a decisive influence on the management or operation of the enterprise of the non-banking entity; indirect influence means influence exercised through another person or other persons,
  2. a legal or natural person that itself or based on an agreement with another member(s) disposes of more than 25% of the voting rights of the non-banking entity; disposing of voting rights means the possibility to exercise voting rights based on one's own discretion regardless of whether and on the basis of what legal reason they are exercised, or a possibility to influence the exercise of voting rights by another person,
  3. a legal or natural persons acting in concert that dispose of more than 25% of voting rights of the entity, or
  4. a legal or natural person that is the recipient of the proceeds of the entity's activities based on another fact.

11 The type of connection may be a direct or indirect property connection, personal connection (i.e. a majority of members of the administrative, managing or supervisory body of the entity who were members of these bodies during the current and previous accounting period until the time of preparation of consolidated financial statements, were appointed solely using their voting rights, or a share in any other entity is at least 20%), or another connection

12 Export Contract Value as per OECD Consensus represents the value of supplies from the Czech Republic and third countries, i.e. the value of the export contract decreased by the value of local supplies i.e. Local Costs

13 FIX or FLOAT rate

14 fee for the provision of credit/reservation of funds

15 principal, interest and fee for the provision of credit/reservation of funds (commitment fee)

IV. Export Contract:
  Subject-matter of the Export Contract
  (goods and services):
  The Export Contract was concluded   on 
 - state the state of negotiations:
  Conditions of effect under the Export Contract:
  Expected date of commencement of
  deliveries:
  Expected date of termination of deliveries:
  Expected number of sub-deliveries:
  Total export value16
  (in the currency of the Export Contract):
Delivery parity  (under INCOTERMS) from year: 
Payment terms of the Export Contract
  Down payment   %, i.e. in the currency of the Export Contract: 
  Amount of deferred payment:   %, i.e. in the currency of the Export Contract: 
  Other payments   %, i.e. in the currency of the Export Contract: 
  Purchase price     in the currency of the Export Contract: 
  Calculated profit     in the currency of the Export Contract: 
  The applicant for insurance has assessed the risks following from the Export Contract:
  Identification of risks of the Export Contract by the applicant for insurance that threaten the proper and timely
  performance of the Export Contract and the return of funding; state how to address them:
Statement of the applicant for insurance to the position of the exporter under the Export Contract:




  a) Obligations of the exporter and sanctions for their non-fulfilment under the Export Contract
  b) Obligations of the importer and sanctions for their non-fulfilment under the Export Contract
  Number of jobs created in the CR by the export
  Number of jobs maintained in the CR by the export
National percentage values:
 Main subcontractors (manufacturers):
  1. Sub-deliveries from contractors based in the Czech Republic17
    1. Name:
        Delivery value:  thousand   (in the currency of the Export Contract)
 % of the total export value
    2. Name:
        Delivery value:  thousand   (in the currency of the Export Contract)
 % of the total export value
  In case of need add other important subcontractors
    Percentage value of Czech deliveries on the total export value: 
  2. Percentage value of local deliveries in the importer's country 18 in the total export value
      thousand   (in the currency of the Export Contract)
      % of the total export value
  3. Sub-deliveries from third countries outside the country of import19
    1. Country:
        Name:
        Delivery value:  thousand   (in the currency of the Export Contract)
 % of the total export value
    2. Country:
        Name:
        Delivery value:  thousand   (in the currency of the Export Contract)
 % of the total export value
  In case of need add other important subcontractors
    Percentage value of sub-deliveries from third countries on the total export value: 

16 price agreed in the Export Contract

17 Exceeding 5% of the total export value

18 costs of goods and services in the importer's country under the OECD Consensus

19 Exceeding 5% of the total export value

V. Importer (foreign buyer)
  Name20:
  Company registration number9:
  Legal form:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Predominant form of ownership
  (state, private):
  Main field of activities:


  Importer's bank:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Is the importer a member of the debtor's or
  guarantor's financial group 7?
  Member of a consolidation unit:
  Name of company that performs
  consolidation for the consolidation unit:
  Your experience with the debtor or importer so far:
  The amount of your receivables from the debtor/importer (in thousands CZK):
  Of which overdue:

7 Financial group of an entity is a group of natural or legal persons, where:

  1. two or more natural or legal persons that, unless proven otherwise, constitute a single risk since one of them has direct or indirect control over the other person(s);
  2. two or more natural or legal persons between which there is not a relationship of control referred to in (a) but that must be seen as persons constituting a single risk because they are interconnected to such an extent that if one of them got into financial difficulties, mainly difficulties with funding or payback, the other person or all other persons would probably also get into difficulties with funding or payback,
    control is understood as a relationship between the parent company and a subsidiary company (persons) where the controlling person (parent company):
    1. has a majority of voting rights of shareholders or members in the other company; or
    2. has the right to appoint or remove a majority of the members of the administrative, managing or supervisory body of the other company and is concurrently a shareholder or member of the company; or
    3. has the right to exercise a dominant influence on any company it is a shareholder or member of within the meaning of a contract concluded with it or pursuant to its constitution or memorandum of association where the law which governs the company allows that it is subjected to such contracts, constitution or memorandum of association; or
    4. is a shareholder or member of any other company and
      1. a majority of members of the administrative, managing or supervisory body of this company who were members of these bodies during the current and previous accounting period until the time of the preparation of the consolidated financial statements, were appointed solely using their voting rights, or a share in any other company is at least 20%; or
      2. exercises, based on an agreement concluded with other shareholders or members of this company, a majority of voting rights of shareholders and members in this company.
      A group of natural or legal persons consisting of central government and all natural or legal persons directly or indirectly controlled by it or interconnected as referred to in (b) are not considered a financially linked group.
    The existence of a financially linked group made of a central or regional government or local bodies ("central bodies") and other natural or legal persons may be assessed separately for each person directly controlled as referred to in (a) or directly interconnected as referred to in (b) or all natural and legal persons that are controlled by this person as referred to in (a) or interconnected with this person as referred to in (b), including central bodies.

9 if the registration number is maintained in a public or similar register in the country of the entity's registered office; if not available, the VAT number

20 exact name according as in the importer's country and in the language in which it will be stated in the Export Contract

VI. Description of the business case
  Include a description of the business case here, i.e. a detailed description of the subject of export or the project, as the case may be, and its funding; references to similar projects of the exporter in terms of the territory of final destination of the export; how the exporter or the funding bank was contacted with the business case, whether the parties to the transaction (funding of the project) are known to the exporter or the bank from previous business cases or completely new, what are the benefits of the project for the exporter (to strengthen its position in the market, to enter a new market, to maintain an existing business relationship, etc.), for the funding bank and for the Czech Republic, what the main expectable risks are and how such risks can be addressed in a practical manner – initial considerations.
Provide any other specific information known to you regarding the required insurance which could be related to the assessment of risk of the business case and to the importer, including your experience with the performance of the contract and adherence to payment terms.
  Insurance of transaction
VII. Application for insurance of a transaction21
Sponsor
  Name8:
  Company registration number9:
  Legal form:
  Registered office:
  Address for postal service:  
     Address
     City
     Post code
     Country
  Predominant form of ownership
  (state, private):
  Is the exporter a member of the financial group7
  of the debtor, the importer or the guarantor?
Specification of the previous row if the answer is Yes:



  Member of a consolidation unit:
  Name of company that performs
  consolidation for the consolidation unit:
Assessment of project risks
Further details about the nature of the project beyond chapter VI:
  Description of the main pillars of the project:
  Description of the current state of the project:
  Debtor's with the necessary licenses and permits for the implementation of construction and operation of the project
  at their disposal:
  Description of how the sales of the project outputs are ensured, including the main buyers of the outcomes:
  Description of how the supplies of key inputs of the projects are ensured in the stage of operation including the main
  suppliers of these inputs:
  Assessment of key risks of sub-contractor agreements with key sub-contractors of the Exporter:
  Value and description of deliveries during construction of the project outside the Export Contract:
  Date of preparation of basic feasibility study of the project in accordance with the instructions
  of the applicant for insurance:
  Main conclusions of the feasibility study:
The main project risks based on the following independent assessments which the applicant for insurance has available, incl. comments on the proposal for addressing risks and their acceptability by the applicant for insurance:
  Economic due diligence:
  Market study:
  Legal due diligence of the key contractual documentation of the project (in particular necessary licenses and permits,
  export contract, contracts on the supply of inputs and take-off of outputs, general enforcement of the law and the
  respective hedging instruments in the territory):
  Technical due diligence - assessment of the proposed technology and feasibility of achieving the expected performance
  parameters:
  Due diligence of commercial insurance contracts (of property and operation of the debtor):

7 Financial group of an entity is a group of natural or legal persons, where:

  1. two or more natural or legal persons that, unless proven otherwise, constitute a single risk since one of them has direct or indirect control over the other person(s);
  2. two or more natural or legal persons between which there is not a relationship of control referred to in (a) but that must be seen as persons constituting a single risk because they are interconnected to such an extent that if one of them got into financial difficulties, mainly difficulties with funding or payback, the other person or all other persons would probably also get into difficulties with funding or payback,
    control is understood as a relationship between the parent company and a subsidiary company (persons) where the controlling person (parent company):
    1. has a majority of voting rights of shareholders or members in the other company; or
    2. has the right to appoint or remove a majority of the members of the administrative, managing or supervisory body of the other company and is concurrently a shareholder or member of the company; or
    3. has the right to exercise a dominant influence on any company it is a shareholder or member of within the meaning of a contract concluded with it or pursuant to its constitution or memorandum of association where the law which governs the company allows that it is subjected to such contracts, constitution or memorandum of association; or
    4. is a shareholder or member of any other company and
      1. a majority of members of the administrative, managing or supervisory body of this company who were members of these bodies during the current and previous accounting period until the time of the preparation of the consolidated financial statements, were appointed solely using their voting rights, or a share in any other company is at least 20%; or
      2. exercises, based on an agreement concluded with other shareholders or members of this company, a majority of voting rights of shareholders and members in this company.
      A group of natural or legal persons consisting of central government and all natural or legal persons directly or indirectly controlled by it or interconnected as referred to in (b) are not considered a financially linked group.
    The existence of a financially linked group made of a central or regional government or local bodies ("central bodies") and other natural or legal persons may be assessed separately for each person directly controlled as referred to in (a) or directly interconnected as referred to in (b) or all natural and legal persons that are controlled by this person as referred to in (a) or interconnected with this person as referred to in (b), including central bodies.

8 exact name as in the entity's country of registration and in the language in which it will be stated in the Credit Contract

9 if the registration number is maintained in a public or similar register in the country of the entity's registered office; if not available, the VAT number

10 Direct owner means another legal or natural person that has a property interest in a business corporation – entity.
    Actual owner of an entity means

  1. a legal or natural person that factually or legally exercises, directly or indirectly, a decisive influence on the management or operation of the enterprise of the non-banking entity; indirect influence means influence exercised through another person or other persons,
  2. a legal or natural person that itself or based on an agreement with another member(s) disposes of more than 25% of the voting rights of the non-banking entity; disposing of voting rights means the possibility to exercise voting rights based on one's own discretion regardless of whether and on the basis of what legal reason they are exercised, or a possibility to influence the exercise of voting rights by another person,
  3. a legal or natural persons acting in concert that dispose of more than 25% of voting rights of the entity, or
  4. a legal or natural person that is the recipient of the proceeds of the entity's activities based on another fact.

21 funding of export with elements of project funding based on the CNB and OECD Consensus methodologies

The following annexes are an integral part of this form:
Annex No. 1 -  Basic terms and conditions for insurance of an export buyer credit “D”
Annex No. 2 -  Schedule of the drawdown and repayment of the credit
Annex No. 3 -  Exporter's statement on the export value percentage
Annex No. 4 -  Questionnaire to assess the environmental and social impact of the export including the exporter's statement
Annex No. 5 -  Exporter's declaration on compliance with legal provisions against bribery in international trade and in prosecution of the exporter
Annex No. 6 -  Overview of submitted documents for final analysis
All information is confidential and is used by the insurer Exportní garanční a pojišťovací společnost, a.s. (Export Guarantee and Insurance Corporation) only for the preparation of insurance including a decision on the provision of insurance and the preparation of a draft insurance contract (contract on the promise of insurance). Exportní garanční a pojišťovací společnost, a.s. (Export Guarantee and Insurance Corporation) reserves the right to request submission of other information and documents necessary for the assessment of the application for insurance and for taking out the insurance.
In the preparation for the provision of insurance of export credit risk, Exportní garanční a pojišťovací společnost a.s. as the insurer primarily assesses the fulfilment of criteria identified as "cut-off" criteria and reserves the right to request submission of other information and documents necessary for their assessment. More information is available at the following links: Examination cut-off criteria of non-banking entities, Examination cut-off criteria of banking entities
Statement of the applicant for insurance
I declare that:
  1. I have acquainted myself with the General Insurance Terms and Conditions of type "D" and basic terms and conditions of insurance of export buyer credit listed in Annex 1, and I confirm that the information stated in this application and its annexes is correct and complete and no important facts known as of the date of filing this application for insurance have been omitted or withheld and are not in conflict with the basic terms and conditions of insurance and the General Terms and Conditions of type "D",
  2. I have acquainted myself with the information on personal data processing by the insurer for the purposes of insurance listed on the insurer's website,
  3. the above business case for the insurance of which I am applying is, based on preliminary assessment, feasible in terms of its structure and financial health of all the stakeholders22, and that I have a serious intent to further negotiate the provision of insurance of this business case, and
  4. I have the consent of all the stakeholders to provide information and documents listed in the submitted application, its annexes and where other material is necessary to assess the application for insurance and to take out insurance, I will request such consent.
I agree to immediately inform the insurer of any additional facts and changes applicable to or related to the requested insurance which occur after submitting this application.
I agree with the provision of data, information and documents provided by me and handed over to the insurer in connection with and regarding insurance to persons providing the insurer with information and assessment and bodies of the company of the insurer including shareholder representatives, and I agree with the provision of such data, information or documents to the respective bodies and persons if provided so by applicable legislation, and with their provision to a reinsurance company and third parties to the extent necessary for negotiations on the conclusion of an insurance contract and for its conclusion.
  Name of the applicant:
  Person(s) authorized to act for the applicant:
  In dated  
[Signature of person(s) authorized to act for the applicant]

22 persons involved in the export (project) and its financing

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