E Insurance of confirmed letter of credit Notification of a threat of an insurance loss

How to work with the form?
 E-mail:
By selecting "Save", data input will be recorded and an internet address for following completion of work with form will be sent to your E-mail.
NOTIFICATION OF A THREAT OF AN INSURANCE LOSS
GIC type E
  Insurance Contract number:
  Insurance Decision number (for framework contracts):
  Cause of an insurance loss according to GIC E Art. VII.:
  Supplementary insurance of exchange rate risk (for contracts before December 31, 2006):
 
I. Insured (bank confirming a Letter of Credit)
  Commercial name:
  Company Identification No.:
  Seat:
  Phone:
  Fax:
  E-mail:
  Contact Person:
  Bank Connection:
  Authorised Person 1):
1) Person for whom the right to indemnification comes into existence as a result of an insurance loss - to be filled in only if it is other person than the insured
II. Issuing bank (bank of Importer issuing the Letter of Credit)
  Commercial name:
  Seat:
  State:
  Debtor:  
  Phone:
  Fax:
  E-mail:
  Contact Person:
  Bank Connection:
III. Data on a threat of an insurance loss:
Receivable No. Amount Currency Issued Due Interest Partial
payment
Net amount
  Share of goods of Czech origin in the total export exceeds 50%:    
IV. Commentary:
  Description of business transaction:
  Reasons and circumstances leading to a threat of an insurance loss (must be filled-in):
  Following steps have been made for recovery/ensurance of the receivable (must be filled-in):
V. Instruction
  • the form has to be duly filled-in and signed by a person authorized to act outwardly on behalf of the company
  • the insured will continue in all necessary measures in cooperation with the insurer to prevent origination of an insurance loss or to lower its extent
  • the insurer has the right to take all necessary measures in cooperation with the insured or independently leading to prevention of an insurance loss or to lowering of its extent
VI. Attachments
  • Copy of the Letter of Credit and related documentation
  • Copies or photocopies of unpaid invoices
  • Customs and transportation documents related to unpaid receivables
  • Export Contract
  • Correspondence with the debtor related to unpaid receivables
  • Documentation on extent of material damage and on circumstances causing it
  • Other attachments:
  Number of attachments:  
  Date:
Signature of insured:   .......................................................................................
 
By selecting OK you can access form in the printing format.
© EGAP  2017
Site Map