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E

Application for conclusion of an insurance contract

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APPLICATION/DECISION
for insurance of a confirmed Letter of Credit
to the Framework Contract No.
GIC type E
1) Applicant
Name:
Address:
2) Letter of Credit Reference Number
3) Exporter
Name:
Address:
4) Issuing bank
Name:
Address:
Country
5) Confirmed currency and amount
Amount in currency
  in CZK
Amount charged by the bank for confirmation of the Letter of Credit
6) Insurance value
Amount in currency
  in CZK
7) Payment terms of the Letter of Credit
Payment deferral days.
8) Place of delivery
9) Final destination place
10) Opening date of the Letter of Credit
11) Date of confirmation of the Letter of Credit
12) Date of presentation of documents
13) The Letter of Credit payable before/transferable to
14) Type of exported goods
Name of a responsible person:
Banking connection:
Phone:
Fax:
E-mail:
Company Identification No:
Tax registration No.:
Application date:
Signature:   .......................................................................................
Decision of the insurer:
(will be filled-in by EGAP)
 
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