I Insurance of Investment in Foreign Countries Application for Insurance of Investment in Foreign Countries (GIC type I)

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APPLICATION
for Insurance of Investment in Foreign Countries
GIC type I
pursuant to Act No. 58/1995 Coll.1

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

  Applicant for insurance2:
  Investment
  Company - subject of investment and
  character and form of investment11:
  Country of final destination of the investment:
  Destination of investment (specify further):
  Final value:

2 investor

I. Applicant for insurance (investor)
  Name:
  Company registration number:
  VAT ID No.:
  File number in Business Register:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
  Applicant’s bank:
  A/C No.:
  Persons authorized to sign for the company:
  Contact person:
  Telephone:
  Fax:
  E-mail:
  Information for assessment of small and medium-sized companies3:
     Number of employees4:
     Annual turnover for the last accounting
period:
     Balance sheet total for the last
accounting period:
  Applies for:
 
 
 
 
 
  Relation of the investor to other entities5:
  Ownership structure:
Names of entities that are part of a group financially linked with the investor5:
  1.
  2.
  3.
  4.
  5.

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

4 as of the date of submitting the application

5 the parent company, a subsidiary and another financially linked group. A financially linked group is understood as 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.
II. Company - the subject of investment6:
  Name:
  Company registration number7:
  VAT ID No.:
  Registered office:
  Address for postal service7:  
     Street
     City
     Country
  Legal form:
  Date of establishment of the company8:
  Subject of activities:
  Complete ownership structure:
  Method of control of the foreign company
  by the investor:
  Participation of the host country9 in the
  company:
  Bank of the company7:
     Registered office:
     Address for postal service:  
        Street
        City
        Country
  Relation of the company to other entities5:
Names of entities that are part of a financially linked group5 with the foreign company which is the subject of investment:
  1.
  2.
  3.
  4.
  5.
  Your experience with the company so far:

5 the parent company, a subsidiary and another financially linked group. A financially linked group is understood as 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.

6 a legal entity with its registered office outside of the territory of the Czech Republic for the purpose of whose establishment of or acquisition of or increase in an interest in such a legal entity or extension of business activities of such a legal entity, the investment being the subject of insurance is expended;

7 not filled out for a newly established company

8 In the event of a newly established company the expected date of establishment/incorporation of the company

9 Country of registered office of the company which is the subject of investment (of the place of destination of the investment)

III. Foreign company of the investor10:
  Name:
  Company registration number:
  VAT ID No.:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Legal form of the foreign company:
  Date of establishment of the foreign
  company:
  Subject of activities:
  Complete ownership structure:
  Method of control of the foreign company
  by the investor:
  Participation of the host country 9
  in the company:
  Bank of the foreign company:
     Registered office:
     Address for postal service:  
        Street
        City
        Country
  Relation of the foreign company to other
  entities:

10 Fill out only in the event of acquisition where the property interest in the company which is the subject of investment is being acquired or increased by a foreign company controlled by the investor – legal entity based in the Czech Republic, or a foreign company is establishing a company which is the subject of investment

IV. Investment
  Company - subject of investment and
  character and form of investment11:
  Specification of activities of the company
  after start-up:
  Method of keeping the investment in the
  investor's accounts:
  Country of final destination of the
  investment11:
  Destination of investment (specify further)11:
  Expected date of commencement of
  investment:
  Expected date of termination of investment:
  Expected date of commencement of
  operation of investment:
  Expected time of life of investment:
  Total investment value11:
  Value already invested by the investor:
     Contribution to the registered capital
     Loan
  Estimated total investment values in
  individual years until the end of investment:
  Licenses for investment obtained so far:
  Pending licenses to obtain:
  This is:
Structure of investment funding:
  Own sources   %, i.e. in the currency of the investment 
  Credit   %, i.e. in the currency of the investment 
  Other sources   %, i.e. in the currency of the investment 
Main subcontractors (manufacturers):
Sub-deliveries from contractors (subcontractors) based in the Czech Republic12
    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:

11 The information must be identical to that in the introduction to the application

12 exceeding 5% of the export value

V. Description of the business case
Include a description of the business case here, i.e. a detailed description of the subject of investment, references to similar transactions of the investor, including in terms of the territory of investment; how the investor or applicant for insurance were contacted with the business case, whether the parties to the investment are known to the applicant for insurance from previous business cases or completely new, what are the benefits of the investment for the investor (to strengthen its position in the market, to enter a new market, to maintain an existing business relationship, etc.) and for the Czech Republic, what are the main expectable risks and how such risks can be addressed in a practical manner.
 
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 debtor, investor and other entities involved in the investment, including your experience with the performance of contracts and compliance with payment conditions.
The following annexes are an integral part of this form:
Annex No. 1 -  Basic terms and conditions for insurance of investment abroad “I”
Annex No. 2 -  Questionnaire to assess the environmental and social impact of the investment including the investor's statement
Annex No. 3 -  Investor's declaration on compliance with legal provisions against bribery in international trade and in prosecution of the investor
Annex No. 4 -  Documents required for insurance of investment abroad “I” (according to the list of required documents)
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.
Statement of the applicant for insurance
Investment in Foreign Countries – GIC „I“
I declare that:
  1. I have acquainted myself with the General Insurance Terms and Conditions of type "I" and basic terms and conditions of insurance of Investment in Foreign Countries (insurance) 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 "I",
  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 stakeholders , 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]

13 persons involved in the investment and its funding – the investor, a foreign company and company which is the subject of investment (unless it is a newly established company)

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