If Insurance of Credit for the Financing of Investment in Foreign Countries Application for Insurance of a Credit for Investment in Foreign Countries against the Risk of Non Repayment of the Credit (GIC type I)

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.
APPLICATION
for Insurance of a Credit for Investment in Foreign Countries
against the Risk of Non Repayment of the Credit
GIC type If
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

  Credit Contract
  Applicant for insurance2:
  Debtor3:
  Amount of the credit:
  Length of loan repayment (in years):
  Investment
  Subject of investment:
  Country of final destination of the investment:
  Destination of investment (specify further):
  Investment value:

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

3 the investor or a foreign company which is the subject of investment

I. Applicant for insurance
  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:
  Applies for:
 
 
   
   
   
II. Investor
  Name:
  Company registration number:
  VAT ID No.:
  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:
  Number of employees:
  Annual turnover for the last accounting
  period:
  Balance sheet total for the last accounting
  period:
  Relation of the investor to other entities4:
  Ownership structure:
Names of entities that are part of a group financially linked with the investor4:
  1.
  2.
  3.
  4.
  5.
  Your experience with the investor so far:
  The amount of your receivables from the investor (in thousands CZK):
  Of which overdue:

4 the parent company, a subsidiary and another financially linked group. Financially linked group means mainly the cases when:

  • one entity holds a property interest (direct or mediated) or interest in voting rights of more than 10% of another entity or other entities or the ability to appoint members of the statutory and supervisory body of the other entity or entities, or the entity in relation to the controlling and controlled entity;
  • legal entities have the same members of statutory and supervisory bodies or senior management, or relatives in these positions (especially family members);
  • entities are economically dependent on each other (for example, trade relations are higher than 40% of total supplies), or
  • entities are interconnected by guarantees, pledges, credits or loans.
III. Foreign company which is the subject of investment
  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 country5
  in the company:
  Bank of the foreign company:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Relation of the foreign company to other
  entities3:
Names of entities that are part of a financially linked group4 with the foreign company which is the subject of investment:
  1.
  2.
  3.
  4.
  5.
  Your experience with the foreign company so far:
  The amount of your receivables from the foreign company (in thousands CZK):
  Of which overdue:

3 the investor or a foreign company which is the subject of investment

4 the parent company, a subsidiary and another financially linked group. Financially linked group means mainly the cases when:

  • one entity holds a property interest (direct or mediated) or interest in voting rights of more than 10% of another entity or other entities or the ability to appoint members of the statutory and supervisory body of the other entity or entities, or the entity in relation to the controlling and controlled entity;
  • legal entities have the same members of statutory and supervisory bodies or senior management, or relatives in these positions (especially family members);
  • entities are economically dependent on each other (for example, trade relations are higher than 40% of total supplies), or
  • entities are interconnected by guarantees, pledges, credits or loans.

5 Country of registered office of the foreign company (of the place of destination of the investment)

IV. Foreign company which will perform acquisition of the purchased company6
  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 country7
  in the company:
  Bank of the foreign company:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Relation of the foreign company to other
  entities3:

3 the investor or a foreign company which is the subject of investment

6 Fill out only in the event of acquisition where the foreign company is purchased by another foreign company controlled by the investor

7 Country of registered office of the foreign company (of the place of destination of the investment)

V. Credit for investments
Credit contract:
  number:
  dated:
concluded with the debtor on:
 
 
Credit purpose:
  Expected length of credit drawdown:   in months
  Expected length of credit repayment:   in years
  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 rate8:   %
  Commitment fee9:   (in the currency of the
  Credit Contract)
  Total:   insured value (in the currency
  of the Credit Contract)10
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:

8 FIX or FLOAT rate

9 fee for the provision of credit

10 principal, interest and fee for the provision of credit (commitment fee)

VI. Guarantor
  Name11:
  Company registration number:
  VAT ID No.:
  Legal form:
  Registered office:
  Address for postal service:  
     Address
     City
     Post code
     Country
  Predominant form of ownership
  (state, private):
  Relation of the guarantor to other entities4:
Names of other entities that are financially linked groups4 with the guarantor:
  1.
  2.
  3.
  4.
  5.

4 the parent company, a subsidiary and another financially linked group. Financially linked group means mainly the cases when:

  • one entity holds a property interest (direct or mediated) or interest in voting rights of more than 10% of another entity or other entities or the ability to appoint members of the statutory and supervisory body of the other entity or entities, or the entity in relation to the controlling and controlled entity;
  • legal entities have the same members of statutory and supervisory bodies or senior management, or relatives in these positions (especially family members);
  • entities are economically dependent on each other (for example, trade relations are higher than 40% of total supplies), or
  • entities are interconnected by guarantees, pledges, credits or loans.

11 exact trading company, name as in the country of registration and in the language in which it will be stated in the Credit Contract

VII. Investment
  Character and form of investment:
  Country of final destination of the
  investment:
  Destination of investment (specify further):
  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 value:
  Value already invested by the investor:  
      Contribution to the registered capital
      Loan
  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 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:

12 exceeding 5% of the total investment value

VIII. I 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 of credit insurance for investments abroad “If”
Annex No. 2 -  Schedule of the drawdown and repayment of the credit for investments
Annex No. 3 -  Questionnaire to assess the environmental and social impact of the investment including the investor's statement
Annex No. 4 -  Investor's declaration on compliance with legal provisions against bribery in international trade and in prosecution of the investor
Annex No. 5 -  Overview of submitted documents for analysis including an analytical statement prepared by the applicant for insurance, which mainly includes a list of the main risks and the manner to address them13
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.

13 The overview shall be signed by the person authorized to sign on behalf of the applicant

Statement of the applicant for insurance
I declare that:
  1. I have acquainted myself with the General Insurance Terms and Conditions of type "If" and basic terms and conditions of insurance of a Credit for Investment in Foreign Countries against the Risk of Non Repayment of the 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 "If",
  2. 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 stakeholders14, and that I have a serious intent to further negotiate the provision of insurance of this business case, and
  3. 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]

14 persons involved in the investment and its financing

By selecting OK you can access form in the printing format.
© EGAP  2017
Site Map