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In case of queries, contact please Mr. Vlastimil Nesrsta, phone +420 222 842 015, GSM: +420 724 761 444, E-mail: nesrsta@egap.cz

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NOTIFICATION OF A THREAT OF AN INSURANCE LOSS

GIC type P

Insurance Contract number:
Insurance Decision number:
Reason for an insurance loss according to the GIC P Art. VII.:

I. Insured (Exporter carrying out the Prospection)

II. Data on Amount of the Financial Loss from the Prospection

III. Commentary:

Description of the case (filling in is compulsory):

Reasons for and circumstances of an occurrence of the financial loss - failure of the Prospection (filling in is compulsory):

Following steps have been made in order to mitigate the financial loss (filling in is compulsory):

IV. Instruction

The form has to be filled in properly and signed by a person authorised to act outward on behalf of the company.
The Insured shall continue in all measures preventing occurrence of the financial loss from the Prospection of the foreign market or to decrease in its extent in cooperation with the Insurer.
The Insured is entitled, in cooperation with the Insured or independently, to take all and any measures directed on prevention of the loss or decreasing of its extent.

V. Annexes

Number of annexes:

Date:

Signature of the Insured	.....................................................................................

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