Z Insurance of a Bank Guarantee Issued in Relation to Fulfilment of Conditions for Winning or Performing an Export Contract Application for Insurance of a Bank Guarantee Issued in Relation to Fulfilment of Conditions for Winning or Performing an Export Contract (GIC type Z)

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APPLICATION
for Insurance of a Bank Guarantee Issued in Relation to Fulfilment
of Conditions for Winning or Performing an Export Contract
GIC type Z
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

 Type of the guarantee
  Applicant for insurance2:
  Mandator:
  Amount of the guarantee:
  Guarantee period:
  Export contract
  Subject:
  To country:
  Total export value3:
  Manufacturer4:
  Main subcontractors:
  Percentage value of sub-deliveries from abroad exceeding 20% in one country:
      Share:
      Country:
  Importer
  Name:
  Country:
  Registered office:

2 the bank issuing the bank guarantee for the obligations of the mandator

3 price agreed in the Export Contract

4 if different from the mandator

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:
  
  Scope of coverage:
II. Mandator: (Exporter)
  Name:
  Company registration number:
  VAT ID No.:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
  Exporter'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 mandator to other entities5:
Names of entities that are part of a group financially linked with the mandator5:
  1.
  2.
  3.
  4.
  5.

5 the parent company, a subsidiary and another company of the 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. Importer
  Name:
  Company registration number:
  VAT ID No.:
  Registered office:
  Country:
  Legal form:
  Importer's bank:
  Registered office importer's bank:
IV. Guarantee
  Type of the guarantee:
  Value of the guarantee  in currency  represents  % of value of the export contracts. 
  Expected date of issuance of the guarantee:
  The guarantee valid to:
  The guarantee period in months:
  Will guarantee follow international rules:  which: 
  Applicable law in the text of the guarantee:
  The way of enforcing rights against the beneficiary in case of unauthorized drawdown of the guarantee:
  Reducing clause in the text of the guarantee:
  Beneficiary of the guarantee:
  Name:
  Registered office:
  Country:
  Other relevant information about the guarantee:
  Guarantor for the mandator towards the applicant in respect of the guarantee:
  Other proposed conditions to the issuance of the guarantee, namely the mandator's liability to submit documents
necessary for its financial evaluation and the financial evaluation of the mandator and guarantor, i.e. mainly financial
statements of the mandator and guarantor, and the documents necessary for the valuation and revaluation of the hedging
instruments including the necessary legal opinion and due diligence:
V. Export Contract
  Subject-matter of the Export Contract
  (goods and services):
  The Export Contract was concluded   on 
 - state the state of negotiations:
  Conditions of effect under the Export Contract:
  Expected date of commencement
  of deliveries:
  Expected date of termination of deliveries:
  Expected number of sub-deliveries:
  Total export value6
  (in the currency of the Export Contract):
Delivery parity  (under INCOTERMS) from year: 
Payment terms of the Export Contract:
  Down payment   %, i.e. in the currency
  of the Export Contract: 
  Payments on delivery   %, i.e. in the currency
  of the Export Contract: 
  Deferred maturity of export receivable 
  (export credit) 
 %, i.e. in the currency
  of the Export Contract: 
  Period of repayment of the export receivable 
  (export credit): 
 years and   months
  Other conditions of the export receivable (export credit):
  (deferment of payments, number and frequency of repayments, assurance of return):
  Security of sources for funding of the production for the export contract:
  Number of jobs created in the CR by the export:
  Number of jobs maintained in the CR by the export:

6 price agreed in the Export Contract

VI. Description of the business case
 Include a description of the business case here, i.e. a brief description of the subject of export, references to similar transactions of the mandator in terms of the territory of export; how the mandator or the bank issuing the guarantee was contacted with the business case, whether the parties to transactions are known to the mandator or the bank from previous business cases or completely new, what are the benefits of the transaction for the mandator (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 other products required with EGAP insurance for this business case (insurance Z, V, B, C, D, E etc.) and a current sate of insurance negotation.
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 importer, including your experience with the performance of the contract and adherence to payment terms.
The following annexes are an integral part of this form:
Annex No. 1 -  Basic terms and conditions of insurance of the bank guarantee “Z”
Annex No. 2 -  Exporter's statement on the export value percentage
Annex No. 3 -  For the advance payment guarantee, the budget of drawing down the advance payment according to items and terms
Annex No. 4 -  Mandator's declaration on compliance with legal provisions against bribery in international trade
Annex No. 5 -  Overview of submitted documents for analysis including an analytical statement prepared by the applicant for insurance (by the bank), which mainly includes a list of the main risks and the manner to address them7
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.

7 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 "Z" and basic terms and conditions of insurance of insurance of a bank guarantee issued in relation to fulfilment of conditions for winning or performing an export contract 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 "Z",
  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 stakeholders8, 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]

8 persons involved in the export and its financing

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