Bf - SMEs - Application for Insurance of a Short Term Export Supplier Credit Financed by a Bank against the Risk of Non Payment (GIC type Bf)

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APPLICATION
for insurance of a Short Term Export Supplier Credit Financed by a Bank against the Risk of Non Payment
GIC type Bf
pursuant to Act No. 58/1995 Coll.1
SMEs
  Applicant for insurance
  Export Contract
  Subject:
  To country:
  Manufacturer:
  Total export value2:

2 price agreed in the Export Contract

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:
  E-mail:
 
HLASKA_MSP_ZOPBF_I_struktura
HLASKA_MSP_ZOPBF_I_v_priloze
  • HLASKA_MSP_ZOPBF_I_odrazka_1
  • HLASKA_MSP_ZOPBF_I_odrazka_2
  • HLASKA_MSP_ZOPBF_I_odrazka_3
  • HLASKA_MSP_ZOPBF_I_odrazka_4
  • HLASKA_MSP_ZOPBF_I_odrazka_5
  HLASKA_MSP_ZOPBF_I_zada_o
  
HLASKA_MSP_ZOPBF_smlouva_o_vyvozu_poznamka2
II. Information about the exporter
  Name:
  Company registration number:
  VAT ID No.:
  File number in Business Register:
  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:
  Contact person:
  Telephone:
  E-mail:
  Number of employees3:
  Annual turnover for the last accounting
period3:
  Total Assets in Last Accounting Period3:
  Relation of the exporter to other entities4:
Names of Entities That Are Part of Financially Interlinked Group with Exporter4:
  1.
  2.
  3.
  4.
  5.
  Exporter’s Outstanding Claim on Application Filing Date According to Central Credit Register – More than 90 Days Past Due     
3 To be completed in line with the definition of small and medium-sized enterprises provided 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 the application of Articles 87 and 88 of the Treaty (General Block Exemption Regulation)
4 A financially interlinked group is a group of natural or legal persons where:
  1. two or more natural or legal persons who, unless proven otherwise, together constitute a single risk, because one of them has direct or indirect control over the other person or other persons;
  2. the control-based relationship referred to under (a) does not exist between two or more natural or legal persons, but they must still be viewed, together, as constituting a single risk, because they are interconnected to the extent that, if one of them faces financial difficulties, in particular, financing or repayment difficulties, another person or all of the other persons would also likely find themselves with financing or repayment difficulties; in this context, control is taken to mean a relationship between a parent and a subsidiary (persons) where the controlling person (parent):
    1. has a majority of the shareholders’ or members’ voting rights in another undertaking; or
    2. has the right to appoint or remove a majority of the members of the administrative, management or supervisory body of another undertaking and, at the same time, is a shareholder in or member of that undertaking; or
    3. has the right to exercise dominant influence over an undertaking of which it is a shareholder or member, pursuant to a contract entered into with that undertaking or to a provision in its memorandum or articles of association, where the law governing that undertaking permits its being subject to such contracts or provisions; or
    4. is a shareholder in or member of any other undertaking, and
      1. a majority of the members of the administrative, management or supervisory bodies of that undertaking who have held office during the financial year, during the preceding financial year and up to the time when the consolidated accounts are drawn up have been appointed solely as a result of the exercise of its voting rights, or its share in any other undertaking is at least 20%; or
      2. it controls, pursuant to an agreement with other shareholders in or members of that undertaking, a majority of shareholders’ or members’ voting rights in that undertaking.
A group of natural or legal persons consisting of the central government and all natural or legal persons directly or indirectly controlled by it or interconnected under (b) is not considered to be a financially interlinked group.
The existence of a financially interlinked group comprising central or regional government, or local authorities (“central authorities”), and other natural or legal persons may be assessed separately for each of the persons directly controlled under (a) or directly interconnected under (b), or all natural or legal persons who are controlled by that person under (a) or are interconnected with that person under (b), including the central authorities.
III. Contract of assignment of receivable/receivables
  Subject-matter of the Contract of
assignment of receivable/receivables:
  Contract was concluded   on 
 - state the state of negotiations:
  Contract number:
  HLASKA_MSP_ZOPBF_III_predmet_smlouvy
  Documents evidencing the creation of receivable/receivables:
  Expected date of assignment of
receivable/receivables:
  HLASKA_ZOPBF_III_pozadovana_hodnota
  Other proposed conditions to the Contract of assignment of receivable, namely the exporter's statement that the importer
is obliged, in relation to the exporter, to submit the documents necessary for the financial evaluation of the importer and
guarantor, i.e. mainly financial statements of the importer and guarantor and the exporter's liability to submit such
documents to the applicant for insurance:
IV. 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 value2
(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 credit (deferment of payments, number and frequency of repayments):
  Form of recouping the export receivable (export credit):
  Calculated profit   %, i.e. in the currency
of the Export Contract: 
  Moment of rise of receivable under the
Export Contract:
  In the Annex No. 2 attach billing schedule of deliveries and repayment of supplier credit by the importer.
  a) Obligations of the exporter and sanctions for their non-fulfilment under the Export Contract
  b) Obligations of the importer and sanctions for their non-fulfilment under the Export Contract
  c) Form of recouping the purchase price (guarantees, bills of exchange, letters of credit, etc.)
National percentage values:
 Main subcontractors (manufacturers):
  1. Sub-deliveries from contractors based in the Czech Republic5
    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: 
  HLASKA_MSP_ZOPBF_IV_podil_mistnich_dodavek
     HLASKA_MSP_ZOPBF_IV_podil_mistnich_dodavek_tisHLASKA_MSP_ZOPBF_IV_podil_mistnich_dodavek_mena
     HLASKA_MSP_ZOPBF_IV_podil_mistnich_dodavek_pr_z_celkove_hodnoty_smlouvy_o_vyvozu
  HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi
    HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_stat_1
        HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_obchodni_firma
        HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_hodnota_dodavky HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_tisHLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_mena
HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_pr_z_celkove_hodnoty_smlouvy_o_vyvozu
    HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_stat_2
        HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_obchodni_firma
        HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_hodnota_dodavky HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_tisHLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_mena
HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_pr_z_celkove_hodnoty_smlouvy_o_vyvozu
  HLASKA_MSP_ZOPBF_IV_subdodavky_ze_tretich_zemi_poznamka
    HLASKA_MSP_ZOPBF_IV_podil_subdodavek_ze_tretich_zemi_na_hodnote_vyvozu_celkem
2 price agreed in the Export Contract
5 exceeding 5% of the export value
V. Importer/debtor (foreign buyer)
  Name:
  HLASKA_MSP_ZOPBF_V_dovozce_identifikacni_cislo
  HLASKA_MSP_ZOPBF_V_dovozce_dic
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Legal form:
  Predominant form of ownership
(state, private):
  Main field of activities:


  Importer's bank:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Relation of the importer
to other entities4:
Names of Entities That Are Part of Financially Interlinked Group with Exporter4:
  1.
  2.
  3.
  4.
  5.
  Your experience with the debtor or importer so far:
  The amount of your receivables from the debtor/importer (in thousands CZK):
  Of which past due – in last three years, by more than 180 days:
VI. Description of the business case
  Include a description of the business case here, i.e. a detailed description of the subject of export, references to similar transactions of the exporters in terms of the territory of export; how the exporter or the funding bank was contacted with the business case, whether the parties to transactions are known to the exporter or the bank from previous business cases or completely new, what are the benefits of the transaction for the exporter (to strengthen its position in the market, to enter a new market, to maintain an existing business relationship, etc.), funding bank 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, F, V 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 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 - insurance of short-tail export supplier's credit Bf - SMEs
Annex No. 2 -  Schedule of supply invoicing and repayment of the supplier's credit by the importer
Annex No. 3 -  Exporter's statement on the export value percentage
Annex No. 4 -  Exporter's declaration on compliance with legal provisions against bribery in international trade and in prosecution of the exporter
HLASKA_MSP_ZOPBF_VI_prilohy_priloha_5a HLASKA_MSP_ZOPBF_VI_prilohy_priloha_5b
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 of a Short Term Export Supplier Credit Financed by a Bank against the Risk of Non Payment – Bf - SMEs
I declare that:
  1. have acquainted myself with the General Insurance Terms and Conditions of type "Bf" and basic terms and conditions of insurance of a short term export supplier credit financed by bank against the risk of non payment 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 "Bf",
  2. I am familiar with the fact that EGAP, to the extent and in accordance with the applicable law, processes the personal data of the natural persons it acquires in connection with its activities. Basic processing information is available at www.egap.cz. I have also informed about this fact and will inform all persons (data subjects) involved in the insurance proces,
  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]
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