D - Preliminary application for Insurance of an Export Buyer Credit against the risk of non payment (GIC type D)

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.
PRELIMINARY APPLICATION
for insurance of an export buyer credit against the risk of non payment
GIC type D
Insurer:
Exportní garanční a pojišťovací společnost, a.s.
(Export Guarantee and Insurance Corporation)
registered office Prague 1, Vodičkova 34/701, zip code 111 21
ID No. 45279314/ VAT ID No. CZ45279314
A. Information on the entities and parameters of the business case
Applicant for the insurance
  Name:
  Company registration number:
  Tax registration number:
  Registered office1:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
  Contact person:
  Telephone(s):
  Fax:
  E-mail:
  Subject of export:
  Estimated value of export2:
  Share of Czech deliveries
  in the value of export2:
  Expected share of local supplies
  in the country of the importer
  in the value of exports2:
  Major subcontractors:
  To country/Country of the final destination
  of the export:
  The Insured3:
Exporter
  Name:
  Company registration number:
  Tax registration number:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
 
Importer
  Name:
  Company registration number:
  Tax registration number:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
Export contract
  Status of export contract negotiations4:
  Payment terms under the export contract:
  Deposit (advance/předplatba):
  Amount of deferred payments:
Debtor5
  Name:
  Company registration number:
  Tax registration number:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
  Form of funding:

Credit parameters
  Principal of the loan:
  Term of drawing:
  Expected starting date of drawing:
  Pay-off term:
An integral part of this application (section "A") is:

the Appendix 1: Basic conditions of insurance

1 head office – full address of the registered office in accordance with a public register

2 price agreed in the Export Contract

3 if different than the applicant

4 e.g. the export contract has been pre-negotiated/initialled/signed, funding conditions analysed by the bank, financing pre-approved by the bank

5 if other then the importer

6 legal entity created for the implementation of the project – special purpose vehicle - SPV

7 please cross out as appropriate

B. Information on the entities and parameters of the business case
Other credit parameters
  Suspension of payments:
  Status of negotiations on providing
  funding financing:
  Suggested reinsurance/security
  of the credit:
  Estimated value insured8:
Description of the business case:
Include here a description of the business case, i.e. a detailed description of the subject of export or the project, as the case may be, and its funding; references to similar projects of the exporter in terms of the territory of final destination of the export; how the exporter or the funding bank contacted with the business case, whether the parties to the transaction (funding of the project) are known to the exporter or the bank from previous transactions or completely new, what are the benefits of the project for the exporter (to strengthen its position in the market, to enter a new market, to maintain an existing business relationship, etc.), for the funding bank and for the Czech Republic, what are the main expectable risks and how such risks can practically be addressed – initial considerations.
Other preliminary information on the export, funding and insurance
other assumed insurance products required (V, Z, F) and their value:
Please provide any additional specific information known to you regarding the required insurance, which could be relevant for the valuation of risks of the business case, the debtor, the importer and other entities involved in the export, including your experience with performance of contracts and compliance with credit and payment terms and conditions:

8 loan principal, interest and commitment fee

An integral part of this application (section "B") is:
 Appendix 2: List of documents required for the initial analysis
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 preliminary analysis of the business case and entities9 involved. 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.

9 entities involved in the export and its funding

Declaration of the applicant for insurance
I declare that:
  1. I have acquainted myself with the General Insurance Terms and Conditions of type "D" and basic terms and conditions of insurance of export buyer credit listed in Annex 1, and I confirm that 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 "D"
  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 stakeholders9, 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 and 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 to 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(s) of person(s) authorized to act for the applicant]

9 entities involved in the export and its funding

By selecting OK you can access form in the printing format.