F - SMEs - Application for Insurance of a Credit for Pre Export Financing of Production for Export (GIC type F)

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APPLICATION
for Insurance of a Credit for Pre Export Financing of Production for Export
GIC type F
pursuant to Act No. 58/1995 Coll.1
SMEs
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:
  Export Contract
  Subject:
  To country:
  Total export value4:
  Manufacturer:
  Main subcontractors:
  Percentage value of sub-deliveries from abroad exceeding 20% in one country:
      Share:
      Country:
  Importer
  Name:
  Country:
  Registered office:
  Company registration number:
2 bank, branch of a foreign bank or a financial institution providing pre-export credit
3 importer or manufacturer
4 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:
  Fax:
  E-mail:
  Applies for:
  
II. 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 exporter to other entities5:
 
  Names of entities that are part of a group financially linked with the exporter5:
  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. Manufacturer (if different from exporter)
  Name:
  Company registration number:
  VAT ID No.:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
  Manufacter'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 manufacturer to other
entities5:
Names of entities that are part of a group financially linked with the manufacturer5:
  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.
IV. Credit for pre-export financing the production for export
   number    dated 
concluded with the debtor on:
  Credit amount  in currency  represents  % of the total export value. 
  Expected length of credit drawdown in
months:
 
  Expected length of credit repayment:  
  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 rate6:   %
  Fees7:   (in the currency of the Credit
Contract)
Total  insured value (in the currency of the Credit Contract)8
  Insured value (in the currency of the Credit Contract):
  Guarantor for the repayment of the pre-export credit9:
      Name:
      Country:
      Registered office:
Attach a schedule of the drawdown and repayment of the principal and any interest required for insurance (Annex No. 4)
6 FIX or FLOAT rate
7 fee for the provision of credit
8 principal, interest and fee for the provision of credit (commitment fee)
9 only if proposed
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 value4
(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): According to Article I, par. 6 GIC “F”
  Calculated profit   %, i.e. in the currency
of the Export Contract:
 
  Moment of rise of receivable under the
Export Contract10:
4 price agreed in the Export Contract
10 e.g. issuing an invoice at the end of production, shipment of goods, shipping, etc. Include according to the facts stipulated 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 exporters and manufacturers in terms of the territory of export; how the exporter, manufacturer or the funding bank was contacted with the business case, whether the parties to transactions are known to the exporter, manufacturer or the bank from previous business cases or completely new, what are the benefits of the transaction for the exporter and the manufacturer(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 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. č. 1 -  Basic terms and conditions „F“
Annex No. 2 -  Exporter's statement on the export value percentage
Annex No. 3 -  Calculation formula of the export value
Annex No. 4 -  Schedule of the drawdown and repayment of the credit (principal and any interest required for insurance)
Annex No. 5 -  Exporter's declaration on compliance with legal provisions against bribery in international trade and in prosecution of the exporter
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.
HLASKA_MSP_ZOPF_VI_prilohy_poznamka
Statement of the applicant for insurance
of a Credit for Pre Export Financing
of Production for Export - F
I declare that:
  1. I have acquainted myself with the General Insurance Terms and Conditions of type "F" and basic terms and conditions of insurance of a Credit for Pre Export Financing of Production for Export 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 "F",
  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 stakeholders11, 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]
11 persons involved in the investment and its financing
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