If - Preliminary application for Insurance of a Credit for Investment in Foreign Countries against the Risk of Non Repayment of the Credit (GIC type If)

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PRELIMINARY APPLICATION
for Insurance of a Credit for Investment in Foreign Countries
against the Risk of Non Repayment of the Credit
GIC type If
Information on the subjects and the parameters of the business case
Applicant for insurance1
  Name:
  Company registration number:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
  Contact person:
  Telephone:
  Fax:
  E-mail:
  Subject of investment:
  The estimated value of investments:
  Main contractor:
  Country of final destination of the investment:

1 Bank, branch of a foreign bank or a financial institution

Investor
  Name:
  Company registration number:
  Registered office:
  Address for postal service:  
     Street
     City
     Post code
  Legal form:
  Ownership structure:
 
Foreign company which is the subject of investment
  Name:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Legal form:
  Complete ownership structure:
  Method of control of the foreign company
  by the investor:
  Participation of the host country2 in the
  company:

2 Country of registered office of the foreign company (of the place of destination of the investment)

Foreign company which will perform acquisition of the purchased company
Fill out only in the event of acquisition where the foreign company is purchased by another foreign company controlled by the investor
  Name:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Legal form:
  Complete ownership structure:
  Method of control of the foreign company
  by the investor:
  Participation of the host country2 in the
  company:

2 Country of registered office of the foreign company (of the place of destination of the investment)

Investment
  Character and form of investment:
  According to Article II, par 9 and article III, par 3 b) basic terms and conditions of credit
  insurance for investments abroad „If“
  Structure of investment funding:  
      Own sources:
      Credit for investment:
      Other sources:
  The anticipated volume of supplies Czech
  suppliers:
Debtor
 
 
Parameters credit for investment
  Credit purpose:
  Principal:
  Expected length of credit drawdown:
  Expected starting date of drawing:
  Expected length of credit repayment:
  Postponement of instalments:
  Status of negotiations on providing funding
  financing:
  Suggested reinsurance/security of the credit:
  Estimated value insured3:

3 loan principal, interest and commitment fee

Description of the business case
Include a description of the business case here, i.e. a detailed description of the subject of investment, references to similar transactions of the investor, including in terms of the territory of investment; how the investor or applicant for insurance were contacted with the business case, whether the parties to the investment are known to the applicant for insurance from previous business cases or completely new, what are the benefits of the investment for the investor (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 - initial considerations.
Other preliminary information on the investment, finance and insurance
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 of credit insurance for investments abroad “If”
 Annex No. 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 entities4 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.

4 persons involved in the investment and its financing

Statement of the applicant for insurance
I declare it:
  1. I have acquainted myself with the General Insurance Terms and Conditions of type "If" and basic terms and conditions of insurance of a Credit for Investment in Foreign Countries against the Risk of Non Repayment of the Credit 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 "If",
  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 stakeholders4, 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]

4 persons involved in the investment and its financing

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