I declare herewith that I am acquainted with General Insurance Conditions "V" and confirm that data entered in this form are truthful, complete and no important data known as on day of submission of this application for insurance have been omitted or withheld.
I obligate myself to inform the insurer without delay on other circumstances and changes related to the requested insurance which could occur after the submission of this application.
I take notice of my duty to reimburse the insurer all expenses accrued in connection with verification of the insurance risk also in case the insurance contract (insurance promise contract) will be prepared on the basis of data entered in this form and the contract will not be signed.
Insurance of export credit risks with state support cannot be given to exports which were negotiated by way of bribery in international trade in the sense of the § 160 and subsequent of the Criminal Code. For these purposes, I declare on behalf of our company and on behalf of persons representing our company that there has been and there will be no breach of rules against bribery in international trade 1). In this relation I further declare that persons acting on behalf of our company or representing our company were not charged by the criminal offence of bribery and they had not been convicted of such criminal offence in last 5 years. Furthermore, I declare that that our company has not been mentioned in the publicly accessible debarment list of the World Bank Group.
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.
I accept that the insurer has the right to verify truthfulness of the above-mentioned declaration and obligate myself to submit all information and documentation the insurer may request in this regard.
According to Art. IX of GIC V, the insurer has the right to refuse indemnification if it has been proven that the applicant entered into the application for insurance incomplete or untruthful data with regard to bribery in international trade.