EXPORT CREDIT INSURANCE PROPOSAL FORM

Transcription

1 Registered Name Trading Name Registration Number Business Commencement Date EXPORT CREDIT INSURANCE PROPOSAL FORM Physical address Postal Address Code Tel Code Fax Bank Branch Account No Name and Surname of Directors, Partners, Members, Sole Proprietor Additional Company to be added as a Joint Assured Registration Number of Joint Assured NATURE OF BUSINESS A. Nature of business (Please tick the appropriate box) Manufacturer Wholesaler Retailer Other B. Description of Goods / Services Rendered

2 Type of Buyers TURNOVER Financial Year End Month Year Nett Turnover* Number of Debtors Normal Terms of Payment *Excluding Government Departments, Buying Agents, Cash & Inter Company BAD DEBT HISTORY Financial Year End Month Year Nett Loss Number of Losses Largest Loss plus Name of Debtor TURNOVER ANALYSIS PER COUNTRY Country Turnover at last Financial Year End Anticipated Turnover for next 12 months Number of Buyers Maximum Credit Period

3 DETAILS OF NEW ANTICIPATED MARKETS Country Anticipated Turnover for next 12 months Number of Buyers Maximum Credit Period Product MAXIMUM BALANCE, ACCOUNTS RECIEVABLE Outstanding Balance Number of Buyers Outstanding Balance Number of Buyers

4 EXPORT CREDIT MANAGEMENT Do you currently insure your Export Debtors If YES, with whom, and why are you considering an alternative quote How long have you been involved in Export Credit Insurance Do you have a separate Export Department Who is responsible for handling your Export Debtors (i) Designation (ii) Period with the company (iii) Period responsible for Export Debtors (iv) Period involved in export market Who is responsible for preparing your shipping documentation What credit precautions do you take before supplying your customers DETAILS OF PRINCIPAL BUYERS

5 BROKER NOMINATION Should we decide to accept the quotation provided, we hereby nominate Specialist Credit Insurance Brokers cc to handle the policy on our behalf. DECLARATION I / We agree that the information provided in this proposal is true, includes all information known to the proposer affecting the risks to be insured, and is the basis of the proposed contract. Signed Date Name Title

6 General Information Registered Name Specialist Credit Insurance Brokers c.c. R.F.C. Registration Number CK95/34112/23 FSB Licence Number 214 Address Head Office nd Avenue P.O. Box Bredell Bredell Tel: Fax : Compliance Officer : Trevor C. Joubert - Compliance Officer Number 130 ref trevor-rfc@telkomsa.net Coface South Africa Insurance Company Ltd New Policies 12.5% of premium on all new policies under R250k; 15% of premium on policies over R 250k p.a. Existing Policies 10% of premium in subsequent years under R250k ; 15% of premium on all policies over R 250k p.a. Nominations 7.5% of premium on all nominations Credit Guarantee Insurance Company Ltd New Policies 10% of premium on all new policies of less than R250k; 15% of premium on policies over R250k p.a. Existing Policies 7.5% of premium on all policies Lombard Insurance Company New Policies 15% of premium on all policies Advice No advice given by any representative of S.C.I.B. c.c. will be binding unless given in a written form. Complaints Complaints can be communicated to S.C.I.B. c.c. by contacting the Head Office above. Payment of Premiums All premiums in respect of the policies must be paid directly to the underwriters involved. Other : All forms must be completed by you and may not be completed by a representative of S.C.I.B c.c. All forms must be completed in ink All forms must be completed in full Keep record of all documentation given to S.C.I.B. c.c. Do not misrepresent any facts that may have a bearing on any contract of insurance or claims arising from such a contract Endeavour to obtain any oral communication confirmed in writing. FAIS Ombudsman P.O. Box Lynnwoodridge 0040 Customer Care Contact Centre Tel : Facsimile :