AMERIABANK CJSC 11CB.9 FO /1 Page 1/8

Transcription

1 AMERIABANK CJSC 11CB.9 FO /1 Page 1/8 Approved by Management Board Decision 87/03/10 as of September 29,2010 Chairman of the Management Board General Director A. Hanesyan Dear Client Please, complete the following application form. It will give us a better understanding of your company and enable to offer most profitable factoring terms and conditions to you. AMERIABANK CJSC Phone: +(37410) , +(37410) ; fax: +(37410) GENERAL 1. BUSINESS INFORMATION NAME / FULL NAME (FOR PRIVATE ENTREPRENEURS ) Tax ID WEB- SITE DATE FULL BUSINESS STARTED / REGISTRATION EXISTING ACCOUNTS WITH BANKS 1. BANK BANK CODE SETTLEMENT ACCOUNT CORRESPONDENT ACCOUNT 2. BANK BANK CODE SETTLEMENT ACCOUNT CORRESPONDENT ACCOUNT LOCATION OFFICE ADDRESS BUSINESS LOCATION/ AREA SQ. M. TYPE OF PREMISES LESSOR LEASE AGREEMENT DURATION ADDRESS OF PREVIOUS OFFICE OWN / LEASED PROPERTY ISOLATED BUILDING BUSINESS CENTER WITHIN A RESIDENTIAL HOUSE WITHIN A N-RESIDENTIAL BUILDING LESSOR S DURATION OF BUSINESS AT CURRENT LOCATION DURATION OF BUSINESS AT PREVIOUS LOCATION OTHER 1

2 AMERIABANK CJSC 11CB.9 FO /1 Page 2/8 ADDRESS OF THE WAREHOUSE/ AREA SQ. M. LESSOR OF THE WAREHOUSE OWN / LEASED PROPERTY LEASE AGREEMENT DURATION 2. MANAGEMENT MANAGER (AUTHORIZED TO SIGN DOCUMENTS WITHOUT RELEVANT POWER OF ATTORNEY) TITLE FULL NAME PASSPORT DATA REGISTERED AT ISSUED BY DATE OF REGISTRATION YEARS IN GIVEN POSITION CHIEF ACCOUNTANT (ACCOUNTING UNIT RESPONSIBLE OFFICER) POSITION FULL NAME PASSPORT DATA REGISTERED AT ISSUED BY DATE OF REGISTRATION COMPANY S CONTACT PERSONS 1) OFFICER RESPONSIBLE FOR TRANSACTIONS, FULL NAME POSITION 2) OFFICER RESPONSIBLE FOR CLIENT RELATIONSHIPS, FULL NAME POSITION / / 3. PRINCIPAL OWNERS 1 COMPANY S OR INDIVIDUAL S FULL NAME (FOR LEGAL ENTITIES) MANAGER REGISTERED AT MANAGER S PASSPORT DATA OWNERSHIP (%) ISSUED BY DATE OWNERSHIP ACQUIRED 2 COMPANY S OR INDIVIDUAL S FULL NAME (FOR LEGAL ENTITIES) MANAGER REGISTERED AT MANAGER S PASSPORT DATA ISSUED BY 2

3 AMERIABANK CJSC 11CB.9 FO /1 Page 3/8 OWNERSHIP (%) DATE OWNERSHIP ACQUIRED 3 COMPANY S OR INDIVIDUAL S FULL NAME (FOR LEGAL ENTITIES) MANAGER REGISTERED AT MANAGER S PASSPORT DATA ISSUED BY OWNERSHIP (%) DATE OWNERSHIP ACQUIRED 4. PARENT/ SUBSIDIARY/ REPRESENTATIVE/ AFFILIATED COMPANIES 1 NAME AND STATUS PLACE OF BUSINESS 2 NAME AND STATUS PLACE OF BUSINESS 5. COMPANY S POSITION IN THE HOLDING/ GROUP COMPANY S POSITION IN THE HOLDING/ GROUP DESCRIPTION OF HOLDING/GROUP STRUCTURE 6. HISTORY AND GENERAL INFORMATION IS YOUR COMPANY A LEGAL SUCCESSOR OF ATHER COMPANY? PLEASE, DESCRIBE YOUR BUSINESS BUSINESS SECTOR GOODS/SERVICES SOLD MANUFACTURING WHOLESALE TRADE RETAIL TRADE FINANCE HEALTH CARE TRANSPORT AND COMMUNICATION CONSTRUCTION AGRICULTURE SERVICES INFORMATION TECHLOGIES SCIENCE AND EDUCATION OTHER (SPECIFY) SPHERE ANNUAL REVENUE PER FISCAL STATEMENTS THIS YEAR LAST YEAR YEAR BEFORE 3

4 AMERIABANK CJSC 11CB.9 FO /1 Page 4/8 LAST YEAR AVG. OF EMPLOYEES (TOTAL) THIS YEAR LAST YEAR YEAR BEFORE LAST 7. GEOGRAPHICAL COVERAGE OF TRANSACTIONS GEOGRAPHICAL COVERAGE OF YEREVAN REGIONS EXPORT IMPORT TRANSACTIONS COUNTRIES OF EXPORT OF BUYERS IN THE ANTICIPATED EXPORT VOLUMES, INCLUDING THOSE WITH COUNTRY MIL. ARMENIAN DRAMS DEFERRED PAYMENT SCHEME IMPORT TRANSACTIONS (TYPE OF GOODS AND COUNTRIES) 8. MAIN COMPETITORS MAIN COMPETITORS ADVANTAGES OF YOUR COMPANY 9. INFORMATION ON CURRENT TRADE TRANSACTIONS TOTAL OF EXISTING BUYERS TOTAL OF EXISTING DEBTORS WHO ARE ALLOWED DEFERRED PAYMENT AVG. REVENUES FOR THE LATEST 2 QUARTERS, THOUS. ARMENIAN DRAMS SHARE OF RECEIVABLES PAID IN TIMELY MANNER, % MAXIMUM ALLOWED A/R PER ALL DEBTORS AT A TIME, THOUS. ARMENIAN DRAMS SHARE OF TRANSACTIONS WITH DEFERRED PAYMENT SCHEME, % SHARE OF N-CASH PAYMENTS, % ALLOWED DAYS BEYOND TERMS MIN. AVG. MAX. AVG. MONTHLY DELIVERIES (TRANSACTION) AVG. TRANSACTION PRICE, THOUS. ARMENIAN DRAMS AVG. DEFERRED PAYMENT TERMS (DAYS) OF BUYERS WHOSE DEBT IS OVER 30 DAYS TOTAL DEBT WHICH IS OVER 30 DAYS DEFERRED, THOUS. ARMENIAN DRAMS TOTAL OD EXISTING SUPPLIERS TOTAL OF EXISTING SUPPLIERS ALLOWING PAST DUE PAYMENT OVER 180 DAYS OVER 180 DAYS 10. INFORMATION ON PRINCIPAL PARTNERS AND LIABILITIES 4

5 AMERIABANK CJSC 11CB.9 FO /1 Page 5/8 PARTNER (BUYER/DEBTOR) GOODS/SERVICES SUPPLIED SHARE % A/R AMOUNT AND CURRENCY STARTING/CLOSING DATE SUPPLIER (CREDITOR) GOODS/SERVICES ACQUIRED SHARE % A/P AMOUNT AND CURRENCY STARTING/CLOSING DATE CREDIT RISK MANAGEMENT DOES THE COMPANY EMPLOY A CREDIT RISK MANAGEMENT PROCEDURE? PLEASE, SPECIFY THE PERSONS MAKING LOAN DECISIONS IN RELATION TO THE COMPANY S DEBTORS. FULL POSITION NAME DOES THE COMPANY SET CREDIT LIMITS FOR DEBTORS? IF, PLEASE, SPECIFY THE RATIONALE USED TO DEFINE THE CREDIT LIMITS. FINANCIAL STATEMENTS WARRANTY WORK EXPERIENCE OTHER MAX. CREDIT LIMIT PER DEBTOR 12. SECURITY SERVICE DOES YOUR COMPANY HAVE A SECURITY SERVICE? INFORMATION ON HEAD OF SECURITY SERVICE (FULL NAME) DOES THE SECURITY SERVICE PARTICIPATE IN DEBTOR ANALYSIS PROCESS? DOES THE SECURITY SERVICE PARTICIPATE IN BAD DEBT RECOVERY PROCESS? 13. SUMMARY OF LOANS RECEIVED/REPAID BANK LOAN AMOUNT, mil. Armenian drams STARTING DATE TERM PURPOSE / SECURITY OUTSTANDING AMOUNT/ INTEREST, Armenian drams 14. INFORMATION ON OVERDUE LIABILITIES CURRENT OVERDUE LIABILITIES TO THE GOVERNMENT RELATING TO LOANS RELATING TO SALARY PAYMENT RELATING TO GUARANTEES ISSUED TO OFF-BUDGET FUNDS RELATING TO TES PLEASE, EXPLAIN THE REASONS FOR PAST DUE LIABILITIES 5

6 AMERIABANK CJSC 11CB.9 FO /1 Page 6/8 HAS THE COMPANY BEEN INVOLVED IN ANY TYPE OF LITIGATION OR LAWSUIT? (PLEASE SPECIFY, INVOLVEMENT AS A PLAINTIFF OR DEFENDANT, WITNESS, etc., AMOUNT, COURT DECISION) 15. ASSETS OWNED BY THE COMPANY N-RESIDENTIAL BUILDINGS AND PREMISES RESIDENTIAL BUILDINGS AND HOUSES LAND, SQ. M. NAME, ADDRESS, SQ. M. VEHICLES, DATE OF MANUFACTURE МАКЕ EQUITY INTEREST IN OTHER COMPANIES, % OTHER FINANCIAL INVESTMENTS FINANCIAL INVESTMENTS, SHARE 16. DOCUMENTS RELATED TO GOODS SOLD TERMS OF DELIVERY EXW DELIVERY CARRIER TRANSFER OF TITLE TO GOODS TO THE BUYER UPON LOADING UPON DELIVERY UPON TRANSFER TO THE CARRIER 17. PLEASE, SPECIFY THE LEGAL ENTITIES WHICH MAY STAND AS A GUARANTOR OF YOUR LIABILITIES 18. COMPANY S DEVELOPMENT OUTLOOK (GOALS, TASKS) NEW PROJECTS REQUIRING INVESTMENTS OF MORE THAN 30,000,000 ARMENIAN DRAMS PROJECTS PURCHASE OF EQUIPMENT AND FACILITIES PURCHASE OF BUILDINGS AND LAND 19. INFORMATION ON ANTICIPATED SCHEME DOMESTIC DOMESTIC N- EXPORT EXPORT N- ANTICIPATED AMOUNT OF, Armenian drams PLEASE, LEAVE BLANK 6

7 AMERIABANK CJSC 11CB.9 FO /1 Page 7/8 TOTAL AMOUNT TO BE FACTORED, Armenian drams 20. OTHER INFORMATION PLEASE, COMPLETE ALL THE AVAILABLE FIELDS. IF ANY OF THE FIELDS DOES T SUIT YOUR CASE, PLEASE, DRAW A LINE TO AVOID MISINTERPRETATION. DATE Hereby I warrant and represent that the above information and the documents (including financial statements and other finance documents) provided herewith are true and accurate to the best of my knowledge and belief. I acknowledge and agree that the bank may request additional information other than provided herein or request to clarify the received data, which in the bank s reasonable opinion will expedite the decision-making process. I hereby authorize Ameriabank CJSC to make an inquiry to ACRA Credit Reporting Ltd. which operates ACRA system. This serves as my request to the latter for the release to Ameriabank CJSC of any information on my current and past financial liabilities received from various sources and available in the ACRA database. The information will be used by the bank in the application review process. I am aware that depending on its contents (which are under responsibility of the entity which filed the information with ACRA) such information may be critical in the decision-making process. Hereby I undertake to reimburse to the bank, at the moment this application is filed, any expenses related to credit investigation. I have read this provision carefully, fully understand and accept it. Please, provide this proof of my consent or its copy to ACRA. MANAGER S TITLE SIGNATURE FULL NAME Seal 7