Cf - Notification of a threat of an insurance loss

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NOTIFICATION OF A THREAT OF AN INSURANCE LOSS
GIC type Cf
  Insurance Contract number:
  Insurance Decision number (for framework contracts):
  Cause of an insurance loss according to GIC Cf Art. VIII.:
  Supplementary insurance of exchange rate risk (for contracts before December 31, 2006):
 
I. Insured
  Commercial name:
  Company Identification No.:
  Seat:
  Phone:
  Fax:
  E-mail:
  Contact Person:
  Bank Connection:
  Authorised Person:
II. Importer
  Commercial name:
  Seat:
  State:
  Importer:  
  Phone:
  Fax:
  E-mail:
  Contact Person:
  Bank Connection:
III. Exporter
  Commercial name:
  Company Identification No.:
  Seat:
  State:
  Phone:
  Fax:
  E-mail:
  Contact Person:
  Bank Connection:
IV. Detailed data on a threat of an insurance loss:
Receivable No. Amount Currency Issued Due Interest Partial
payment 		Net amount
V. Commentary:
  Characteristics of business transaction:
  Reasons and circumstances leading to a threat of an insurance loss (must be filled-in):
  Following steps have been made in order to prevent an insurance loss (must be filled-in):
VI. Instruction
  • the form has to be duly filled-in and signed by a person authorized to act outwardly on behalf of the company
  • the insured will continue in all necessary measures in cooperation with the insurer to prevent origination of an insurance loss or to lower its extent
  • the insurer has the right to take all necessary measures in cooperation with the insured or independently leading to prevention of an insurance loss or to lowering of its extent
VII. Annexes
(demonstrative enumeration, a list of annexes will be specified by the Insurer upon receipt of this Notice)
  Number of attachments:  
  Date:
Signature of insured:   .......................................................................................
 
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