E - Application for insurance of confirmed letter of credit (GIC type E)

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APPLICATION
for insurance of confirmed letter of credit
GIC type E
pursuant to Act No. 58/1995 Coll.1
HLASKA_ZOPE_poznamka0
1) Applicant for insurance
  Name:
  Company registration number:
  VAT ID No.:
  File number in Business Register:
  Registered office2:
  Address for postal service:  
     Street
     City
     Post code
  Applicant's bank:
  A/C No.:
  Persons authorized to sign for the company:
  Contact person:
  Telephone:
  E-mail:
 
HLASKA_ZOPE_I_struktura
HLASKA_ZOPE_I_v_priloze
  • HLASKA_ZOPE_I_odrazka_1
  • HLASKA_ZOPE_I_odrazka_2
  • HLASKA_ZOPE_I_odrazka_3
  • HLASKA_ZOPE_I_odrazka_4
  • HLASKA_ZOPE_I_odrazka_5
  HLASKA_ZOPE_I_zada_o   
  
HLASKA_ZOPE_I_poznamka
2) Exporter
  Name:
  Company registration number:
  VAT ID No.:
  Legal form:
  Registered office2:
  Address for postal service:  
     Street
     City
     Post code
  HLASKA_ZOPE_II_vyvozce_banka
  HLASKA_ZOPE_II_vyvozce_cislo
  HLASKA_ZOPE_II_vyvozce_osoby
  Number of employees3:
  Annual turnover for the last
  accounting period3:
  HLASKA_ZOPE_II_vyvozce_kapital
  Balance sheet total for the last
  accounting period3:
  HLASKA_ZOPE_II_vztah_vyvozce
  HLASKA_ZOPE_II_clen_skupiny   
  HLASKA_ZOPE_II_clen   
  HLASKA_ZOPE_II_nazev
HLASKA_ZOPE_II_nazvy_subjektu
  HLASKA_ZOPE_II_vztah_1
  HLASKA_ZOPE_II_vztah_2
  HLASKA_ZOPE_II_vztah_3
  HLASKA_ZOPE_II_vztah_4
  HLASKA_ZOPE_II_vztah_5
HLASKA_ZOPE_II_poznamka
HLASKA_ZOPE_III_referencni_cislo_akreditivu0
  3) Reference number of the letter of credit
4) Issuing bank
  Name:
  Company registration number4:
  VAT ID No.:
  Registered office:
  Address for postal service:  
     Street
     City
     Country
  Relation to other entities5:
HLASKA_ZOPE_IV_nazvy_subjektu
  HLASKA_ZOPE_IV_vztah_1
  HLASKA_ZOPE_IV_vztah_2
  HLASKA_ZOPE_IV_vztah_3
  HLASKA_ZOPE_IV_vztah_4
  HLASKA_ZOPE_IV_vztah_5
HLASKA_ZOPE_IV_jiny_dluznik
  HLASKA_ZOPE_IV_jiny_dluznik_nazev
  HLASKA_ZOPE_IV_jiny_dluznik_ic
  HLASKA_ZOPE_IV_jiny_dluznik_dic
  HLASKA_ZOPE_IV_jiny_dluznik_sidlo
  HLASKA_ZOPE_IV_jiny_dluznik_korespondencni_adresa  
  HLASKA_ZOPE_IV_jiny_dluznik_korespondencni_adresa_ulice
  HLASKA_ZOPE_IV_jiny_dluznik_korespondencni_adresa_mesto
  HLASKA_ZOPE_IV_jiny_dluznik_korespondencni_adresa_stat
  HLASKA_ZOPE_IV_jiny_dluznik_vztah_k_jinym_subjektum
  HLASKA_ZOPE_IV_jiny_dluznik_postaveni
HLASKA_ZOPE_IV_poznamka
5) Amount of the letter of credit
  Amount  in currency 
  HLASKA_ZOPE_V_pripadna
  Amount charged by the bank for confirming the letter of credit 
6) Insurance value
  Amount  in currency 
7) Payment terms of the letter of credit
  Deferment of payments  days
8) Date of opening the letter of credit
9) Date of confirmation of the letter of credit
10) The deadline for presentation of documents / validity of the letter of credit
11) Expected date of payment of the letter of credit
HLASKA_ZOPE_XI_dokumenty
HLASKA_ZOPE_XI_ostatni
12) Export contract
  Subject-matter of the Export Contract
  (goods and services):
  HLASKA_ZOPE_XII_smlouva_o_vyvozu_do_zeme
  The Export Contract was concluded:  on 
 - state the state of negotiations:
  Conditions of effect under the Export Contract:
  Expected date of commencement
  of deliveries:
  Expected date of termination of deliveries:
  Expected number of sub-deliveries:
  Total export value6
  (in the currency of the Export Contract):
Delivery parity  (under INCOTERMS) from year: 
  HLASKA_ZOPE_XII_pocet_prac_mist_vytvori
  HLASKA_ZOPE_XII_pocet_prac_mist_udrzi
Payment terms of the Export Contract:
  Down payment   %, i.e. in the currency of the Export Contract: 
  Amount of deferred payment   %, i.e. in the currency of the Export Contract: 
  Other payments   %, i.e. in the currency of the Export Contract: 
  „Other proposed conditions to the export contracts, namely the importer's liability to submit documents necessary for
its financial evaluation and the financial evaluation of the guarantors, i.e. mainly financial statements of the debtor
and guarantor“
HLASKA_ZOPE_XII_narodni_podily
 HLASKA_ZOPE_XII_narodni_podily_hlavni_subdodavatele
    HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_nazev_1
        HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky_tisHLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky_mena
HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_pr_z_celkove_hodnoty_o_vyvozu
    HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_nazev_2
        HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky_tisHLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky_mena
HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_pr_z_celkove_hodnoty_o_vyvozu
    HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_nazev_3
        HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky_tisHLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_hodnota_dodavky_mena
HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_pr_z_celkove_hodnoty_o_vyvozu
  HLASKA_ZOPE_XII_subdodavky_od_dodavatelu_se_sidlem_v_ceske_republice_poznamka
    HLASKA_ZOPE_XII_podil_ceskych_dodavek_na_hodnote_vyvozu_celkem
  HLASKA_ZOPE_XII_podil_mistnich_dodavek
     HLASKA_ZOPE_XII_podil_mistnich_dodavek_tisHLASKA_ZOPE_XII_podil_mistnich_dodavek_mena
     HLASKA_ZOPe_XII_podil_mistnich_dodavek_pr_z_celkove_hodnoty_smlouvy_o_vyvozu
  HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi
    HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_stat_1
        HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_nazev
        HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_hodnota_dodavky HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_tisHLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_mena
HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_pr_z_celkove_hodnoty_smlouvy_o_vyvozu
    HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_stat_2
        HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_nazev
        HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_hodnota_dodavky HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_tisHLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_mena
HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_pr_z_celkove_hodnoty_smlouvy_o_vyvozu
  HLASKA_ZOPE_XII_subdodavky_ze_tretich_zemi_poznamka
    HLASKA_ZOPE_XII_podil_subdodavek_ze_tretich_zemi_na_hodnote_vyvozu_celkem
HLASKA_ZOPE_VI_poznamka
13) Importer
  Name7:
  Company registration number5:
  Registered office:
  Address for postal service:  
     Address
     City
     Country
  Legal form:
  Predominant form of ownership
  (state, private):
  Main field of activities:


  HLASKA_ZOPE_XIII_dovozce_vztah_dovozce
HLASKA_ZOPE_XIII_nazvy_subjektu
  HLASKA_ZOPE_XIII_vztah_1
  HLASKA_ZOPE_XIII_vztah_2
  HLASKA_ZOPE_XIII_vztah_3
  HLASKA_ZOPE_XIII_vztah_4
  HLASKA_ZOPE_XIII_vztah_5
  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.

2 head office – full address of the registered office in accordance with a public register

3 fill out in accordance with the definition of small and medium-sized enterprises listed in Annex I to the Commission Regulation (EC) No 800/2008 of 6 August 2008 declaring certain categories of aid compatible with the common market in application of Articles 87 and 88 of the Treaty (General block exemption Regulation)

4 if the registration number is maintained in a public or similar register in the country of the entity's registered office

5 A financially linked group is understood as a group of natural or legal persons where:

  1. two or more natural or legal persons that, unless proven otherwise, constitute a single risk since one of them has direct or indirect control over the other person(s);
  2. two or more natural or legal persons between which there is not a relationship of control referred to in (a) but that must be seen as persons constituting a single risk because they are interconnected to such an extent that if one of them got into financial difficulties, mainly difficulties with funding or payback, the other person or all other persons would probably also get into difficulties with funding or payback;

control is understood as a relationship between the parent company and a subsidiary company (persons) where the controlling person (parent company):

  1. has a majority of voting rights of shareholders or members in the other company; or
  2. has the right to appoint or remove a majority of the members of the administrative, managing or supervisory body of the other company and is concurrently a shareholder or member of the company; or
  3. has the right to exercise a dominant influence on any company it is a shareholder or member of within the meaning of a contract concluded with it or pursuant to its constitution or memorandum of association where the law which governs the company allows that it is subjected to such contracts, constitution or memorandum of association; or
  4. is a shareholder or member of any other company and
    1. a majority of members of the administrative, managing or supervisory body of this company who were members of these bodies during the current and previous accounting period until the time of the preparation of the consolidated financial statements, were appointed solely using their voting rights, or a share in any other company is at least 20%; or
    2. exercises, based on an agreement concluded with other shareholders or members of this company, a majority of voting rights of shareholders and members in this company.

A group of natural or legal persons consisting of central government and all natural or legal persons directly or indirectly controlled by it or interconnected as referred to in (b) are not considered a financially linked group.
The existence of a financially linked group made of a central or regional government or local bodies ("central bodies") and other natural or legal persons may be assessed separately for each person directly controlled as referred to in (a) or directly interconnected as referred to in (b) or all natural and legal persons that are controlled by this person as referred to in (a) or interconnected with this person as referred to in (b), including central bodies.

6 price agreed in the Export Contract

7 exact name as in the entity's country of registration and in the language in which it will be stated in the Credit Contract

The following annexes are an integral part of this form:
Annex No. 1 -  Basic terms and conditions of insurance of confirmed letter of credit “E”
Annex No. 2 -  Exporter's statement on the export value percentage
Annex No. 3 -  Exporter's declaration on compliance with legal provisions against bribery in international trade and in prosecution of the exporter
Annex No. 4 -  Current annual report of the issuing bank including an analytical statement prepared by the applicant for insurance (bank)
HLASKA_ZOPE_prilohy_priloha_5a HLASKA_ZOPE_prilohy_priloha_5b
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 decision on the provision of insurance and the preparation of a draft insurance contract (contract on the promise of insurance). 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.
Statement of the applicant for insurance
I declare that:
  1. I have acquainted myself with the General Insurance Terms and Conditions of type "E" and basic terms and conditions of insurance of a Confirmed Letter of 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 "E",
  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 is, based on preliminary assessment by the applicant for insurance, feasible in terms of its structure and financial health of all the stakeholders , 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, i.e. Exportní garanční a pojišťovací společnost a.s. (Export Guarantee and Insurance Corporation), 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]

8 persons involved in the export (transaction) and its financing

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