Request to accept inclusive insurance P6L or EASY Pauschal

Transcription

1 page 1 of 7 Request to accept inclusive insurance P6L or EASY Pauschal APPLICANT (INSURANCE POLICY HOLDER) Full company name and address WE ARE APPLYING FOR COVER PRIOR TO DELIVERY (PRE-SHIPMENT RISK) yes no Space for additional comments WE REQUEST THE SUPPLY GUARANTEE (GRACE PERIOD IN THE EVENT OF TERMINATION OF COVER) yes for 1 month 2 months 3 months no TRANSACTION INFORMATION Goods/service Standard company payment terms WE CURRENTLY HAVE CREDIT INSURANCE yes no OeKB Versicherung a brand of Acredia Versicherung AG 1010 Vienna, Weihburggasse 30, Tel , Fax Linz, Robert-Stolz-Straße 7, Tel , Fax registered office: Himmelpfortgasse 29, 1010 Vienna, Commercial Court Vienna, reg. no: 59472i, DPR: , VAT no: ATU , IBAN: AT , BIC: OEKOATWW

2 page 2 of 7 Request to accept inclusive insurance P6L or EASY Pauschal REPORT ON BUSINESS TRANSACTIONS IN THE LAST FINANCIAL YEAR of which export receivables of countries applying for cover amount in dated DETAILS OF COUNTRIES APPLYING FOR COVER Anticipated bad debt losses (persistent late payment, debt collection, insolvency) Amount receivables in Bad debt losses in the last two financial years Amount receivables in

3 page 3 of 7 Request to accept inclusive insurance P6L or EASY Pauschal WE ARE APPLYING FOR THE INCLUSION OF jointly insured companies (Sales or production companies; the risk of non-payment by the end user remains on their books) Full company name/address agents (Sales or production companies who transfer the risk of non-payment to the applicant) Full company name/address

4 page 4 of 7 Request to accept inclusive insurance P6L or EASY Pauschal Please fill in all revenues for all countries applying for cover in the table below, including revenue of all those jointly insured companies/agents. Albania Algeria Andorra Angola Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Belarus Belgium Belize Benin Bhutan Bolivia Bosnia Herzegovina Botswana Brazil Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Chile China Colombia Congo Costa Rica Croatia Cyprus Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Estonia Finland France Gabon Gambia Georgia Germany

5 page 5 of 7 Request to accept inclusive insurance P6L or EASY Pauschal Ghana Greece Guatemala Guinea Guinea-Bissau Guyana Honduras Hungary Iceland India Indonesia Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kosovo Kuwait Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau/China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Mauritania Mauritius Mexico Moldavia Monaco Mongolia Montenegro Morocco Mozambique Namibia Netherlands New Zealand Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay

6 page 6 of 7 Request to accept inclusive insurance P6L or EASY Pauschal Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saudi Arabia Senegal Serbia Singapore Slovakia Slovenia South Africa South Korea Spain Sri Lanka Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Trinidad & Tobago Tunisia Turkey Turkmenistan UAE Uganda UK Ukraine Uruguay USA Uzbekistan Venezuela Vietnam Yemen Zambia revenue in Space for additional comments We will send on the following documents later

7 page 7 of 7 Request to accept inclusive insurance P6L or EASY Pauschal We hereby acknowledge that the policy is only accepted on the basis of the details in the application. The correctness of these details, any documents provided and the validity of the insured rights will not be checked until an insurance claim is processed. We expressly agree to our data being transferred by Acredia Versicherung AG to group companies and reinsurers. (Group companies can be found online on the website of OeKB Versicherung a brand of Acredia Versicherung AG at We agree to Acredia Versicherung AG using our data when sending product and customer information. We can revoke our agreement at any time in writing. All information received by Acredia Versicherung AG about customers or third parties will be treated as strictly confidential. We obtain this information without any obligation to Acredia Versicherung AG. We therefore waive any claims that we may have against Acredia Versicherung AG as a result of such confidential communications. We agree to indemnify Acredia Versicherung AG against any claims by third parties who may become aware of such confidential information. Place and date Administrator Telephone Fax number address Applicant s authorised signature