Policy Application - Bank Master Policy

Applicant Details Applicant Business Details Trade Finance Business Declaration

Applicant Details

Contact Person(s)*

Action	Add	Name	Position	Email ID	Mobile No.
	Add

The Main Shareholders*

Action	Add	Name	Nationality	% of Subscription
	Add

Insurance Terms Requested

Business Details

Date of Incorporation *		Legal Status of the Company *
Paid up Capital * (USD)		Date of Commencing Business

Is the Applicant located in Free Zone?

No Yes

Is the Applicant part of a group, Please state

No Yes

Sector *

Sub Sector

Brief On the Business Activities

Trade Finance Business

Experience of the Applicant in export finance business(in Years)
Average annual sales for export finance business	(USD)

Expected business turnover for the coming 12 months for export/import finance Business (Intended to be covered) *

Action	Add	Country	Expected export/import finance Business Turnover for coming 12 months(USD)
	Add

The Major Clients : (The clients on which you want to receive an indicative Limits, along with the Policy Offer) *

Action	Add	Client Name	Country	Address	Fiscal Code/VAT/Regn No.	Sales Turnover for last 12 month(USD)	Credit Limit Requested(USD)
	Add

Losses Incurred

Losses incurred during last 3 years

Action	Add	Clients Name	Country	Amount of Loss	Date of Loss	Reason of Non Payment
	Add

Applicant Experience with Credit Insurance

Are you currently insuring your credit business with any credit insurance provider?

No Yes

Did you obtain credit insurance in the past?

No Yes

File Attachment

Note: To select the file please click on Browse... button and to upload click on Add button
Please attach the following documents along with the application :
Copy of the applicant Commercial Registration Certificate *
Copy of membership of the Chamber of Commerce *
Three latest Annual Reports (or Audited Financial Statements) *
Brouchure on the Applicant and its activities (Bank Profile) *

Declaration of the Applicant

- We the applicant above, certify that the statement made and the information provided by us are true and we have not misrepresented or omitted any material information relevant to the policy or to the risk to be insured hereunder. We agree that such statements and information will form the basis of and will be incorporated in the policy. - We will not enter into any other additional credit insurance contract or indemnity without your written consent. - We agree that the truth of such statements and information and due performance of each liability on your part under the policy. - We are not aware of any circumtances relating to any particular bank or contract, which might adversely affect your decision to insure them. If such circumtances arise at any time, we will notify you immediately.
I Agree *