ࡱ>  r`bjbj m&DDDDDDD$h P\hj` P4_83PA&=&c$xhpD__DD$>DDDDD PիAi XD& &:0jj&PPLPD8:Q4Xjhhh hhh hhhDDDDDD  Application Supply of Capital Equipment / Services Before answering these questions, please consult the explanatory notes at the end of this form. In certain cases you may be required to complete an environmental impact assessment form. See the relevant form.  Other application forms can be downloaded from:  HYPERLINK http://www.atradius.nl/dutchstatebusiness www.atradius.nl/dutchstatebusiness (Use the correct application form for your transaction)  The processing of your application by Atradius: After we have received your application, we will send you an acknowledgement of receipt. If Atradius lacks financial information or has inadequate financial information about your buyer, we will take steps to gather such information. If we lack financial information or have inadequate financial information of you or your guarantor for recourse obligations, we will ask you to send us such information. As soon as we have the necessary information at our disposal (see points 2 and 3), we will be able to process your application. While your application is being processed, we will keep you informed regularly about the current progress. You will be required to pay the following costs in connection with the processing of your application (barring possible changes). Contribution towards the cost of gathering information: a maximum of 120 Commission for the issue of a promise of cover: 0.05 per cent of the maximum indemnification payable, subject to a minimum of 150 and a maximum of 1,500 Cost of issuing a policy: 0,5% of the maximum liability with a minimum of 150 and a maximum of 3,000.  1. The Applicant a. Name of the applicant, as listed in the Trade Register: FORMTEXT       b. Full address (including post code): FORMTEXT       c. Address for correspondence (P.O. Box and post code): FORMTEXT       d. Bank giro account number and name of bank: FORMTEXT       e. Group of which the applicant is part: FORMTEXT      f. Name and position of applicant's contact: FORMTEXT      Telephone: FORMTEXT      Fax: FORMTEXT      E-mail: FORMTEXT      g. Name and address of insurance intermediary: (if involved) FORMTEXT       2. The Buyer(It is advisable to send with this form any (business) information which you have about the buyer (e.g. annual reports). Name of the buyer in respect of whom you are running a non-payment risk: FORMTEXT       Address and country of the buyer: FORMTEXT      Telephone: FORMTEXT      Fax: FORMTEXT      E-mail: FORMTEXT      Is the buyer a public body? FORMCHECKBOX  Yes  FORMCHECKBOX  No Name and address of the buyer 's bank: FORMTEXT       Have you concluded transactions with this buyer previously? (see explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMTEXT      Have all payments in respect of these transactions taken place on time? FORMCHECKBOX  Yes  FORMCHECKBOX  No  (If not, please explain) FORMTEXT       What has been your general experience of this buyer in the past? FORMTEXT       3. The Contract (See explanatory notes)Has the contract with the buyer in respect of whom you are running a non-payment risk already taken effect? (See also question 10a) FORMCHECKBOX  Yes  FORMCHECKBOX  No Date:  FORMTEXT       FORMTEXT       Have you already experienced unforeseen circumstances when carrying out the preparation for the work? (See explanatory note)  FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf the contract with the buyer in respect of whom you are running a non-payment risk is to be or has been concluded by a third party, what is his name and address? FORMTEXT      Where applicable, the information requested below should relate to the contract between the third party stated and the buyer. Please give further particulars of the contract between you and that third party in an annex. (E.g. the composition of your cost price)If you are not running a non-payment risk in respect of the full amount, how large is the part in respect of which you are at risk? FORMTEXT .... % of the contract price with the buyer Who are the other parties running a non-payment risk in respect of the buyer?Name: FORMTEXT      Country: FORMTEXT      for: FORMTEXT      %Name: FORMTEXT      Country: FORMTEXT      for: FORMTEXT      %Name: FORMTEXT      Country: FORMTEXT      for: FORMTEXT      % Description of the goods to be supplied to the buyer:capital equipment: FORMTEXT       services: FORMTEXT       Are the capital equipment / services manufactured / provided entirely by you? FORMCHECKBOX  Yes  FORMCHECKBOX  No (If not, please explain) FORMTEXT      What is the destination of the capital equipment / services? FORMTEXT       4. Delivery (See explanatory notes)Where and how does transfer of title take place under the contract? with regard to the capital equipment: FORMTEXT       with regard to the services: FORMTEXT       Does the contract contain provisions for delivery to take place all at once or in parts? with regard to the capital equipment: FORMTEXT       with regard to the services: FORMTEXT       Latest dates by which delivery must be made under the contract? with regard to the capital equipment: FORMTEXT       with regard to the services: FORMTEXT       In the event of force majeure, is the delivery period to be extended indefinitely under the contract? FORMCHECKBOX  Yes  FORMCHECKBOX  No(If not, what arrangement has been made?) FORMTEXT       Please attach the force majeure provisions or send them to us for assessment as soon as possible. Does the delivery represent an extension of or a change to an existing project or part of a new project? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, please give a description of the project: FORMTEXT       5. Price What is the contract price agreed with the buyer? with regard to the capital equipment: FORMTEXT       with regard to the services: FORMTEXT       Does the contract provide for the price to be adjusted to take account of rises in wages and/or prices ? (See also question 6) FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, please explain: FORMTEXT       Does the contract contain a provision for payment of work carried out over and above the terms of the contract? (See also question 6d) FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, please explain: FORMTEXT      Does the contract price include substantial development costs and/or licences? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, what percentage of the contract price relates to these costs? FORMTEXT       % What will be the proceeds of the finished goods if they are sold to third parties, if you do not proceed to delivery to the buyer? FORMTEXT       6. Payment In what instalments and on what dates must the contract price be paid? with regard to the capital equipment: FORMTEXT       with regard to the services: FORMTEXT       In what currency and to what place must the agreed contract price be paid? (If relevant, please indicate what exchange rate should be contractually applied):Currency:  FORMTEXT      Place:  FORMTEXT       Has a legally valid conversion / transfer licence been obtained for currency that is non-transferable, either in whole or in part? FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, do you require cover for the transfer risk in narrow terms?  FORMTEXT        If so, for what part of the contract price? (See explanatory note)   FORMTEXT       In what instalments and on what dates must the amount that results from rises in wages and/or prices be paid? FORMTEXT      In what instalments and on what dates must the price for the work carried out over and above the terms of the contract be paid? FORMTEXT      Do you charge interest separately to the buyer until the due date? FORMCHECKBOX  Yes  FORMCHECKBOX  NoWhat interest rate has been agreed? FORMTEXT .... % per year, chargeable from  FORMTEXT ....(date)Is interest calculated in each case on the total outstanding amount, as a result of which the interest payments decrease?  FORMCHECKBOX  Yes  FORMCHECKBOX  No (If not, please explain) FORMTEXT      On what dates must the interest payments be made? FORMTEXT      Is the buyer contractually obliged to pay interest on arrears? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, at what percentage per year? FORMTEXT       %Are you liable to tax in the country of the buyer on the interest paid by the buyer? FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf so, at what percentage per year? FORMTEXT       %  7. SecurityDo you require security for the payment? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  NoWhat form does the security take ? (e.g. guarantees, letter of credit, mortgage, retention of title) FORMTEXT       c. What parts of the contract price are covered by the above-mentioned security? FORMTEXT       d. When must this security be provided? FORMTEXT       e. Name and address of the parties providing the above-mentioned security: FORMTEXT       8. Composition of cost priceWhat is the maximum cost price of all capital equipment and other services not originating from the Netherlands? (See explanatory note) FORMTEXT       What proportion of this cost price relates to: 1. local expenditure: FORMTEXT       2. raw materials and semi-manufactures: (not obtained from the debtor's country) FORMTEXT       3. other capital equipment and/or services: (not obtained from the debtor's country) FORMTEXT       4. Commission and/or other fees to be paid: (in the Netherlands and abroad) FORMTEXT       c. What is the net profit? FORMTEXT       What proportion of the contract price represents commission and/or other fees and what is the nature of these commission / fees? FORMTEXT      Name, address and position of the party to whom commission / fees must be paid by you: FORMTEXT       On what date(s) must the commission / fees be paid? FORMTEXT       Are you bound to pay the commission / fees in all circumstances, e.g. including if the buyer does not pay? FORMCHECKBOX  Yes  FORMCHECKBOX  No If not, what arrangement has been made? FORMTEXT       9. Requested cover Do you require partially or fully to transfer the part not insured by Atradius (own risk)? FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, what part and to whom? FORMTEXT       Do you require a promise for the issue of Direct Guarantees to your lender for: - bills of exchange or promissory notes to be discounted by him? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  No - advances to be paid by him under a letter of credit? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  No Does your buyer require you to provide one or more bank guarantees under the contract? (See question 9f) FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, what guarantees: FORMTEXT       Do you require these guarantees to be insured by Atradius as well? (Supplementary Cover) (See explanatory note) (Questions 9e and 9f also relate to this point). FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf you require Supplementary Cover, you should complete the following table. Type of guaranteeAmountDuration in monthsFromMovement*Advance-payment bond FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN Performance bond FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN Maintenance bond FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN *Linear / Progressive / RegressiveDoes your bank require a Counter-guarantee from Atradius for the guarantees mentioned above? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  NoWhich cover do you require? FORMCHECKBOX  political and commercial  FORMCHECKBOX  political only  FORMCHECKBOX  commercial only Do you require cover for FORMCHECKBOX  the manufacturing and the credit riks  FORMCHECKBOX  the credit risk only 10. Other particulars a. The application relates to: (See explanatory note) FORMCHECKBOX  a Promise of Cover (if the contract has not yet taken effect). FORMCHECKBOX  an Insurance Contract (if the contract has already taken effect). FORMCHECKBOX  a pro forma application to support the application to the lending bank. If a Promise of Cover has already been given for this transaction, what is its number? FORMTEXT      Will a bank provide a loan to the buyer in connection with this transaction? (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  No Is it the intention that this loan be insured by Atradius by means of a Buyer Credit Policy? FORMCHECKBOX  Yes  FORMCHECKBOX  No (If so, your bank should also submit an application to us as soon as possible) If particulars of any loan do not come to your attention until at a later stage, would you please let us know without delay. (See also the third indent under "Signature" below!)Has an application for a grant, aid financing or any other subsidy been submitted to the Dutch Government for this transaction, or will one be submitted, for the purpose of paying the purchase price or the interest either in whole or in part or of reducing the contract interest payable?* (If so, for what proportion of the contract price, and what is its reference number? (See explanatory note) )   FORMCHECKBOX  Yes  FORMCHECKBOX  No Amount:  FORMTEXT       Reference number:  FORMTEXT       Do you object to consultation with foreign credit insurers and/or authorities which are competent in matters of credit insurance? FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, please explain. See explanatory note FORMTEXT       Are you aware that in connection with the contract to which this application relates any payment or donation has or will be given or offered; any pledge has or will be made; any service has or will be performed or offered; any benefit of whatever nature (including intangible benefits and benefits in kind) has or will be awarded, pledged or offered, by you or by another person to persons who are in the public service of a foreign state or public international body, whether or not this is dependent on the fulfilment of a further condition or conditions, which payment, donation, pledge, service or benefit could be interpreted in such a way that bribery or attempted bribery has taken place or will take place, or at least that an attempt has or will be made in an improper manner to obtain a competitive advantage, a better negotiating position, more favourable contract terms, or any other benefit?  (See explanatory note) FORMCHECKBOX  Yes  FORMCHECKBOX  NoAre there any facts or circumstances about which information has not been requested specifically above, but that may be relevant to an assessment of the application by Atradius? FORMCHECKBOX  Yes  FORMCHECKBOX  No (If so, please explain. See explanatory note) FORMTEXT       11. Signature(If the application form is not completed properly or in full, this may result in unnecessary delay in processing the application and may negate the Promise of Cover or the Insurance Contract. See explanatory note)The undersigned declares:that the questions in this form have been answered correctly and completely and that no circumstances of importance to Atradius have been concealed;that the information provided in this application form gives a true and complete picture of the non-payment risks involved in this transaction, as known to him at the time of submission of this application;that he will notify Atradius without delay in writing of any fact or circumstances which become known to him after the submission of this application and which may be relevant for Atradiuss assessment of the application; (See explanatory note) that in connection with the awarding and the performance of the contract to which this application relates he will at all times refrain from bribery as referred to in question 10f of the application form and the explanatory note thereto and from inciting or being an accessory to such bribery;that he has taken note of the OECD Guidelines for Multinational Enterprises and will endeavour to apply these in his business to the best of his ability. (See explanatory note) If questions 9b, 9f or 10c are answered Yes, Atradius should be supplied with the fullest possible financial information about your business or guarantor, including annual reports for the last three years.Place/ Town: FORMTEXT      Date: FORMTEXT      Name: FORMTEXT      Signature: FORMTEXT      The officer who signs this application should be competent to commit the applicant to at least amounts of the same order of magnitude as the amount of the transaction to be insured.If your application results in a policy being issued, Atradius will publish certain information about your transaction on its web site one month after the date of issue of the policy. (See explanatory note)  Explanatory notes to the questions on the application form entitled "Supply of Capital Equipment / Services" Processing of your application by AtradiusIf in the case of an application for a promise of cover by an exporter it is clear that the buyer credit will be provided and the identity of the lending bank is not known at that stage, a promise of cover may be issued for the buyer credit risk in respect of the export transaction in addition to the promise of cover for the pre-credit and credit risk. This promise of cover in respect of the buyer credit will be issued to the exporter in the name of MTB Bank Y; MTB Bank Y is the notional name for a bank to be determined. Once the identity of the lending bank for the buyer is known, the bank concerned must submit an application for the loan. Following approval for this application, a policy will be issued to the bank concerned when the loan agreement enters into effect based upon the promise of cover to MTB Bank Y. Question 2e and g:When answering these questions you must also state the experiences of other group companies with the buyer of which you are aware, and/or your own experiences or experiences of other group companies of which you are aware with enterprises affiliated to the buyer.Question 3:An insurance contract (policy) may be applied for if a contract with the buyer has taken effect. A contract may have been signed but not yet have taken effect because it includes certain conditions precedent. In the absence of such conditions, the contract may generally be said to take effect on signing. In most cases, your application will relate to a contract which has not yet taken effect; in that case, your application relates to a promise of cover.Question 3aIt may be the case that during the preparation for or the performance of the work you have already experienced circumstances of which you are aware or suspect that they will or may hinder the performance of the work in some way and/or will or may lead to a substantial increase in the costs. If this is the case, you must declare these unforeseen circumstances.Question 3b, c and d:If you conclude a contract jointly with other companies or if you are working together with other companies, it is possible that the contract has been concluded not only at your expense and risk but at the expense and risk of more than one company. If that is the case, you should state in answer to question 3c what percentage of the contract price has been concluded at your expense and risk.Question 3e and f:If you are a subcontractor running a risk not in respect of your direct buyer but in respect of the person with whom your buyer concludes a contract, Atradius must know about all of the capital equipment or services which come under the overall contract with the ultimate buyer. You should therefore describe the overall contract in answer to the questions relating to price (see 5).Question 4a, b and c:You should describe here how and when transfer of title is to take place. This means the time when the capital equipment / services transfer to the legal ownership of the buyer. That may be when the capital equipment leaves the factory, the loading on to an ocean-going vessel or the receipt of a takeover certificate (all as set out in the contract). 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