Credit Limit Request Form – Prisma Invest

PRISMA Die Kreditversicherung – a brand of Acredia Versicherung AG
Himmelpfortgasse 29, 1010 Vienna, Austria, Tel. +43 (0)5 01 02-0, Fax -2199, www.prisma-kredit.com
PR1SMA
Die Kreditversicherung.
Credit Limit Request Form – Prisma Invest
Please fill in this form and send or fax it back to PRISMA at +43 (0)5 01 02-2199. Please enter all amounts in EUR 1,000.
Just call +43 (0)5 01 02-2222 and we will be happy to assist you. All details will be treated in the strictest confidence.
for a quotation for single transaction cover
application for cover under Policy No. Company ......................................................................... Contact person.......................................................................
.......................................................................................... .................................................................................................
.......................................................................................... Phone...................................................................................... Address ........................................................................... Fax...........................................................................................
ZIP, city............................................................................. E-mail.......................................................................................
Complete company name (incl. legal form and address of your customer)
.................................................................................................................................................................................................
.................................................................................................................................................................................................
.................................................................................................................................................................................................
Your customer’s company bank
.................................................................................................................................................................................................
Is your customer an…?
end user
trading company
general contractor
Type of goods sold/services provided ..................................................................................................
series production
customized goods
Conditions of delivery
Commencement of deliveries...................................................
End of deliveries.......................................................................
Acceptance/commissioning.....................................................
Do you require cover for work in progress? Yes
No
Prime costs for manufacture/subcontracting
(excluding prepayments) ........................................................
Commencement of manufacture..............................................
End of manufacture..................................................................
Period of cover required commencement ...................... end........................................
Invoice currency.....................................................................................................................................................................
.
Invoice value/contract value (exclusive of VAT)
. . , - - Prepayments
. . , - = Remaining amount outstanding
. . , - + Interest (please give the amount)
. . , - = Insurable amount outstanding
. . , - Payment terms
.................................................................................................................................................................................................
.................................................................................................................................................................................................
.................................................................................................................................................................................................
Have you agreed any security instruments?
Type, amount, date issued, name and address of guarantor:
.................................................................................................................................................................................................
.................................................................................................................................................................................................
Has legally valid retention of title been agreed? Yes
No
Other conditions agreed with your customer
.................................................................................................................................................................................................
.................................................................................................................................................................................................
I have had a business relationship with the customer since............................................................................................. Turnover in the year before last
....................................................................................................................
Turnover last year
Turnover in current year
....................................................................................................................
Oldest invoice still outstanding
....................................................................................................................
Current outstandings
....................................................................................................................
....................................................................................................................
Were all payment obligations met on time without
prolongation of due date or payment delays?
Yes
No
Reclamation of goods in previous business:
.................................................................................................................................................................................................
.................................................................................................................................................................................................
We hereby authorize Acredia Versicherung AG to pass the information given here on to Acredia Services GmbH on our behalf and for
our account for the purpose of credit assessment. Acredia Services GmbH is entitled and obliged to communicate the results of this
assessment directly and exclusively to Acredia Versicherung AG only.
We hereby declare our agreement to the charging of a credit rating fee for credit assessment as per the rate stipulated in the Schedule
to Policy No. or alternatively in the amount of 1 ‰ of the limits requested (subject to a minimum
amount of EUR 100,- and a maximum of EUR 700,- plus VAT in each case).
This fee will be invoiced by Acredia Services GmbH. Receipt of the request by Acredia Versicherung AG shall be deemed to constitute
receipt by Acredia Services GmbH.
Date: Company Stamp and Signature: