1. ENQUIRER |
| 1.1 Details of
Enquirer |
Name
of Company(Indicate party on whose behalf enquiry
is being made ):
|
Contacts
Details (Name of contact person):
|
Email:
|
Tel:
|
Fax:
| |
Capacity
in which Enquiry is being made (indicate whether broker/ intermediary/
potential insured):
|
Principal's
Authority (applicable for brokers/ intermediaries - a letter
of appointment from the potential insured is required):
|
Transaction
for which insurance cover is requested (state whether it is an
equity investment; shareholder loan; commercial loan; loan guarantee;
mobile asset; trade in goods/services on open account, leasing etc.):
|
| 2. TYPE OF INSURANCE COVER REQUESTED |
| 2.1 Details of
Cover |
Amount and Currency of Cover Requested:
|
Tenor (indicate period for which
cover is requested in months/years):
|
Expected policy start date:
|
| Type
of Cover (tick below the type(s) of risk for which insurance cover is requested): |
|
| 3. TRANSACTION/ INVESTMENT PARAMETERS |
| 3.1 Details of
Party to be Insured |
Name:
|
Country:
|
Legal Form (indicate
whether natural person, private, public listed, sub-sovereign, parastatal,
other;);
|
Nature of Business
|
| 3.2 Details of
Risk Counterparty/ Project Enterprise |
Name:
|
Country:
|
Legal
Form (indicate whether natural person, private, public
listed, sub-sovereign, parastatal, other;);
|
Nature
of Business
|
| 3.3 Details of the Transaction/Project |
Insured Transaction/Project (Brief
description):
|
Value and Currency of Transaction/Project:
|
Transaction/Project
Type (state
whether it is a supplier credit, buyer credit, supply agreement,
leases agreement etc.):
|
Contract
Terms & Conditions (if applicable, please provide
details of contract/draft loan term sheet):
|
Terms and Method of Payment:
|
Transit Countries (if applicable):
|
Specific Comments (if necessary,
please provide additional comments not captured in this enquiry form):
|
How did you get to know
about ATI:
|
|
