Enquiry Form – African Trade Insurance

Confidentiality / Authorisation for Limited Disclosure

All information contained in this Enquiry Form will be treated by ATI as confidential material. However, ATI may be required to disclose the documentation or information contained therein, or attached thereto, to its professional advisors, law enforcement or regulatory authorities, its facility brokers and insurance partners as there may be from time to time, and their reinsurers, it being further understood that this information will only be disclosed by ATI on the basis of each recipients(s) acknowledging to observe similar obligations of confidentiality in respect of that information. The Enquirer understands and hereby agrees that, by submitting this Enquiry Form, its attachments and any additional information to be submitted by the Enquirer at a later stage, the Enquirer has expressly authorised ATI to disclose the documentation or information contained in the Enquiry form in the manner aforementioned.

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Step 1 of 4

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  • 1. ENQUIRER

  • (Indicate party [& legal form - private, public, other] on whose behalf enquiry is being made ):
  • (Name and address of contact person):
  • (indicate whether broker/ intermediary/ potential insured):
  • (applicable for brokers/ intermediaries - a letter of appointment from the potential insured is required)
  • (state whether it is an equity investment; shareholder loan; commercial loan; loan guarantee; mobile asset; trade in goods/services on open account, leasing etc.):

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