Proposal-Form-2011(Updated)-V4

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1、 . . . . Short-Term Domestic Credit Insurance Proposal Form国贸易短期信用保险投保单We need the information requested in this form to establish the type of cover that we can offer you. We will treat information you give in the strictest of confidence and will use it for the purpose of calculating an offer only.

2、我们在此投保单上要求的信息是用于为您提供一个信用保险报价。 对以下信息，我们将严格为您，且仅将其用于计算报价。1. Your basic information 您的基本信息Company Name公司名称Phone Number/ Fax Number/ Contact Person / 联系人Address / Post Code地址 /Company Registration Number公司工商注册号Nature of Company公司性质Name of parent company, if available母公司名称，如果有2. Your business 您的业务What do

3、 you sell /what services do you provide? (E.g. Manufacture and sales of computer / Wholesale of clothing etc.)贵公司销售什么货物/ 提供什么服务？(例如：计算机生产与销售；服装批发等)What are the Maximum /Normal terms of payment specified in contracts with your clients for domestic sales?在国贸易中，您与买方在合同中约定的最长/通常付款期限是？通常付款期限：最长付款期限：Pleas

4、e further specify your detailed payment terms. 请进一步说明不同的付款条件L/C/Cash/Payment in advance 信用证/现金/预付款1-45 days 赊销期限1-45天45-90 days 赊销期限45-90天90-180 days赊销期限90-180天Others, please specify 其他， 请说明Total Sales amount总营业金额Corresponding Amount (CNY) 对应营业额Percentage占比3. Your business and bad-debts situation in

5、 the last three years 您过去三年的业务与坏账情况Currency in CNY / 人民币Next 12 months未来12个月Current Year今年Last Financial Year去年Previous Financial Year前年Period (year end) 年度Total turnover including domestic and export sales公司总营业额Total export turnover出口贸易营业额Total non-OA sales in domestic turnover国贸易营业额中的非赊销部分Total in

6、surable domestic turnover*全部可保营业额(国赊销贸易)*Please exclude sales to any associated companies/ private individuals and sole proprietorships/ sales to publicly owned buyers of P.R.China,as the policy doesnt apply to such business.请扣除卖给关联公司/个人与个体工商户/政府与官方机构的营业额，因为此营业额不在保险合同承保围。Net totalbad-debt losses amo

7、unt总净损失额Number of bad-debt losses 损失次数Largest single bad-debt loss*最高单次损失额Details of Three Largest Bad Debts over the past three years在过去三年中最大三笔坏账的详情Financial year财务年度Debtors (Name and Address) 坏账客户名称与地址Amount of Loss坏账损失金额Original Due Day 最初付款到期日Reason for loss 导致坏账的原因Action taken and current situa

8、tion采取的措施与目前解决情况4. Your debtor profile / Trial balance analyze current month(figures as at_year_month_date)应收账款情况/ 试算平衡表分析当月 (以下为_年_月_日之数据)Note: The purpose of Part 4 and Part 5 is to analyze your receivables at the chosen date from different angles, therefore, the total amount for these two parts s

9、hall be exactly identical. If not, please double check.说明:第4部分与第5部分意在从不同角度对相应截止日期的应收账款情况进行分析，因此，该两部分的总计金额应完全相同。若否，请检查是否填写错误。Currency in CNY / 人民币Max.Amount Outstanding最高应收账款围Total amount owed in this range 此围应收账款数额Percentage百分比%Number in range 此围客户数量Over 25,000,00010,000,001 -25,000,0005,000,001 -10

10、,000,0001,000,001 -5,000,000500,001- 1,000,000250,001 -500,000100,001 -250,00050,001 100,00025,001 50,000Below 25,000Total总计5. Aged balance analysis current month (figures as at_year_month_date)目前逾期账款分析 当月 (以下为_年_月_日之数据)Currency in CNY / 人民币Amount 金额Percentage百分比%Numbers客户数量Current (before due date)

11、未到期应收账款1 -30 days after due date应收账款到期1-30 天31 -60 days after due date应收账款到期31 -60 天61 -90 days after due date应收账款到期61-90 天Over 90 days after due date应收账款到期超过90 天Total 总计6. Total trade debtor balance at quarterly end in the latest 12 months您过去12个月每季度末客户应收账款余额Total Trade Debtor balances at 各季度末客户应收账款

12、总额31 March 三月31日30 June 六月30 日30 September 九月30 日31 December 十二月31 日Average number of days, from invoice date, for which sales are outstanding (DSO) 平均应收帐款天数7. Please could you rank your motivations for considering the purchase of Credit Insurance in order of importance?(Please input 1-4, 1=most imp

13、ortant, 4=least important)请您注明贵公司考虑购买信用保险的主要原因 (填入1-4，1 最重要，4 最次要)Risk Mitigation规避风险Financing Reasons财务融资原因Better information on our customers更好了解买方信息Improve our credit management提高公司信用风险管理机制8. Collections and security 催收与担保措施How many days after due date do you contact your customers?账款逾期多少天后您联系您的客

14、户？by telephone 打days天by letter 致函days天by visit 面访days天by stopping dispatch停止出货days天by debt collector通过追账公司days天Retention of title 货权保留I Do all of your insured contracts incorporate an ”all monies ”Retention of Title clause?您所投保的合同下所卖出的货物都有约定货权保留条款吗？Yes 是No 否Do you have any factoring or invoice disco

15、unting agreements or other security relating to any accounts?您的应收账款是否有作了保理，付款折扣或是其他担保的安排？Yes 是No 否Do you have any existing credit insurance policies?您是否现在有信用保险合同？Yes 有No 没有If Yes please give brief details (including current insurer, renewal date, etc.)如果有，请给出简单信息（包括现保险人，续保日期等）9. Your credit manageme

16、nt 您公司的信用风险管理When do you raise your invoices?e.g. “X days after dispatch”您什么时间发出账单？ 例如在货物发送几天后？When do you send statements to your debtors?您什么时间给客户寄出对账单？How do you assess your buyers creditworthiness? e.g. status reports, trade experience 您如何评估买方的信用？ 例如：用信用报告，贸易经验等Do you maintain and operate credit

17、limits?您是否为客户建立信用额度？How often do you update your credit information?您多经常更新您的信用信息？Who in your company is responsible for your credit management policy?谁是公司信用管理政策的负责人？NamePosition 职位10. Your principal customers (for pre-checking you can also provide a separate excel file about these buyers) 您主要的客户 ( 信

18、息将用于信用额度初审，您也可以使用另外的表格来提供相关信息)Currency in CNY / 人民币Company Name in Chinese and English (if available) 客户名称 (若有英文名请注明)Address地址Annual turnover年营业额Terms of payment付款条件Applied Credit Limit申请的信用额度 1 23 4 5 6 7 8 9 10 Your declaration 您的声明I, the undersigned and any joint applicants, declare and warrant t

19、hat the information and all attached documents provided herein is true and correct.本签字人与其他联合申请人声明并保证在此提供的信息与所附相关文档均真实准确。We undertake to make full disclosure of all material facts and circumstances in good faith where you could rely thereon.我们承诺如实充分地披露所有重要事实与事项。We acknowledge that all information dis

20、closed to you would be used entirely by your discretion and purpose necessary for your effective risk assessment.我们认可所有披露的信息将完全由作有效风险评估自主使用。We have read and understand the companys Short Term Domestic Trade Credit Insurance clause and extensions (including the Exclusions and the applicants or insure

21、ds Obligations).我们声明对国贸易短期信用保险条款与附加险条款（包括责任免除和投保人与被保险人义务部分）的容与说明已经了解。Our disclosure and warranty does not disclaim your right or any liability against us. We acknowledged and agreed that this application form will be binding and accepted as part of the contract, in addition to any other documents issued to us, upon the inception of the policy.我们对信息的披露与保证不会免除对本公司的权利或义务。我们承认并同意在保单生效后，此投保单具有约束力，并将连同其他签发的文件共同作为合同的一部分。Signature签名:Date日期:7 / 7