Portfolio Of Credit Risks Quote

For a single credit risk quote – please fill in a different form: Single Credit Quote Form
For a political risk quote – please fill in a different form: Political Risk Quote Form

Your Company Information

Annual Sales Projection

Your Credit Control Function

Please note that you are required, where applicable, to take all practicable measures to exercise your Retention of Title clause in every case.

If you have answered yes to this question you will only be insured for the risk of non-payment of debts where those conditions are incorporated into your sales contract.

Your Trading History

Insert total annual turnover and other metrics for the last three complete financial years, excluding cash sales, sales to associated and subsidiary companies, UK government and local authorities, sales made on letters of credit confirmed by a bank in the UK and Value Added Tax

Current Year

Previous Year

Year Before Previous

Your Total Sales

Total Number of Bad Debt Cases

Total Value of Bad Debts

Value of Largest Single Bad Debt

Debtor Analysis

Current amounts owing by your debtors listed by the value currently outstanding

Debtor range - number of debtors

Combined value of debt by these debtors

Debtor range - number of debtors

Combined value of debt by these debtors

Overdue Accounts

The value outstanding by the number of days overdue past the due date of payment at the current moment

Key Customers

List your key customers and the credit limit required

Ultimate Beneficial Owner(s) - UBO

We have one or more Ultimate Beneficial Owner(s) with an Interest in us of 25% or more. Details below

Why do we require details of the company’s ultimate beneficial owners?
Due to the regulations on the prevention of the use of the financial system for laundering of money, the financing of terrorism and the obligation
to adhere to sanction regulations, financial institutions are obliged to comply with national and international rules and regulations. As an insurance broker,
there is a regulatory requirement for us to identify the persons with whom we have a ‘relation’.

General Information


The Applicant confirms that its statements in this Application are true and no material information has been withheld. The Applicant confirms that the existence of any policy issued will not be disclosed to the obligor(s) or any other third party other than our own professional advisors on a confidential basis or as required by law and except as may be permitted in accordance with the terms of any policy issued. The Applicant also confirms that it is aware that non-disclosure of any material information known to the insured may void the policy.
The Authorized Officer of the Applicant agrees that all information in this Application will be treated confidentially by the Applicant. Signing of this Application does not bind the Applicant to purchase the requested insurance. The Applicant hereby appoints Political And Credit Risks Ltd as our broker of record for the placement of any policy of which this Proposal Form forms the basis.