Single Credit Risk Quote – PCR | Political And Credit Risk Insurance Brokers

Your Company Information

Company Name

Country

Sector

Detailed Business Description

Telephone Number

Email Address

Confirm Email Address

Name of Contact Person

Exposure To Be Insured

Currency of Transaction

Size of Your Exposure Before Insurance

Type of Transaction

Tenor of Exposure (please specify days, months, years)

Name of Main Obligor

Main country of operations of the obligor

Address of the main obligor

Major shareholders and ownership of the main obligor

Main obligor's principal industry

Public rating of the obligor, if available ((long-term, foreign currency) Moody's, S&P, Fitch)

If applicable, any other obligor(s) involved in the transaction (guarantors, sureties, co-borrowers, etc.) and their principal activities

Explain the involvement of the other obligor(s) and how recourse to them is invoked in case of the main obligor's default

Are there any other third parties involved (e.g. offtakers, suppliers, collateral agents)? Please describe their role and provide their addresses.

Any other comments regarding the counterparties involved in the transaction?

Previous Experience of the Applicant Relevant to the Risk(s) To Be Insured

Does the Applicant have a previous experience of working with the obligor(s) and/or in the country of risk

Yes No

if yes, please describe

How long has the Applicant had a working relationship with the obligor(s) and other parties in the transaction?

Has the Applicant or their affiliates ever experienced a loss in working with the obligor(s) and/or in the country of risks? If yes, please describe

Is the Applicant aware of any issues with the obligor(s) or in the country of risk which may give rise to a claim under the policy? If yes, please describe

Please provide full details of any material problems with working with obligor(s) and/or in the country of risk previously.

The Applicant represents that to the best of its knowledge and belief (Please check all that apply)

No obligor(s) has defaulted on any senior obligations in the course of the last five years (if this is not the case, please provide details below)

The obligor(s) have met their obligations within max of 90 days of due dates in the last five years (if not, please provide details below):

Any repayment difficulties have not lead to a rescheduling of the debts of the obligor(s), in the last five years (if not, please provide details below):

Repayment difficulties if any

Type of Insurance Cover Sought

Type of insurance (please tick one)

Comprehensive non-payment insurance

Non-performance insurance

Sovereign default cover

Unfair calling of a guarantee by a beneficiary

Political risk insurance only (PRI)

Amount of cover requested by the Applicant

Indemnity percentage, X% of total exposure

Period of cover requested (e.g. 12 months starting until inclusive)

Please describe any material events that may have occurred since the start of the transaction and the reason for the Applicant's interest to use the insurance market to reduce its existing exposure

Please provide any other comments relating to the insurance coverage sought

Supporting documents for the underlying transaction (jpg, pdf, txt files only)

Declaration

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.