企业短期出口信用保险

订单号码:201605261327362833

1.申请人基本信息 Basic Information of Applicant

公司中英文名称 Name of Applicant
企业注册号 Registration No.
成立日期 Date of Establishment
注册地址 Place of Incorporation
联系人 Contact Name
联系人职务 Position of Contact Person
电话 Telephone
传真 Fax
电邮地址 E-mail
企业性质 Type of Organization
投保业务类别 Business Nature
买方所属行业 Sectors Sold To
投保人关联企业信息 Details of Associated Companies
是否已有信用险保单 Any existing credit insurance cover
投保币种 (以下所提供的资料皆以此币种表示)Currency Required
(to be used for all information provided)
预计未来12个月的投保营业额Estimated Insurable Turnover of next 12 months

2.业务描述 Business Description

投保之产品或服务 Products/Services to be Covered
业务的特殊性 Business Particularity
合同中是否有物权保留条款 Is there retention of title clause in your contract
销售常用的付款方式Typical Payment Terms of Your Sales
否为买家提供较长赊账期 Do you allow long credit period

3.销售额 Turnover

最近三年销售记录
Turnover of Credit Sales for Latest 3 Years
财务年度 Financial Year 国内贸易 Domestic 出口贸易 Export
1 2 3
1 2 3
1 2 3

对争议解决方式的选择

上一财年出口销售组成
Breakdowns of Export Credit Sales for Last Financial Year
现金交易占比 Percentage of Cash Transactions
信用证交易占比 Percentage of L/C Transactions
关联交易占比 Percentage of Associated Transactions
赊账交易占比 Percentage of O/A Transactions
托收交易占比 Percentage of DP&DA Transactions
合计 Total
预计2016年所须投保的信用销售总额(按国别分类)
Forecasted Insurable Credit Sales Turnover in 2015(By Country)
国别
Country
年销售额
Annual Turnover
赊账期内最高的曝险赊销金额
Highest Credit Amount in Credit Period
买家个数
Number of Buyers
付款方式
Payment Terms
1 2 3 4 5
1 2 3 4 5

4.应收账款余额分布 Distribution of A/R of Debtors

截止日期As of:
内贸 Domestic 出口 Export
未偿债务总额
Total Outstanding
债务人数量
No. of Buyers
未偿债务
Amount Outstanding
债务人数量
No. of Buyers
未偿债务总额
Total Outstanding
1-10,000
10,001-20,000
20,001-50,000
50,001-100,000
100,001-500,000
500,001-1,000,000
1,000,001-5,000,000
5,000,000-∞
总计Total

5.账龄及坏账分析 Breakdown of Debt Ages

截止日期As of:
内贸
Domestic
企业销售变现天数
Days sales outstanding (DSO)
出口
Export
金额
Amount
占比
Percentage
账龄
Credit Period
金额
Amount
占比
Percentage
未到期
Current
超期01-30天
Overdue 01-30days
超期31-60天
Overdue 31-60days
超期61-90天
Overdue 61-90days
超期>90天
Overdue> 120days
总计Total

Please provide details of customers that are 31+ days overdue or giving cause for concern

如有买方逾期31天以上,请提供以下详细信息

买方名称/国家
Buyer Name/Country
总账款余额
Total Debt Outstanding
逾期账款
Overdue debt
最早到期日
Due Date
已执行的催收方案
Action taken
1 2 3 4 5
坏账分析
财务年度
Financial Year
坏账损失总计
Total Bad Debt
最大的单个坏账损失金额(人民币)
Largest Single Bad Debt Loss
坏账损失的个数
Number of Bad Debts
成功追回款项
Amounts Recovered
1 2 3 4 5
过去三年中三笔最大的呆坏账详情
Details of 3 Largest Bad Debts Over the Past Three Years
债务人 (姓名及地址)
Debtor(Name and Address)
年份
Year
国家
Country
付款条件
Payment Terms
坏账原因
Reason of Bad Debts
坏账金额
Amount of Bad Debts
处理现状
Status
1 2 3 4 5 6 7

6.投保的前十大买家(按赊销额) Top 10 Buyers to be Covered(by Credit Sales Turnover)

名称
Customer Name
地址
Address
国别
Country
付款方式
Payment Terms
年赊销金额
Annual Credit Amount
信用限额需求**
Limit Requested
1 2 3 4 5 6
是否同意保险公司联系买家并透露投保人名字 Agree the Insurance company to contact the buyer and disclose your company name

信用限额需求可设定为单个买家最高曝险金额,具体可以未来一年内该买家的最高应收账款额为参考

Credit limit is usually set as the maximum exposure towards each single buyer, with the maximum aggregate A/R outstanding towards each buyer being a good reference.

7.公司信用管理 In-house Credit Management

何时开具发票? When are invoices issued?
货物发送日后Day after despatch/delivery
其它 – 请注明何时 Other – please state when
负责信用风险控制和管理人员的详细资料
Details of all staff with responsibility for credit risk management and control
职务 Job Title 职责范围 Responsibility 授权等级 Level of Authority
1 2 3
是否每个客户都被授予内部信用额度? Is each customer allocated an internal credit limit?
如果以上回答为“是”,请提供内部信用额度审批所依据信息的主要获取渠道(如付款表现,企业年报,实地拜访等),并陈述针对新买方/已有买方如何应用。Please provide details on a separate sheet of all information sources (payment performance, annual accounts, visits, etc.) used in setting internal credit limits. Please advice from what level they are used for new / existing customers.
1
应收帐款如何催收?
How are debts collected?
是Yes
/ 否No
自到期日至采取行动日的天数
By what day from due date?
到期日前致电客户
Telephone calls BEFORE due date
到期日后致电客户
Telephone calls AFTER due date
催收信函
Chasing letters
暂停发货
Deliveries suspended
实地拜访
Visits
委托追帐公司
Debt collectors
诉诸法律手段
Legal action
其它 – 请详述
Others – please specify

8. 争议处理 Settlement of Disputes

本保险合同项下的争议解决方式:

According to Policy Article 5.08, the Insured and CPIC need to choose either of the following dispute resolution mechanism for settlement of disputes under this insurance:

5.08 因履行本保险合同发生的争议,由被保险人和保险人友好协商解决,协商不成的,提交 仲裁委员会仲裁;

All disputes arising from the performance of this insurance shall be resolved by the Insured and CPIC through friendly negotiation. If a dispute

cannot be settled through friendly negotiation, it shall be submitted to Arbitration Commission for arbitration.

9.投保人申明 Declaration

本公司在此申明,本投保单及其附件中所提供的信息均属实无误,且构成与保险人签订的正式保单的基础。本公司承担在正式保单生效前向保险人告知任何重要信息变更的义务。

本公司理解,除非之后的正式保单开始生效,否则本投保单对双方都不具约束力。以下签名为本公司授权人,代表本公司签订本投保单。

We declare that the information given is to the best of our knowledge true and accurate and that this proposal form and any attaching information form the basis of the insurance policy between us and CPIC. We undertake to advice of any change to a material fact prior to completion of this insurance policy. We understand that signing this proposal form does not bind us unless an insurance policy is subsequently incepted. The signature below is that of an individual who is authorised to sign on behalf of the company in this capacity.

我已仔细阅读并同意以上申明及《保险条款》