Application Form
Whole Turnover Policy
1. Applicant:
Established:
Address:
Postnumber.:
City:
Country:
Contact Person:
Phone:
E-mail:
Comp. ID:
Web:
We hereby apply for credit insurance, from date:
Do the company export a) NO
b)Yes, since (date)
2. Description of the goods /services that you want to insure:
3. Estimate for the insured volume (in NOK) the nest 12 months, divided on different countries:
4. How large outstanding amount, at the same time, do the company anticipate it will get (in NOK) under the policy?
Credit Insurance application form
5. Fill in how many buyers the company anticipate it will have in each group below: (Outstanding amounts)
Below NOK 100.000:
Over NOK 100.000 up to NOK 1.000.000:
Over NOK 1.000.000 up to NOK 5.000.000:
Over NOK 5.000.000 up to NOK 50.000.000:
Over NOK 50.000.000:
6. What is the company’s standard terms of payment:
Average terms of payment is:
Days after delivery
Maximum terms of payment:
Days after delivery
7. List up the loss on receivables the company has experienced the last 5 years (amount, debtor and country):
8. Do the company make their own credit evaluation/check of the customers?
Do the company have special employees dedicated to follow up the receivables, send reminders, start debt collection
etc. or do the company buy this service from others?
Credit Insurance application form
9. Do the company want to have a form of deductible in the policy in order to reduce premium, or is it preferred to have as
high coverage as possible under the policy?
10. Please list up your 5-10 biggest customer with name, address, country, and maximum outstanding amount.
GIEK will use this information to make a pre-credit-check in order to see if we are able to insure you customers.
11. Other relevant information:
Credit Insurance application form
12. Corruption, money laundering etc.
We (the policyholder) herby confirm that we will respect the prohibition in the Norwegian Criminal Code §§ 135,
332-336, 337-341 og 387-388, jf. § 15. The provisions regulate corruption and more, against players in the public
and private sectors. We understand that any violation of this obligation would violate GIEK Kredittforsikring’s
insurance and could lead to rejection of payment of claims under the insurance contract.
We also acknowledge that suspicion of breach of the above criminal provisions may entail notice to Økokrim.
We accept
Place:
Date:
Signature:
Applying:
The Application form may be send by regular mail to
GIEK Kredittforsikring, postbox 1341 Vika, 0113 Oslo.
Or e-mail to: [email protected]
If you have any questions regarding the application form you may find contact data on all our employees on our website:
https://www.giekkreditt.no/KontaktAlleAnsatte/Menu/AlleAnsatte
or you may call our company at: +47 468 72 000.