THE QUESTIONNAIRE FOR THE OFFER OF THE FACTORING
CONTRACT
Client:
Business activity:
Turnover 2017: CZK
mil
Turnover 2016: CZK
mil
Turnover 2015: CZK
mil
Expected turnover in the frame of factoring cooperation :
Czech Republic:
Slovak Republic:
Direct export:
Standard payment terms:
Actual payment period (in days):
Min. + max. invoice value:
Number od debtors:
Expected number of invoices:
Share of credit notes (in %):
Customers/Debtors
Outstanding amounts as at
/
/
Czech Rep
2017
Slovak Rep.
Export
TOTAL
Before maturity
Overdue to 30 days:
Overdue to 60 days:
Overdue to 90 days:
Overdue to 180 days:
More than 180 days:
TOTAL
Five biggest customers:
Name of the firm:
Five biggest customers:
% of the sales in 2016:
Name of the firm:
CSOB Factoring, a.s.
Praha 10, Vinohrady, PSC 101 00, Benesovska 2538/40; IC: 45794278
registered in the business register kept by the Municipal court in Praha, part B, enclosure 1647
% of the balance of
receivables as at
/
/ 2017
Bad debts analysis (in CZK):
Customers with capital
participation of the client:
Firms with capital or other
Participation of the client::
Is there by any customer, whose claims will be assigned:
1. The possibility of concentration more than 20% of the assigned claims?
2. Restriction on assignment?
Suppliers/Creditors
Obligations structure as at
/ 2017
/
CR/SR
Direct import
TOTAL
Maturity
Securities
Before maturity
Overdue to 30 days:
Overdue to 60 days:
Overdue to 90 days:
Overdue to 180 days:
More than 180 days:
TOTAL
Obligations towards financial authorities, healthcare and welfare execution:
Loans and banks – as at
Bank
/
Type of credit
/ 2017
Balance
Please enclose :
1. B/S and P/L for 2017 - actual, 2016, 2015 (copy passed on to Financial Authority including Tax return) +
Auditor’s report
2. List of customers (Name, IČO, seat, monthly turnover, payment terms, expected volume of outstanding
amounts in the top season)
3. The list of outstanding amounts according to customers/suppliers
4. History of the company, structure and organisation of the company, description of the product, market
position, business and finance plan for 2017
5. Copy of the Business Registration
Stamp + Signature
If necessary enclose another paper.
The outstanding amounts analysis, balance of outstanding amounts of biggest customers, structure of obligations and loans please
make to the same date.
CSOB Factoring, a.s.
Praha 10, Vinohrady, PSC 101 00, Benesovska 2538/40; IC: 45794278
registered in the business register kept by the Municipal court in Praha, part B, enclosure 1647