Proposal-Form-2011(Updated)-V4

1 Short Term Domestic Credit Insurance Proposal Form 国内贸易短期信用保险投保单国内贸易短期信用保险投保单 We need the information requested in this form to establish the type of cover that we can offer you We will treat information you give in the strictest of confidence and will use it for the purpose of calculating an offer only 我们在此投保单上要求的信息是用于为您提供一个信用保险报价 对以下信息 我们将严格为您 保密 且仅将其用于计算报价 1 Your basic information 您的您的基本信息基本信息 Company Name 公司名称 Phone Number Fax Number Contact Person 电话 传真 联系人 Address Post Code 地址 邮编 Company Registration Number 公司工商注册号 Nature of Company 公司性质 Name of parent company if available 母公司名称 如果有 2 Your business 您的业务您的业务 What do you sell what services do you provide E g Manufacture and sales of computer Wholesale of clothing etc 贵公司销售什么货物 提供什么服务 例如 计算机生产与销售 服装批发等 What are the Maximum Normal terms of payment specified in contracts with your clients for domestic sales 在国内贸易中 您与买方在合同中约定的最长 通常付款期限是 通常付款期限 最长付款期限 Please further specify your detailed payment terms 请进一步说明不同的付款条件 L C Cash Payment in advance 信用 证 现金 预付款 1 45 days 赊销期限 1 45 天 45 90 days 赊销期限 45 90 天 90 180 days 赊销期限 90 180 天 Others please specify 其他 请说明 Total Sales amount 总营业金额 Corresponding Amount CNY 对应营业额 Percentage 占 2 比 3 Your business and bad debts situation in the last three years 您过去三年的业务及坏账情况您过去三年的业务及坏账情况 Currency in CNY 人民币 Next 12 months 未来 12 个月 Current Year 今年 Last Financial Year 去年 Previous Financial Year 前年 Period year end 年度 Total turnover including domestic and export sales 公司总营业额 Total export turnover 出口贸易营业额 Total non OA sales in domestic turnover 国内贸易营业额中的非赊销部分 Total insurable domestic turnover 全部可保营业额 国内赊销贸易 Please exclude sales to any associated companies private individuals and sole proprietorships sales to publicly owned buyers of P R China as the policy doesn t apply to such business 请扣除卖给关联公司 个人及个体工商户 政府及官方机构的营业额 因为此营业额不在保险合同 承保范围内 Net total bad debt losses amount 总净损失额 Number of bad debt losses 损失次数 Largest single bad debt loss 最高单次损失额 Details of Three Largest Bad Debts over the past three years 在过去三年中最大三笔坏账的详情 3 4 Your debtor profile Trial balance analyze current month figures as at year month date 应收账款情况应收账款情况 试算平衡表分析试算平衡表分析 当月当月 以下为以下为 年年 月月 日之数据日之数据 Note The purpose of Part 4 and Part 5 is to analyze your receivables at the chosen date from different angles therefore the total amount for these two parts shall be exactly identical If not please double check 说明说明 第 4 部分与第 5 部分意在从不同角度对相应截止日期的应收账款情况进行分析 因此 该两部分的总 计金额应完全相同 若否 请检查是否填写错误 Currency in CNY 人民币 Max Amount Outstanding 最高应收账款范围 Total amount owed in this range 此范围内应收账款数额 Percentage 百分比 Number in range 此范围内客户数量 Over 25 000 000 10 000 001 25 000 000 5 000 001 10 000 000 1 000 001 5 000 000 500 001 1 000 000 250 001 500 000 100 001 250 000 50 001 100 000 25 001 50 000 Below 25 000 Total 总计总计 5 Aged balance analysis current month figures as at year month date 目前逾期账款分析目前逾期账款分析 当月当月 以下为以下为 年年 月月 日之数据日之数据 Currency in CNY 人民币 Amount 金额Percentage 百分比 Numbers 客户数量 Current before due date Financial year 财务年度 Debtors Name and Address 坏账客户名称及地址 Amount of Loss 坏账损失金额 Original Due Day 最初付款到期日 Reason for loss 导致坏账的原因 Action taken and current situation 采取的措施及 目前解决情况 4 未到期应收账款 1 30 days after due date 应收账款到期 1 30 天 31 60 days after due date 应收账款到期 31 60 天 61 90 days after due date 应收账款到期 61 90 天 Over 90 days after due date 应收账款到期超过 90 天 Total 总计总计 6 Total trade debtor balance at quarterly end in the latest 12 months 您过去您过去 12 个月内每季度末客户应收账款余额个月内每季度末客户应收账款余额 31 March 三月 31 日 30 June 六月 30 日 30 September 九月 30 日 Total Trade Debtor balances at 各季度末客户应收账款总额 31 December 十二月 31 日 Average number of days from invoice date for which sales are outstanding DSO 平均应收帐款天数 7 Please could you rank your motivations for considering the purchase of Credit Insurance in order of importance Please input 1 4 1 most important 4 least important 请您注明贵公司考虑购买信用保险的主要原因请您注明贵公司考虑购买信用保险的主要原因 填入填入 1 4 1 最重要 最重要 4 最次要最次要 Risk Mitigation 规避风险 Financing Reasons 财务融资原因 Better information on our customers 更好了解买方信息 Improve our credit management 提高公司信用风险管理机制 8 Collections and security 催收及担保措施催收及担保措施 How many days after due date do you contact your customers 账款逾期多少天后您联系您的客户 5 by telephone 打电话 days 天 by letter 致函 days 天 by visit 面访 days 天 by stopping dispatch 停止出货 days 天 by debt collector 通过追账公司 days 天 Retention of title 货权保留 I Do all of your insured contracts incorporate an all monies Retention of Title clause 您所投保的合同下所卖出的货物都有约定货权保留条款吗 Yes 是No 否 Do you have any factoring or invoice discounting agreements or other security relating to any accounts 您的应收账款是否有作了保理 付款折扣或是其他担保的安排 Yes 是 No 否 Do you have any existing credit insurance policies 您是否现在有信用保险合同 Yes 有No 没有 If Yes please give brief details including current insurer renewal date etc 如果有 请给出简单信息 包括现保险人 续保日期等 9 Your credit management 您公司的信用风险管理您公司的信用风险管理 When do you raise your invoices e g X days after dispatch 您什么时间发出账单 例如在货物发送几天后 When do you send statements to your debtors 您什么时间给客户寄出对账单 How do you assess your buyers creditworthiness e g status reports trade experience 您如何评估买方的信用 例如 用信用报告 贸易经验等 Do you maintain and operate credit limits 您是否为客户建立信用额度 6 How often do you update your credit information 您多经常更新您的信用信息 Who in your company is responsible for your credit management policy 谁是公司信用管理政策的负责人 10 Your principal customers for pre checking you can also provide a separate excel file about these buyers 您主要的客户您主要的客户 信息将用于信用额度初审 您也可以使用另外的表格来提供相关信息信息将用于信用额度初审 您也可以使用另外的表格来提供相关信息 Currency in CNY 人民币 Company Name in Chinese and English if available 客户名称 若有英文名请注明 Address 地址 Annual turnover 年营业额 Terms of payment 付款条件 Applied Credit Limit 申请的信用额度 1 2 3 4 5 6 7 8 9 10 Your declaration 您的声明您的声明 I the undersigned and any joint applicants declare and warrant that the information and all attached documents provided herein is true and correct 本签字人及其他联合申请人声明并保证在此提供的信息及所附相关文档均真实准确 We undertake to make full disclosure of all material facts and circumstances in good faith where you could rely thereon 我们承诺如实充分地披露所有重要事实及事项 We acknowledge that all information disclosed to you would be used entirely by your discretion and purpose necessary for your effect