Portfolio Of Credit Risks Quote – PCR | Political And Credit Risk Insurance Brokers

For a single credit risk quote – please fill in a different form: Single Credit Quote Form
For a political risk quote – please fill in a different form: Political Risk Quote Form

Your Company Information

Registered Company Name

Address

Country

Company registration number

VAT number

Sector

Detailed Business Description

Telephone Number

Email Address

Confirm Email Address

Name of Contact Person

Annual Sales Projection

Projected Annual Turnover - Domestic

Projected Annual Turnover - Export

Currency

Your Credit Control Function

Does your credit control operate from your mailing address?

Yes No

What are your normal payment terms?

Are your terms and due dates shown on your invoices?

Yes No

Are you always a contractual principal, i.e. a party legally entitled to take recovery action?

Yes No

How many days after the goods are delivered/services rendered do you issue an invoice?

How many days after due date do you chase the customer?

How many days after the due date do you put an account on stop?

When do you start legal action?

Please note that you are required, where applicable, to take all practicable measures to exercise your Retention of Title clause in every case.

Do you have an all-monies retention of title clause in your terms and conditions of sale?

Yes No

Do you incorporate those conditions into every contract of sale with your customer?

Yes No

If you have answered yes to this question you will only be insured for the risk of non-payment of debts where those conditions are incorporated into your sales contract.

Your Trading History

Insert total annual turnover and other metrics for the last three complete financial years, excluding cash sales, sales to associated and subsidiary companies, UK government and local authorities, sales made on letters of credit confirmed by a bank in the UK and Value Added Tax

Current Year

Previous Year

Year Before Previous

Your Total Sales

Total Number of Bad Debt Cases

Total Value of Bad Debts

Value of Largest Single Bad Debt

Debtor Analysis

Current amounts owing by your debtors listed by the value currently outstanding

Debtor range - number of debtors

Over 500,000

250,001-500,000

100,001-250,000

50,001-100,000

25,001-50,000

Combined value of debt by these debtors

Over 500,000

250,001-500,000

100,001-250,000

50,001-100,000

25,001-50,000

Debtor range - number of debtors

10,001-25,000

5,001-10,000

2,501-5,000

1,001-2,500

up to 1,000

TOTALS - Number of Debtors

Combined value of debt by these debtors

10,001-25,000

5,001-10,000

2,501-5,000

1,001-2,500

up to 1,000

TOTALS - Combined Value of Debt

Overdue Accounts

The value outstanding by the number of days overdue past the due date of payment at the current moment

1-30 days overdue

31-60 days overdue

61-90 days overdue

>90 days overdue

Key Customers

List your key customers and the credit limit required

Name of customer

Address

Ultimate Beneficial Owner(s) - UBO

We have one or more Ultimate Beneficial Owner(s) with an Interest in us of 25% or more. Details below

Why do we require details of the company’s ultimate beneficial owners?
Due to the regulations on the prevention of the use of the financial system for laundering of money, the financing of terrorism and the obligation
to adhere to sanction regulations, financial institutions are obliged to comply with national and international rules and regulations. As an insurance broker,
there is a regulatory requirement for us to identify the persons with whom we have a ‘relation’.

First name and surname

Address of UBO

Date of Birth of UBO

Ownership %

General Information

Number of years trading

Do you currently have credit insurance?

Yes No

Have you ever been refused a credit insurance policy or been refused the renewal of one?

Yes No

How did you hear about us?

Please specify

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.