Application for Credit Limit Endorsement
1
Your Company Name - The Insured
2
Broker or Agent's Name
(if any)
3
Policy Number
Your Customer - The Buyer
4
Name of Buyer
(correct legal entity)
5
Trade or Business Name
6
Registration No.
(e.g.. ACN,ABN)
7
Postal Address
8
Post Code
9
Country
10
Telephone
11
Fax
*
=Use the currency unit the policy is denominated in.
12
Credit Limit Required
*
13
Existing Credit Limit
*
(if any)
14
Terms of Payment
(only if different from the endorsed Terms of Payment)
15
Orders on hand
16
Expected Date of Delivery
17
Contracts on Hand / Amount
*
/ Duration
18
Buyer is:
18a
New Account
Existing Customer
If buyer is existing customer answer the following questions in full:
18b
Pays Within
Days from
18c
Credit Allowed
*
Previous Experience: Traded for
18d
Years
18e
Months
Are you aware of any adverse nature affecting this buyer?
18f
Yes
If yes. Please comment
No
If yes. Please comment
18g
Outstandings
19
Amount Delivered / Dispatched not yet paid
(Aged)
Currency of Outstanding
Delivery Date
Due Date for Payment
Trade References
20
Name
Telephone No.
Contact Name
1
2
3
20a
Buyer's Bank & Address
General Comments
21
General Comments and other information you think may be helpful to assist us to provide the required cover
