Application
Export Credit Guarantee
Other application forms can be downloaded from:

(Use the correct application form for your transaction)
The processing of your application by Atradius:
  1. After we have received your application and if the (prospective) insured is not you, wehave received a declaration of noobjection from the (prospective) insured against theissuing of an Export Credit Guarantee, we will send you an acknowledgement of receipt.
  2. If Atradius lacks financial information or has inadequate information about you or your refinancier, we will take steps to gather such information.
  3. The loan facility agent (also if you are the agent) also needs to complete an applicationform for the buyer’s credit cover.
  4. As soon as we have the necessary information at our disposal (see points 2and 3), we will be able to process your application.
  5. While your application is being processed, we will keep you regularly informed aboutthecurrent progress.

1. The Applicant
a.Name and number of the applicant, as listed in the Trade Register:
b.Full address (including post code):
c.Address for correspondence (P.O. Box and postal code):
d.International Bank Account Number (IBAN):
e.Group of which the applicant is part:
f.Name and position of applicant's contact:
Telephone: / Telefax: / Email:
g. / Name and address of insurance intermediary(if involved):
2. The Refinancier
(It is advisable to send with this form any (business) information which you have about the refinancier (e.g. annual reports).
a. / Name and number of the refinancier and proposed beneficiary of the Export Credit Guarantee, as listed in the Trade Register:
b. / Address and country of the refinancier:
c. / International Bank Account Number (IBAN):
d. / Name and position of refinancier's contact:
Telephone: / Telefax: / Email:
3. The Loan to be refinanced
a.Has Atradius issued a promise of cover or policy for the
loan (part of which) you want an Export Credit
Guaranteefor? / Yes No
If yes, what is the promise of cover or policy number?
If no, please provide details hereunder
Name of the Bank to be insured:
Name of the Borrower:
Currency and Loan amount:
Date of Application for buyer’s credit cover:
b. What amount (in principal) would you like the Export
Credit Guarantee to be issued for?
c.Would you require the Export Credit Guarantee to cover
the disbursement period as well? / Yes No
d.The refinancing will be effected through:
A transfer of the loan to the refinancier / Yes No
A separate refinancing agreement for the loan / Yes No
The issue of pfandbriefs by the Applicant / Yes No
4. Other particulars
a.Do you object to consultation with foreign credit insurers and/or authorities which are competent in matters of credit insurance?
(If so, please explain) / Yes No
b.Are there any facts or circumstances about which information has not been requested specifically above, but that may be relevant to an assessment of the application by
Atradius? / Yes No
(See explanatory note)
5. Signature
The undersigned declares:
- that the questions in this form have been answered correctly and completely and that no circumstances of importance for the assessment have been concealed;
- that the information provided in this application form gives a true and complete picture of the refinancing of this loan, as known to him at the time of submission of this
application;
- that he will notify Atradius without delay in writing of any fact or circumstances which become known to him after the submission of this application and which may be relevant for the State of the Netherlands assessment of the application;
- that, if Atradius is prepared to issue the Export Credit Guarantee, he will accept the
guarantee and will pay the premium for this;
- that he agrees that the Export Credit Guarantee will be governed by Dutch law and
thathe will refer all disputes to the judgement of a competent courtin Amsterdam,
except inthe case of appeal and/ or appeal in cassation;
Incomplete or inaccurate information in this form may result in a delay of processing the application. If, before issuing the guarantee, it appears that you were or should have been aware of not reported facts or circumstances which were relevant for the assessment of the application, this may result in immediate and full recourse against you.
Place/ Town:
Date:
Name:
Signature:
Place/ Town:
Date:
Name:
Signature:
Atradius
David Ricardostraat 1, Amsterdam
PO Box 8982
1006 JD Amsterdam, The Netherlands
/ Phone +31 (0)20 553 92693
e-mail / IBAN NL43 ABNA 0469 8010 50
BIC ABNANL2A
Trade register Amsterdam 33226495
Registered Atradius Dutch State Business NV
VAT NL.8014.22.917.B.04

Explanatory notes to the questions on the application form entitled "Export Credit Guarantee"

Question 4a: / By virtue of international agreements in the context of the EU and OECD, the Government of the Netherlands is not allowed to take certain decisions, in particular decisions to insure a loan having a term in excess of 5 years, without first having consulted the foreign credit insurers and/or the authorities which are competent in matters of credit insurance. Information about the scope and nature of such consultation may be obtained verbally from Atradius.
Question 4b: / Based upon your answers to the questions in this form, the Government of the Netherlands will consider whether and if so, on what conditions, it will issue a guarantee. You should bear in mind that facts and circumstances may also be relevant even if you are not asked explicitly to provide information regarding these facts or circumstances and in your answer to this question you must therefore declare these facts or circumstances. If it is found later that you were aware or ought to have been aware of facts or circumstances that you have not declared and that might have been relevant to an assessment of the application by Atradius, this may result in immediate and full recourse at you for amounts paid under the Export Credit Guarantee.
Atradius
David Ricardostraat 1, Amsterdam
PO Box 8982
1006 JD Amsterdam, The Netherlands
/ Phone +31 (0)20 553 92693
e-mail / IBAN NL43 ABNA 0469 8010 50
BIC ABNANL2A
Trade register Amsterdam 33226495
Registered Atradius Dutch State Business NV
VAT NL.8014.22.917.B.04