APPLICATION FOR FOREIGN INVESTMENT GUARANTEE
EXPORT CREDIT INSURANCE CORPORATION OF SOUTH AFRICA LIMITED
APPLICATION FOR FOREIGN INVESTMENT GUARANTEE
Confidential Page 1
APPLICATION FOR FOREIGN INVESTMENT GUARANTEE
Block C7 & C8, Eco Origins Office Park
349 Witch Hazel Ave, Highveld Ext 79
Centurion
0157
TELEPHONE: +27-12-471-3800
P.O. BOX 7075
CENTURION
0063
FACSIMILE: +27-12-471-3850
Confidential Page 1
APPLICATION FOR FOREIGN INVESTMENT GUARANTEE
1. Details of Investor:
1.1. Full Name
(Legal Form)
1.2. VAT Number
1.3. Registration Number
1.4. Full Address
1.5. Postal Address
1.6. Activities[1]
2. Details of The Foreign Business in which the Investment will be made
2.1. Full Name
(Legal Form)
2.2. Tax Registration Details
2.3. Registration Number
2.4. Full Address
2.5. Postal Address
2.6. Activities[2]
2.7. The principal shareholders in the Foreign Business and their country of domicile, after the investment has been made, will be:
Name of Shareholders / Principal Business / Country of Domicile of Shareholders / % Shareholding in Foreign BusinessTOTAL
3. Details Regarding The Investment[3]
3.1. The investment will be for a total amount of United States Dollars and will be made through:
3.1.1. The acquisition of shares in the Foreign Business at a cost of, and ______
3.1.2. The provision of loan finance to the Foreign Business for, and/or[4] ______
3.1.3. The provision of guarantee facilities to the Foreign Business for, and/or[4] ______
3.1.4. The provision of other facilities to the Foreign Business for, [4] ______
3.2. If the investment is:
3.2.1. Financed from a source outside of South Africa, please give reason and full details concerning the source:
3.2.2. Channelled through an intermediate country, state reason and give full details including the name of the country:
3.2.3. The investment will promote South Africa’s export and/or assist in the economic development of the host country in the following ways:
4. Insurance Cover Required[5]
4.1 The investment should be covered for a period of:
4.1.1. ______years in respect of the acquisition of shares;
4.1.2. ______years in respect of the loan finance;
4.1.3. ______years in respect of the guarantee facilities;
4.1.4. ______years in respect of the other facilities.
5. ANTI-BRIBERY5.1 Exporter’s Undertaking/Declaration
Exporter:
(Full legal names and registration number)
Undertaking against bribery
We confirm that neither we nor anyone acting on our behalf, such as employees or agents, have been engaged or will be engaged in acts of bribery of foreign public officials or have committed or will commit bribery in connection with the export contract forming part of this application.
Declaration of bribery charges or convictions
Is the exporter or anyone acting on their behalf in connection with the transaction charged or convicted in a national court or equivalent national administrative measures for the violation of laws against bribery or bribery of foreign public officials of any country (including South Africa) within a five-year period preceding the application?
YES NO
Internal Control System
We have noted ECIC’s initiative to encourage us to develop, apply and document internal management control systems to detect, prevent and combat bribery in international business transactions within our organizations.
Consequences of Bribery
We take notice that in terms of the Prevention and Combating of Corrupt Activities Act 2004 (Act No. 12 of 2004) bribery of foreign public officials in international business transactions is crime in South Africa and contravention thereto is punishable with a fine and imprisonment including life sentence.[6]
We also take notice that ECIC has the right to refuse to provide export credit support in connection with this application if:
(i) the exporter, and where applicable, the applicant, is listed on the publicly available debarment list of one of the following international financial institutions: World Bank Group, the African Development Bank, the Asian Development Bank, the European Bank for Reconstruction and Development, and the Inter-American Development Bank; or
(ii) the exporter, and where applicable, the applicant, is under charge or has been convicted in a national court or equivalent national administrative measures for the violation of laws against bribery of foreign public officials of any country within a five-year period preceding the application; or
(iii) credible evidence of bribery is found in connection with the award or execution of the export contract
For and on behalf of the Exporter
Full names:
Position:
Date:
5.2 Agent’s Commission
5.2.1 Please state the details of the Agent or any person acting on the exporter or applicant’s behalf in connection with the export contract or the project:
Full Names:
Registration Number / Identification Number:
Full Physical Address:
Details of Business Activities:
5.2.2 Please state the amount you will pay or anticipate to pay as agent's commission in respect of the procurement/handling of the contract and purpose of the commission or fee:
5.2.3 Is this amount included the export contract? (Specify item)
5.2.4 When do you expect to pay this commission?
6. Declaration
We warrant and agree that:
6.1 We have not made nor are we irrevocably committed to make the investment which is the subject of this application;
6.2 All discussion and correspondence in connection with this application and with any Policy arising therefrom are to be treated as confidential;
6.3 We shall consult with the ECIC immediately on any contemplated changes to any of the facts disclosed in this form;
6.4 This preliminary application form is being submitted in order to register our intent of seeking cover for our proposed investment and in order to obtain an in principal decision on the availability of cover. We understand that a comprehensive application from together with supporting documentation will need to be provided to the ECIC before a policy can be issued.
Signed at this day of 20___
______
Authorised Signature Name (In Block Letters)
ANNEXURE A
1. Assessment Fees for New Applications
The fee charged for every new application will be a fixed at ZAR10,000-00 plus VAT. In the event that the project is approved by the ECIC and policies are executed, the total assessment fee paid will NOT be reimbursed by ECIC. In the event of an application not being approved by the ECIC the Application Fee will NOT be refunded.
2. Fee for an Extension of an Offer of Cover
A flat fee of ZAR 3,000-00 will be charged in respect of each request for an extension of the validity period of an offer of cover once it has lapsed. This fee will not be reimbursed by the ECIC. In the case of the non-approval of an extension for an Offer of Cover presented to the Technical Committee and/or the Credit Insurance Committee, the first option extension fee of ZAR 3,000-00 plus tax paid by the client, will be refunded. In all other cases option fees are not refundable. No interest shall be paid on any fees refunded to the client.
3. Invoicing of the Fees
It should be noted that the new fees as well as the VAT charges thereon would be invoiced and payable in South African Rand.
4. Validity Period for Offers of Cover
ECIC has reviewed the current three-month validity period for offers of cover. With effect from 01 June 2005 the validity period for an offer of cover, including any subsequent extension, will be six (6) months and that period shall commence from the date of issue of the offer of cover. Any extension for the validity period of an offer of cover that has elapsed will be subject to the payment of the ZAR 3,000-00, as explained in part 2 above. All offers of covers that have already been issued and will expire on or after 01 June 2005 and at the discretion of the ECIC may be further extended for a period of six (6) months subject to the payment of the new ZAR3,000-00 fee and the ECIC’s normal approval processes.
ANNEXURE B
As a short-term insurance policyholder or prospective policyholder, you have the right to the following information:
1 GENERAL INFORMATION
Registered Name: Export Credit Insurance Corporation of South Africa Limited
Abbreviated Name: ECIC
Registration Number: 2001/013128/06
VAT Number: 4170197125
FSB License Number: 30656
FSB License Category: Short Term Insurance, Commercial Lines, Financial Advisory Services and Financial Intermediary Services
E-mail: ()
Website: www.ecic.co.za
Telephone: +27124713800
Fax: +2712 471 3850/51
Office: 349 Witch Hazel Ave, Highveld Ext 79, Centurion
P O Box 7075, Centurion, 0046
Any changes to the above information will be communicated to you in writing
2. COMPLIANCE DEPARTMENT
Manager and Compliance Officer: Mr Lesego Mosupye
Telephone: + 27 12 471 3817
Fax: + 27 471 3850/51
Email:
Delivered to our offices addressed to: “The Compliance Officer” / 3. OTHER MATTERS OF IMPORTANCE
· ECIC issues policies on its behalf with the government as the ultimate insurer;
· ECIC must give written reasons for repudiating your claim;
· ECIC is obliged to notify you directly of the cancellation of your insurance contract; and
· All the ECIC representatives have a letter of appointment verifying the ECIC accepts responsibility for activities performed within the scope of, or in the course of their mandated duties.
4. THE FAIS OMBUDSMAN
If any complaint made to the intermediary or insurer is not resolved to your satisfaction, you may submit your complaint to the FAIS Ombudsman who can be reached at:
Address: PO BOX 74571
Lynnridge
0040
Email:
Telephone: +27 12 470 9080/0860 324 766
Fax: +27 12 348 3447
5. THE SHORT TERM INSURANCE OMBUDSMAN
The short-term Insurance Ombudsman is available to advise you in the event of claim problems which are not satisfactorily resolved by the insurer. The Ombudsman can be reached at:
Address: P O Box 32334
Braamfontein
2017
Website: www.insuranceombudsman.co.za
Telephone: + 27 11 726 8900
Fax: + 27 11 726 5501
Confidential Page 1
[1] The business carried on by the Investor (and by the group if applicable) in South Africa
[2] The business carried on by the Foreign Business (and by the group if applicable)
[3] An investment must be for a minimum total amount of ZAR 200,000-00 to be eligible for insurance cover.
[4] Facilities enumerated under 3.1.2, 3.1.3 & 3.1.4 are only eligible for insurance cover if they are made in conjunction with a share investment, which is to be insured
[4]
[4]
[5] The minimum and maximum periods for which cover is available are 5 and 15 years respectively.
[6] Section 26 Chapter 5: Penalties and Related Matters in the Prevention and Combating of Corrupt Activities Act 2004 (Act No. 12 of 2004)