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Name of Contact *(required)
Position*
Email Address*
Company Name*
Company Reg No
Telephone No*
What goods/service do you provide?
Do you have existing credit insurance policies? YesNo
If yes (answer questions in italics)
Name of insurer
Type of indication required select type of indicationUnited KingdomExportCombineSingle Risk
Anticipated INSURABLE TURNOVER over the next 12 months (£)
How many customers do you allow a credit limit of over £500 to?*
Maximum amount any client is likely to owe you at any one time (£)*
Have you suffered any bad debts in the last 3 years* YesNo
IF YES PLEASE COMPLETE THE FOLLOWING
Total INSURABLE TURNOVER for the past 3 years (£)
Total BAD DEBTS for this period
Value of largest debt in this period (£)