Confidential Credit Application Form

Confidential Credit Application Form

To establish a new account, please complete the credit application form provided thereafter together with the following documents that you can send to your sales contact's email address:
- The last three audited annual financial accounts, to include Balance Sheet, Profit and Loss statement, Cash-flow statement, auditor’s opinion and notes attached. If required, a Non Disclosure Agreement ("NDA") can be provided to this effect.
- An organizational chart of the Lessee’s Group of companies (specifying the shareholders as well as the subsidiaries of the Lessee).
- Company Brochures and website address.
This Credit Application is completed by:
Name:
Title: Job title
Date: Date
E-mail: Email
Tel: Full Phone Number
Section 1: Customer Information

Including legal, compliance, addresses
Full Company Legal Name
Please also insert the social denomination, such as Limited, SARL, SA...
Trade name (if different) Name
Date of incorporation Date
Place of incorporation City, Country
Identification number Full id number
Company's website address:   www.
Direct shareholders   All direct shareholders
Majority ultimate shareholder
(individual(s))   All ultimate controlling individuals
Number of employees
Registered address
HQ address
Billing address
Section 2: Management

Officer level
Chairman of the Board   First Name   Last Name
Chief Executive Officer     First Name   Last Name
Chief Financial Officer   First Name   Last Name
Operations Manager   First Name   Last Name
Section 3: Activity of the customer

Description
Please select (several)

Deep-sea shippingDomestic sea-shippingDomestic inlandTruckingAsset leasingStatic storageOther
If "Other", please describe in details

How much percentage of total revenues is derived from shipping activities (in %) From 0% to 100%
What are the top routes (in % of total revenue)
Trade and % total revenues
Trade and % total revenues
Trade and % total revenues
Trade and % total revenues
Top customers Please provide names
Top cargo types Please provide type of cargoes
Section 4: Fleets

Containers and tanks
Total employed
(in teus and units)
Of which total owned
(in teus and units)
Lessors used

Top customers Please provide names
Top cargo types Please provide type of cargoes
Section 5: Insurer

Copy of insurance certificate to be provided
Name of insurer Full Name
Location of insurer   City, country
Policy number
Expiry date   Date
What does it include?

Physical LossDamage insuranceTheftThird party liability
For Physical loss or damage insurance
Please indicate also the currency for the amounts below
Total level of cover
Level of cover per accident
Excess
For third party liability, what does it include?

Contractual liabilityProperty damageInjury or death of personTortious liabilityProducts liability
For Public liability insurance
Name of insurer (if different) Name
Location of insurer   City, Country
Expiry Date   Date
Please indicate also the currency for the amounts below
Total Level of cover
Level of cover per accident
Excess

Name

First NameLast Name
Section 6: References

Bank/Trade references
Reference 1: Bank Name
Locationblanks
Contact name:
Tel:
Email:
Reference 2: Bank Name
Locationblanks
Contact name:
Tel:
Email:
Trade Reference 1 Company name:
Locationblanks
Contact name:
Tel:
Email:

Trade Reference 2 Company name:
Locationblanks
Contact name:
Tel:
Email:
Section 7: Business expectations

Current/ Future
Initial requirements (first 6 months)
Please detail
Equipment lease type and type of lease expected:
Please detail
Future requirements:
Please detail
Please send the information here

Parcourir les fichiers
(Financials, brochure, presentation, etc.) Cancelof
Parcourir les fichiers
(Financials, brochure, presentation, etc.) Cancelof
Agreement

(By checking these boxes you are agreeing to our terms - should you have any questions please contact us)
Agreement and Terms*

By submitting this credit application, you authorize us to make inquires into the banking and buisness references that you provided.
Enter the word as it's shown*
Signature

Clear
Should be Empty:

Section 1: Customer Information

Section 2: Management

Section 3: Activity of the customer

Section 4: Fleets

Section 5: Insurer

Section 6: References

Section 7: Business expectations

Agreement