Credit Insurance Application

Please fill in your details below.

Your Company Information
 
 
 
 
 
 
 
Turnover
 
 
 
 
Major Clients
 
 
(By value of outstanding credit)
 
 
Name
Location
Company reg no.
Credit Limit Requd.
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8
 
9
 
10
 

 
* Normal credit terms offered
days before end of month date of invoice
Bad Debt Losses
 
 
This financial year
Last financial year
Prev financial year
Total Losses
 
Number of Losses
 
Largest Individual debt
 


* Indicates a required answer
 
Continue to Apply for Credit Insurance