Insurance Inquiry Form
  1. Name of Company*
    Please type your full name.
  2. Contacts Details (Name of contact person):*
    Please type your full name.
  3. E-mail*
    Invalid email address.
  4. Telephone*
    Please type your full name.
  5. Fax*
    Please type your full name.
  6. Your role in this transaction?
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  7. Principal's Authority (applicable for brokers/ intermediaries - a letter of appointment from the potential insured is required):*
    Please type your full name.
  8. Transaction for which insurance cover is requested (state whether it is an equity investment; shareholder loan; commercial loan; loan guarantee; mobile asset; trade in goods/services on open account, leasing etc.): the potential insured is required):*
    Please type your full name.
  9. TYPE OF INSURANCE COVER REQUESTED
    Details of Cover
  10. Amount and Currency of Cover Requested:*
    Please type your full name.
  11. Tenor (indicate period for which cover is requested in months/years):*
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  12. Expected policy start date:
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  13. Number of Employees*
    Please tell us how big is your company.
  14. TYPE OF COVER
    (tick below the type(s) of risk for which insurance cover is requested):
  15. POLITICAL RISKS









  16. COMMERCIAL RISKS
    (tick below the type(s) of risk for which insurance cover is requested):

  17. SURETY BONDS




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  18. TRANSACTION/ INVESTMENT PARAMETERS
    Details of Party to be Insured
  19. Name*
    Please type Name.
  20. Country*
    Please type your full name.
  21. Legal Form
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  22. Nature of Business*
    Please type Nature of Business
  23. Details of Risk Counterparty/ Project Enterprise
  24. Name:*
    Please type Name.
  25. Country*
    Please type your full name.
  26. Legal Form
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  27. Nature of Business*
    Please type your full name.
  28. Details of the Transaction/Project
  29. Insured Transaction/Project (Brief description):
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  30. Value and Currency of Transaction/Project:*
    Please type Name.
  31. Transaction/Project Type
    Invalid Input
  32. Contract Terms & Conditions (if applicable, please provide details of contract/draft loan term sheet):
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  33. Terms and Method of Payment:*
    Please type your full name.
  34. Specific Comments (if necessary, please provide additional comments not captured in this enquiry form):
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  35. How did you get to know about ATI:
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  36.   RefreshInvalid Input
  37.   
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