Construction Guarantee - Lombard

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					                                                                               APPLICATION FOR A CONSTRUCTION GUARANTEE
                                                                               Note: This form is for existing clients of Lombard Insurance Company Ltd that wish to apply for a new construction guarantee to be issued by
                                                                               Lombard Insurance Company Ltd. Companies that are not clients of Lombard Insurance Company Ltd should first apply for a Guarantee Facility.

                                                                               Instructions:
                                                                               1. Complete the application form in full and attach supporting documentation:
                                                                                   1.1 Employer's letter of award or purchase order
                                                                                   1.2 Pro forma guarantee wording (if non-standard)
                                                                                   1.3 Copy of joint venture agreement if applying for a guarantee which is to be issued on behalf of a joint venture
                                                                               2. Return the signed application to your broker or to Lombard Insurance Company Limited

                    1. APPLICANT DETAILS
                   1.1 Applicant (facility holder)                                                                                                  1.2 Company reg. no.

                   1.3 Contractor                                                                                                                   1.4 Company reg. no.

                   1.5 Physical address                                                                                                             1.6 Contractor VAT no.

                   1.7 Contact person                                                                                                               1.8 Tel. no.

                   1.9 E-mail                                                                                                                      1.10 Mobile no.

                    2. BROKER DETAILS
                   2.1 Company                                                                                                                      2.2 FSP Number

                   2.3 Physical address                                                                                                             2.4 Tel. no.

                   2.5 Contact person                                                                                                               2.6 Mobile no.

                   2.7 E-mail

                    3. CONTRACT DETAILS
                   3.1 Employer (guarantee beneficiary)

                   3.2 Employer physical address                                                                                                    3.3 Employer tel. no.

                   3.4 Consultant / Principal agent                                                                                                 3.5 Consultant tel. no.

                   3.6 Quantity surveyor                                                                                                            3.7 QS tel. no.

                   3.8 Contract title (description)




                   3.9 Contract number                                                                  3.10 Contract location/Site description

                 3.11 General conditions of contract                                                    3.12 % of contract to be subcontracted

                 3.13 Contract value (incl VAT)                     ZAR                                 3.14 List of tenderers and tender prices

                 3.15 Expected net profit %                                                                       1st                                                          ZAR

                 3.16 Expected gross profit %                                                                     2nd                                                          ZAR

                 3.17 Expected start date                                                                         3rd                                                          ZAR

                 3.18 Expected completion date                                                                    4th                                                          ZAR

                 3.19 Expected end of maintenance date                                                            5th                                                          ZAR

                    4. GUARANTEE DETAILS
                   4.1 % of contract value                                                                4.2 Guarantee value                                                             ZAR                     0.00

                   4.3 Type of guarantee                                                                  4.4 Is maintenance period to be covered by the guarantee?

                   4.5 Guarantee wording                                                                  4.6 % reduction at start of maintenance period

                   4.7 Guarantee expiry date                                                              4.8 Wording as per previous guarantee number

                   4.9 Date that guarantee is required                                                  4.10 Will subcontractors give guarantee?

                 4.11 Special delivery, JV invoicing and other
                      instructions


                    5. DECLARATION BY APPLICANT
                 I/we hereby declare that the details and information furnished in this application are correct and I/we have not concealed any material facts relevant to this application. I/we authorise the verification of any
                 aspect of this application. I/we declare that I/we am/are authorised by the applicant (facility holder) to apply for this guarantee and to bind the applicant (facility holder) by this guarantee application.


                   5.1 Signature                                                                                                                    5.6 Signature 2
                                                                                                                                                        (if required)


                   5.2 Name                                                                                                                         5.7 Name

                   5.3 Designation                                                                                                                  5.8 Designation

                   5.4 On behalf of

                   5.5 Date




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