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					Business Debtorinsure (Brokers) Pty Ltd
Trade Debtor Insurance Questionnaire
(1) Applicant Details

Correct Legal Entity……………………………………………………………………………………
Address…………………………………………………………………………………………………
………………………………………………………………………………………………………….
ACN ……………………..          Telephone……………..……….. Fax……………………………

(2) Nature Of Business

Type of goods sold/services provided…………………………………………………………………
Industry sector to which they are sold/provided……………………………………………………….
How long have you been trading in this area?…………………………………………………………

(3) Turnover
                               Estimated Annual Turnover     Approximate          Normal Terms Of
    Australian Trade           Of Credit Sales               Number Of            Payment
                               (See note below *)            Active Accounts
New South Wales
Victoria
Queensland
Western Australia
South Australia
Tasmania
Australian Capital Territory
Northern Territory
                    Total      A$                            No.
Export Trade - Country




                    Total

* Sales to associated/subsidiary companies ,cash sales and sales to public authorities/governments,
and sales and other taxes, should be excluded.

(4) Policies, Guarantees/Securities, Special Terms Of Payment, And Contracts

Consignment stock trading………………… Yes / No                If yes, please provide details………
Forward dating of invoices………………… Yes / No               If yes, how many days?……………
Long term contracts………………………… Yes / No
Retention monies…………………………… Yes / No
Special terms of payment…………………… Yes / No                If yes, please provide details………
Retention of title clause …………………… Yes / No
Factoring arrangement or invoice discounting Yes / No     If yes, please provide details………
Personal guarantees .……………………… Yes / No                   If yes, please provide details………
Other security ..……………………………… Yes / No                    If yes, please provide details………
Work in progress…………………………… Yes / No                      If yes, please provide details……

Are all transactions closed off on the last working day of the month? Yes / No
Are statements prepared? Yes / No              If yes, when are they sent out? ………………..
                                                 -2-


(5) History

Financial Year     Turnover       Total Bad      Net Bad     No.      Largest Bad   Name
Ending             (excluding     Debts          Debts       Bad      Debt
                   Sales Tax)                                Debts




Financial Year
To Date




(6) Total Of Debtors Balances

As at 31st March                               As at 30th September
As at 30th June                                As at 31st December




(7) Debtors Analysis (As at end of last month)

Debt Outstanding         Number       % Total        Debt Outstanding          Number       % Total
                                      Turnover                                              Turnover
Up to $5,000                                         $50,001 to $100,000
$5,001 to $10,000                                    $100,001 to $150,000
$10,001 to $15,000                                   $150,001 to $250,000
$15,001 to $ 25,000                                  $250,001 to $500,000
$25,001 to $50,000                                   Above $500,000




(8) Overdue Accounts
    (Please detail accounts which are over 90 days or which you believe are in financial difficulty)

Name and Address          Amount Outstanding         Original Due Date         Action Taken
                                          -3-


(9) Largest Customers

Customer                Max    Credit limit   Amount   Annual     Additional
                        Days                  Owing    Turnover   Information
                                                -4-


(10) Credit Procedures


Do you have a credit procedure manual?    Yes / No If yes, please attach copy.
Is credit control centralised?            Yes / No If no, please provide details.

Who is responsible for credit control procedures?
Name………………………………… Position…………………………………….

Do you obtain the following?

Credit application form ……………………….Yes / No
Trade references……………………………….Yes / No
Mercantile reports…………………………….. Yes / No If yes, which agency?
Financial information…………………………. Yes / No
Credit bureau information…………………….. Yes / No
Bank reports……………………………………Yes / No
Are credit limits established on all accounts?….Yes / No
Are credit limits established from the outset …. Yes / No
How often are credit limits reviewed?………………………………………………..
Are orders received verbally or in writing?……………………………………….…..

What is the basis for calculating credit limits?
Buyers requested limit…………………………. Yes / No
Buyers financial strength………………………. Yes / No
Level of trade references………………………. Yes / No
Multiple of sales estimate……………………… Yes / No
Visiting buyers…………………………………. Yes / No
Financial statements……………………………. Yes / No
Other?…………………………………………………………………………………………


Are the following procedures used for overdue accounts?

Reminder by telephone?    Yes / No   If yes, how many days past due date?   (    )

Reminder in writing?      Yes / No   If yes, how many days past due date?   (    )

Stop credit?              Yes / No   If yes, how many days past due date?   (    )

Legal action?             Yes / No   If yes, how many days past due date?   (       )

Use of collection agencies? Yes / No If yes, which collection agency, and how many days after
                                         due date are they instructed? ……………………………….

Do you currently insure your debtors? Yes / No If yes, please provide details.



Our bankers are:………………………………… .Branch:……………………………………
                                                   -5-


(11) Notice to proposed insured

Your attention is drawn to Section 21 of the Insurance Contract Act 1984 (Commonwealth) which
provides, in relation to your duty of disclosure, as follows:

Section 21     Subject to this Act, an Insured has a duty to disclose to the Insurer, before the relevant
contract of insurance is entered into, every matter that is known to the Insured being a matter that:
       (a) the Insured knows to be a matter relevant to the decision of the insurer whether to accept
       the risk, and if so, on what terms, or
       (b) a reasonable person in the circumstances could be expected to know to be a matter so
        relevant.

The duty of disclosure does not require the disclosure of a matter:

       (a) that diminishes the risk,
       (b) that is of common knowledge,
       (c) that the Insurer knows or in the ordinary course of his/her business as an Insurer ought to
        know, or
       (d) as to which compliance with the duty of disclosure is waived by the Insurer.

Where a person:
       (a) fails to give an answer, or
        (b) gives an obviously incomplete or irrelevant answer to a question included in a proposal
        form about a matter,
        the insurer shall be deemed to have waived compliance with the duty of disclosure in relation
        to the matter.



(12) Declaration

We confirm that we have read the section of this form relating to our duty of disclosure. We declare
that the information given on this form (including any additional lists, forms, schedules or
attachments) is to the best of our knowledge and belief correct and we are not aware of any additional
circumstances which might influence your acceptance of the risk. We further declare that none of the
customers is a subsidiary or associated company of ours and that we have no interest direct or indirect,
in any of the customers.




Signed ………………………………………………….Name………………………………………….


Position in Company………………………………….. Date…………………………………………



Business Debtorinsure (Brokers) Pty Ltd
P.O. Box 267,
Burwood      Victoria 3125
Phone (03) 98890144        Fax (03) 98091301              Email    bdib@bluep.com

				
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