Sgiga - application forms
SOLVENCY GUARANTEE FACILITY
CHECKLIST: GUARANTEE APPLICATIONS FOR NEW CLIENTS Note:
The attached Proposal Form is intended for companies that wish to apply for a guarantee facility with
SGI Guarantee Acceptances a division of Constantia Insurance Company Ltd (SGIGA).
Existing clients of SGIGA should use the 1 page application form.
The Proposal Form attached is to be completed and returned to us with the entity’s most recent
AUDITED Financial Statements and the latest Management Accounts. The documents submitted will be assessed in line with the particular requirements of the entity and an indication given of whether or not we are able to assist and on what basis.
To avoid time delays you are requested to complete the proposal form in full and submit ALL
information and documents as soon as possible.
Please print pages 2 – 6 of the Proposal Form.
Complete the Proposal Form and send it with all supporting documents back to SGIGA.
Please tick the appropriate box on this checklist as information is provided to SGIGA.
SGIGA Proposal Form completed in detail and signed by the client
Copies of the Company’s most recent Management Accounts
3 Years’ Audited Financial Statements (compulsory requirement) (copies can be provided)
A Copy of the Personal Asset and Liability Statement of the Member/s/Individual
A Detailed CV of the Member, if applicant is a CC/Sole Proprietor
A Pro-forma copy of the guarantee wording
SGIGA Solvency Guarantee Proposal Form
This form consists of 6 pages in total
SGI Guarantee Acceptances a Division of Constantia Insurance Company Limited
Telephone: 011 789 3352, Facsimile: 011 781 1875
Unit 3 Stellenberg 363 Pretoria Avenue Randburg, PO Box 2672 Cramerview, 2060
Constantia Insurance Company Limited is an authorised Financial Services Provider FSP Licence No. 31111
SOLVENCY GUARANTEE PROPOSAL FORM
1. CLIENT INFORMATION
2. CONTACT INFORMATION
3. BROKER INFORMATION
4. LEGAL ACTION
Please note details of any legal action, summons, judgements, liquidation/sequestration orders or offer of
compromise against the company, its holdings, subsidiaries or associated companies.
5. GUARANTEE HISTORY
Who has issued Guarantees for you previously?
Has any Guarantee issued on your behalf ever been called up? (If yes, supply
Has any application ever been turned down? (If yes, by whom and why?)
Have you applied to anyone else for this guarantee or facility? (If yes, by whom and
6. DETAILS OF EXISTING GUARANTEES
7. GUARANTEE FACILITY REQUIRED
8. DETAILS OF GUARANTEE
Guarantee Amount: R_____________________________________________________
Period for which required: ________________________________________________
The Guarantee is to be issued in favour of:
PHONE NO.: __________________________________________________________
Is the Guarantee wording specified by Point 8.3 above?
Please provide a short summary of why the guarantee is required and what we are standing surety
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________
Date by which Guarantee is required:
9. SECURITY/COLLATERAL OFFERED
Yes | No Comments
Personal sureties: Directors/Shareholders/Members/Owners
Counter Indemnities from Shareholders/Associated Companies
Mortgage Bonds over immovable properties
Please attach sworn valuations for 3 and 6 above, if offered as collateral.
10. TRADE CREDITOR DETAILS
Name of Reference
11. LEASE/HIRE PURCHASE DETAILS
(Note: if more that six parties, please supply separate schedule)
% Shares Held ID Number
Have any of the key personnel been a director/shareholder of a company which was liquidated or compromised with creditors?
If Yes, please provide details: __________________________________________________________
13. SUBSIDIARY/ASSOCIATE COMPANIES
(Note: please also submit Financial Statements for these companies)
% Shares Held
14. PERSONNEL -
TOTAL NUMBER OF EMPLOYEES:_______AS AT ________________ 20___.
15. BANKING DETAILS
16. CURRENT DEBTORS STATUS
No. Name of Debtor
I hereby declare that the details and information furnished in this application, to the best of my knowledge, fairly represent the true state of affairs of the company/business and I authorise SGIGA to verify any aspect of this application and the credit record of the applicant. This includes, but is not limited to: credit checks with credit checking of references and validating information supplied as part of the application. I have not concealed any material fact relevant to this application and this questionnaire will form the basis upon which any guarantee, surety or bond may be issued. I/we hereby declare that if SGIGA agrees to issue guarantees on my/our behalf, I/we hereby bind myself/ourselves as follows: a) To reimburse SGIGA for all amounts which I/we are called upon to pay in respect of the guarantees. b) I/we nominate, constitute and appoint SGIGA irrevocably and in rem suam to be my/our lawful agent to
obtain payment of and give valid receipts for any money due to me/us by way of retention or otherwise, whether such money became due before, at the time of or after my/our failure, default or breach of Contract.
c) To reimburse SGIGA for any legal or other costs and charges which may reasonably be incurred by them in
consequence of the aforegoing clauses or resulting from this application.
d) To pay to SGIGA such consideration as it may require in the form of premium for the guarantees hereby
applied for and for any extension thereof beyond the completion date stated herein.
e) To reimburse SGIGA for any costs including valuation costs incurred in regard to guarantees provided or to
f) In terms of the new National Credit Act (NCA) I give my consent to SGIGA conducting a credit check. I note
that my/our credit data will be part of the equation in assessing the guarantee application, which could impact on the risk rating and ultimately affect the premium.
(Being duly authorised to sign this document)
APPENDIX C2: CLASSIFICATION INSTRUCTIONS AND SURVEY INSTRUMENT INSTRUCTION BOOKLET INSTRUCTION BOOKLET (Use in Conjunction with Self-Survey Questionnaire) The following instructions provide specific guidelines, definitions and examples for use in completing theself-survey questionnaire. It is recommended that the questionnaire be completed by the staff member whois most familiar with t
Dr. med. Silviana Spring FMH Angiologie und Innere Medizin Klinik HirslandenAngiologieWitellikerstrasse 40CH-8032 Zürich T +41(0)44 387 29 25F +41(0)44 387 29 [email protected] Publikationsliste 1. B. van der Loo, E. Krieger, J. Katavic, S. Spring, V. Rousson, B. Amann-Vesti and R. Koppensteiner. Carotid intima-media thickness, carotid wall shear stress and resten