Application for
Credit Limit Endorsement
Use the currency unit the policy is denominated in.
Your Company Name - The Insured Policy Number
Broker or Agent's Name(If any) Date
Your Customer - The Buyer
(All amounts should be expressed in your policy currency)
Name of Buyer (correct legal entity) Registration No. ACN,ABN (if applicable)
Trading or Business Name
Register Address Postcode Country
Telephone Fax
Credit Limit Required Existing Credit Limit (if any)
Terms of Payment (only if different from the endorsed Terms of Payment) Orders on Hand Excepted Date of Delivery
Contacts on Hand, Amount and Duration
Buyer is: New Account Existing Customer
If Buyer is existing customer answer the following questions in full: Previous experience:
Pays within Days from Credit allowed Traded for Years Months
Are you aware of anything of an adverse nature affecting this buyer? Yes No If yes, please comment below
Amounts delivered/despatched not yet paid (Aged) Corrency of Outstandings Del.Date (Mth & Yr) Due Date for Payment (Mth & Yr)
Trade References
Name Telephone Number Contact Name
Buyer's Bank & Address
General Comments
General Comments and any other information you think maybe helpful to assist us provide the required cover
Office Use Only
Buyer Number Application Number
Austbrokers Trade Credit Pty Ltd ABN 42 089 012 037 is a Corporate Authorised Representative of Austbrokers Sydney Pty Ltd ABN 14 061 968 090 AFSL 244244