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

Outstanding

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  1  2  3

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