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Chubb Global Markets Political Risk & Credit1133 Avenue of the Americas New York, NY 10036(212) 835-3138 (NY)(312) 612-8827 (Chicago)(213) 612-5512 (Los Angeles)Application – Trade Credit InsuranceMulti BuyerThe information provided in this Application will be treated in the strictest confidence and, if fully completed, willenable us to assess your risks and determine whether we can indicate terms.In the event that we issue a Policy to you, this Application form, any attachments and additional information(oral and written) you have provided to us, shall form the basis of the Policy.1. APPLICANT’S DETAILSCompany Name:Address:Zip Code:Contact name:Tel. No.:Position:E-mail: Is cover required for any other group company?Yes NoIf yes, please provide full details:2. LOSS PAYEE (If Applicable)Please provide the following details of the company that you want to receive payment in the event of a claim:Company Name:Address:Zip Code:Contact name:Tel. No.:Position:E-mail:3. BUSINESS ACTIVITIESWhat kind of goods / services do you sell (Goods Insured)?To which trade sector do you sell them?What is the period from date of contract to date of shipment?Do you manufacture the goods that you sell? Yes NoWhat are your normal terms of payment?Page 1 of 10

What extended terms of payment do you sell on?What is your average Days’ Sales Outstanding? Is your business seasonal?Yes NoIf yes, please provide details:Do you require any special features of cover (e.g. consignment stock)?4. OTHER CREDIT INSURANCE POLICIES, GUARANTEES, SECURITIESDo you at present hold any credit insurance policy, guarantees or security in connection with the credit risk on any of your Buyers?Yes NoIf yes, what is it? Do you factor, discount or otherwise assign your debts?Yes NoIf yes, please provide details:Have you ever had an insurance policy cancelled or a renewal refused by an insurer? Yes NoIf yes, please provide details:5. PAST EXPERIENCE (please state currency if not US )Financial Year EndingMonth/ YearSalesLosses*Largest Individual LossNumber ofLosses* Please indicate if Losses given are (a) arising from shipments made during the year, or (b) in respect of losses occurring duringthe year. Please do not give write-offs made during the year.Page 2 of 10

Please provide details of largest individual losses:Financial Year EndingMonth/ YearName of BuyerCause of Loss6. ACCOUNTS RECEIVABLE BALANCES (please state currency if not US )As at last:31 March 30 June30 September 31 December7. CURRENT AGED ACCOUNTS RECEIVABLE ANALYSIS (please state currency if not US )As at:RangeTotal debt outstandingCurrent (not yet due)1-30 days past due date31-60 days past due date61-90 days past due dateOver 90 days past due date8. BUYER PROFILE (please state currency if not US , and amend the range values if appropriate)As at:RangeTotal debtoutstandingNumber ofBuyersRange0 – 5,00075,001 – 100,0005,001 – 10,000100,001 – 250,00010,001 – 25,000250,001 – 500,00025,001 – 50,000500,001 – 1,000,00050,001 – 75,0001,000,000 Total debtoutstandingNumber ofBuyersPage 3 of 9

9. PROJECTED SALES DETAILS (please state currency if not US )Please provide details of your projected sales excluding the following: sales to any associated or subsidiary companies;government departments, public authorities or nationalized undertakings except where you require coverage in respectof Public Buyer Default.Period From: to:CountryEstimatedSalesMaximum Exposureat any one timeNo. of BuyersTerms ofPaymentPlease continue on a separate sheet if necessaryPage 4 of 9

10. PRINCIPAL BUYERS (please state currency if not US )Name & AddressCredit LimitRequiredAnnual SalesTerms ofPaymentPlease continue on a separate sheet if necessaryPage 5 of 9

11. LIST OF ACCOUNTS MORE THAN 60 DAYS OVERDUE, ACCOUNTS GIVING CAUSE FOR CONCERN AND/ORWHERE DELIVERIES HAVE BEEN STOPPEDAs at:Name & AddressAmountOriginal due dateAction takenOutstandingPlease continue on a separate sheet if necessary12. CREDIT PROCEDURESWe require a fully completed ACE Credit Procedures Questionnaire before a Policy can be issued.Do you have a credit procedures manual?If yes, please attach. Yes NoAttached13. FRAUD STATEMENTSFRAUD WARNING STATEMENTS (ALL STATES)NOTICE TO ARKANSAS APPLICANTS: Any person whoknowingly presents a false or fraudulent claim forpayment of a loss or benefit or knowingly presents falseinformation in an application for insurance is guilty of acrime and may be subject to fines and confinement inprison.NOTICE TO COLORADO APPLICANTS: It is unlawful toknowingly provide false, incomplete, or misleading factsor information to an insurance company for the purposeof defrauding or attempting to defraud the company.Penalties may include imprisonment, fines, denial ofinsurance, and civil damages. Any insurance companyor agent of an insurance company who knowinglyprovides false, incomplete, or misleading facts orinformation to a policyholder or claimant for the purposeof defrauding or attempting to defraud the policyholderor claimant with regard to a settlement or awardpayable from insurance proceeds shall be reported tothe Colorado Division of Insurance within theDepartment of Regulatory Agencies.NOTICE TO DISTRICT OF COLUMBIA APPLICANTS:WARNING: It is a crime to provide false or misleadinginformation to an insurer for the purpose of defraudingthe insurer or any other person. Penalties includeimprisonment and/or fines. In addition, an insurer maydeny insurance benefits if false information materiallyrelated to a claim was provided by the applicant.NOTICE TO FLORIDA APPLICANTS: Any person whoknowingly and with intent to injure, defraud or deceivePage 6 of 9

any insurer files a statement of claim or an applicationcontaining any false, incomplete or misleadinginformation is guilty of a felony of the third degree.NOTICE TO KENTUCKY APPLICANTS: Any personwho knowingly and with intent to defraud any insurancecompany or other person files an application forinsurance containing any materially false information orconceals, for the purpose of misleading, informationconcerning any fact material thereto commits afraudulent insurance act, which is a crime.NOTICE TO LOUISIANA APPLICANTS: Any personwho knowingly presents a false or fraudulent claim forpayment of a loss or benefit or knowingly presents falseinformation in an application for insurance is guilty of acrime and may be subject to fines and confinement inprison.NOTICE TO MAINE APPLICANTS: It is a crime toknowingly provide false, incomplete or misleadinginformation to an insurance company for the purpose ofdefrauding the company. Penalties may includeimprisonment, fines or a denial of insurance benefits.NOTICE TO MARYLAND APPLICANTS: Any personwho knowingly and wilfully presents a false orfraudulent claim for payment of a loss or benefit or whoknowingly and wilfully presents false information in anapplication for insurance is guilty of a crime and may besubject to fines and confinement in prison.NOTICE TO NEW JERSEY APPLICANTS: Any personwho includes any false or misleading information on anapplication for an insurance policy is subject to criminaland civil penalties.NOTICE TO NEW MEXICO APPLICANTS: Any personwho knowingly presents a false or fraudulent claim forpayment of a loss or benefit or knowingly presents falseinformation in an application for insurance is guilty of acrime and may be subject to civil fines and criminalpenalties.NOTICE TO NEW YORK APPLICANTS: Any personwho knowingly and with intent to defraud any insurancecompany or other person files an application forinsurance or statement of claim containing anymaterially false information, or conceals for the purposeof misleading, information concerning any fact materialthereto, commits a fraudulent insurance act, which is acrime, and shall also be subject to a civil penalty not toexceed five thousand dollars and the stated value of theclaim for each such violation.NOTICE TO OHIO APPLICANTS: Any person who, withintent to defraud or knowing that he is facilitating afraud against an insurer, submits an application or filesa claim containing a false or deceptive statement isguilty of insurance fraud.NOTICE TO OKLAHOMA APPLICANTS: WARNING:Any person who knowingly, and with intent to injure,defraud or deceive any insurer, makes any claim for theproceeds of an insurance policy containing any false,incomplete or misleading information is guilty of afelony.NOTICE TO OREGON APPLICANTS: Any person whoknowingly and with intent to defraud any insurancecompany or another person, files an application forinsurance or statement of claim containing anymaterially false information, or conceals information forthe purpose of misleading, commits a fraudulentinsurance act, which may be a crime and may subjectsuch person to criminal and civil penalties.NOTICE TO PENNSYLVANIA APPLICANTS: Anyperson who knowingly and with intent to defraud anyinsurance company or other person files an applicationfor insurance or statement of claim containing anymaterially false information or conceals for the purposeof misleading, information concerning any fact materialthereto commits a fraudulent insurance act, which is acrime and subjects such person to criminal and civilpenalties.NOTICE TO TENNESSEE APPLICANTS: It is a crime toknowingly provide false, incomplete or misleadinginformation to an insurance company for the purpose t, fines and denial of insurance benefits.NOTICE TO VIRGINIA APPLICANTS: It is a crime toknowingly provide false, incomplete or misleadinginformation to an insurance company for the purpose t, fines and denial of insurance benefits.NOTICE TO WASHINGTON APPLICANTS: It is a crimeto knowingly provide false, incomplete, or misleadinginformation to an insurance company for the purposesof defrauding the company. Penalties includeimprisonment, fines, and denial of insurance benefits.NOTICE TO WEST VIRGINIA APPLICANTS: Anyperson who knowingly presents a false or fraudulentclaim for payment of a loss or benefit or knowinglypresents false information in an application forinsurance is guilty of a crime and may be subject tofines and confinement in prison.NOTICE TO ALL OTHER APPLICANTS:ANY PERSON WHO KNOWINGLY AND WITH INTENTTO DEFRAUD ANY INSURANCE COMPANY ORANOTHER PERSON, FILES AN APPLICATION LLYFALSEINFORMATION, OR CONCEALS INFORMATION FORPage 7 of 9