SCR Proposal - Form No-121

ईसीजीसी लिलिटेड ( ECGC LTD )
PROPOSAL FORM FOR SHIPMENTS (COMPREHENSIVE RISKS) POLICY/ SMALL

EXPORTERS POLICY – (Form No-121)
“We hereby apply for Shipments (Comprehensive Risk) Policy / Small Exporters Policy. We have
read and understood the terms and conditions of the Policy and found the same to be suitable for
our requirements. We have also obtained necessary clarification about the benefits, the details of
documents/evidence required, procedure to be followed for settlement of claims, if any, and we
further undertake not to seek refund of premium from ECGC for whatsoever reason except as
provided under the policy.”
FRESH RENEWAL
1. Name of the
___________________________________________________
Company
2. Address
________________________________________________________
________________________________________________________
________________________________________________________
City__________________________ Pin _______________________
Phone____________________________ Fax___________________
E-Mail _____________________________________________
3. I.E.C. No.
___________________________
Company PAN
___________________________
No.
4. Bank’s Name and
________________________________________________________
Address
________________________________________________________
________________________________________________________
City______________________________ Pin ___________________
Phone___________________________ Fax___________________
E-Mail _____________________________________________
5. Contact Person
________________________________________________________
6. Status of
the Unit
Proprietorship  Partnership  Pvt. Ltd.
Co. 
(Mark “X”
(I) Public Ltd. Co.
(Listed)  Public Ltd. Co.
(Unlisted)  100% EOU 
at the
appropriat
PSU 
e box) Export House  Star Trading
House  Other 
(II)
Trading House  Super Star
Trading House 
7. Names of Proprietor / Partners / Directors (Separate sheet may be attached if necessary)
Sl. Names Son/ Daughter/ Date of Birth PAN No.

Husband/ Wife of
8. Names of Sister Concerns (With Addresses):
9. Do you make shipments to your overseas associate concerns? Yes No

If yes, do you want to cover the same against Political Risks? Yes No
10. Cover required: No option to Exclude Non L/C shipments
L/C Shipments: (Mark “X” at the appropriate box)
(i) No cover required  (ii) Only Political Risks 

(iii) Political risk and Insolvency and Default of L/C opening bank 
11. Anticipated export turnover for next 12 months (in Rs.)
Under L/C
Under DP/CAD
Under OD/DA
Under Advance
Total
(MINIMUM DEPOSIT PREMIUM PAYABLE FOR STANDARD POLICY IS Rs. 10000/- FOR SMALL
EXPORTER POLICY IS Rs. 5000/- or TWO MONTHS ADVANCE PREMIUM WHICHEVER IS HIGHER)
We accept the premium rate quoted by you. Cheque for Rs._______________ is enclosed towards
minimum premium.
Signature:
Place:
Date: Office Stamp:
Note: Wherever space provided is insufficient, attach separate sheet.

Incase of Renewal, please submit the following statement duly attested by your banker(s), indicating
export turnover during the last 12 months.
SHIPMENT MADE BY US DURING THE PERIOD ______________ TO ____________
(IN RUPEES)
Total shipments made against L/C
Total shipments made against DP/ CAD ________________________
Total shipments made against OD/ DA ________________________
Total shipments made against advance payment

(Advance- Remittance should be before Bill of Lading
Date)
GRAND TOTAL ________________________
_________________________ _____________________________________
Seal and Signature of Exporter Seal and Signature of the Exporter’s Banker(s)
______________________________________________________________________
(A Govt. of India Enterprise)

Chennai Exporters Branch: Spencer Towers, VII Floor, 770-A, Anna Salai, Chennai - 600002
Phone: 28491026 to 33 / Fax: 044 – 28491025
E-mail : [email protected] Also visit at : www.ecgcindia.com
______________________________________________________________________
Registered Office : Express Towers, Nariman Point, Mumbai – 400 021

Tel No. 22845452 / 22845471 – 73 Fax : 22045253 / 22023267

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ईसीजीसी लिलिटेड ( ECGC LTD )

PROPOSAL FORM FOR SHIPMENTS (COMPREHENSIVE RISKS) POLICY/ SMALL

Sl. Names Son/ Daughter/ Date of Birth PAN No.

8. Names of Sister Concerns (With Addresses):

9. Do you make shipments to your overseas associate concerns? Yes No

10. Cover required: No option to Exclude Non L/C shipments

L/C Shipments: (Mark “X” at the appropriate box)

(i) No cover required  (ii) Only Political Risks 

11. Anticipated export turnover for next 12 months (in Rs.)

Date: Office Stamp:

Note: Wherever space provided is insufficient, attach separate sheet.

SHIPMENT MADE BY US DURING THE PERIOD ______________ TO ____________

Total shipments made against DP/ CAD ________________________

Total shipments made against OD/ DA ________________________

Total shipments made against advance payment

GRAND TOTAL ________________________

(A Govt. of India Enterprise)

Registered Office : Express Towers, Nariman Point, Mumbai – 400 021

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