Aanvraagformulier - nationaleborg.nl

1. Contractor

Complete legal name of entity

Postal code

City

Contact person

E-mail

Phone

Registration no. Chamber of Commerce

Bank account number

Location/town of bank

Guarantee Facility No.

Topholding No.

Relationship manager

Save my data

2. Beneficiary Please answer the above-mentioned questions first

Complete legal name of entity

Address

Area code and town

Contact person beneficiary

Phone number beneficiary

3. Kind of request Please answer the above-mentioned questions first

New Bond or Declaration

Increase amount of issued Bond

Extension of issued Bond

Replacement of issued Bond

Number of issued Bond/Declaration

4. Total order amount Please answer the above-mentioned questions first

Yes

Currency

Amount

Including V.A.T.

Excluding V.A.T.

5. Request for Bond or Declaration Please answer the above-mentioned questions first

Bond

Bank declaration

Declaration of Willingness (Note: an estimate of the contract amount will need to be given!)

Combined Declaration of willingness and Bankdeclaration (Note: an estimate of the contract amount will need to be given!)

Other

Currency

Amount

Including V.A.T.

Excluding V.A.T.

Percentage of contract amount for which the declaration of willingness is asked

Only the amount will be mentioned in the text

Only the percentage will be mentioned in the text

Amount + percentage will be mentioned in the text

Combined Declaration of willingness and Bankdeclaration

Currency

Amount

Including V.A.T.

Excluding V.A.T.

Percentage of contract amount for which the declaration of willingness is asked

Only the amount will be mentioned in the text

Only the percentage will be mentioned in the text

Amount + percentage will be mentioned in the text

Other kind of Bond

Currency

Amount

Including V.A.T.

Excluding V.A.T.

6. End date Please answer the above-mentioned questions first Not applicable. Please answer the next question

Definitive End Date

Exptected End Date

End date is included in Bond text; Bond/Declaration will expire automatically after the mentioned end date if no extension is asked and/or no claim is done.

Definitive End Date

End Date is not included in Bond text; Bond/Declaration will expire after having received the original document back from the Benificiary.

Exptected End Date

7. Pre-dominant text Please answer the above-mentioned questions first

Standard wording Nationale Borg

According to pre-dominant text (please enclose sample wording)

Language:

Dutch

English

German

French

8. Contract number/reference Please answer the above-mentioned questions first Not applicable. Please answer the next question

Contract number/reference

Contract Date

Scope of supply/work

9. Original Bond to be sent to Please answer the above-mentioned questions first

The original guarantee will normally be sent to the Beneficiary, unless instructed otherwise. A copy of the guarantee will be sent to the applicant.

Contractor

Applicant (to be defined at question 10)

Other

Complete legal name of entity

Address

Area code and town

Contact person beneficiary

Phone number beneficiary

10. Applied by (name applicant) Please answer the above-mentioned questions first

Contractor

Other

Contact person

Phone number

E-mail

Complete legal name of entity

Address

Area code and town

Registration no. Chamber of Commerce

Contact person

Phone number

Fax number

E-mail

11. Urgent Please answer the above-mentioned questions first

Is your request urgent? Urgent requests which we receive before 12 am will be sent the same day. After 12 am please contact our Guarantee Service Centre. For further questions or comments, please use the following textbox.

Yes

by courier

by fax

by E-mail

Please answer the above-mentioned questions first

Fax number

Please answer the above-mentioned questions first

E-mail

12. Details/Comments Please answer the above-mentioned questions first

Details/Comments

Guarantee Application Form for Existing Customers