APPLICATION FOR COMPENSATION The application for compensation must be submitted to EKN within the time limit stated in the applicable General Conditions. Guarantee holder (name and address): Rightsholder/transferee under the guarantee (name and address): Buyer/borrower (name and address):
1. EKN’s guarantee number:
2. Outstanding amount/s for which compensation is requested:	Reference: Due date Currency: Amount: (YY-MM-DD):
Total amount for which compensation is requested:	Currency: Amount:
3. Has the applicable waiting period passed by the date of the application for compensation?	Yes No If no, please state the reason:
4. Does the agreement covered by the EKN guarantee explicitly state that the buyer/borrower is obliged to pay default interest?	Yes No

30.03.2022 /KSo

5. Reason for non-payment by the buyer/borrower:
6. Has the buyer/borrower disputed the amount/s for which compensation is requested?	Yes No If yes, please describe:
7. Does the agreement covered by the EKN guarantee include a clause which limits the guarantee holder’s right to assign the rights under the agreement and any security related thereto?	Yes No If yes, please describe:
8. Does the guarantee holder have outstanding claims on the buyer/borrower which are not guaranteed by EKN?	Yes No If yes, please specify due date (YY-MM-DD), currency and amount:
9. Has the guarantee holder assigned the rights under the EKN guarantee?	Yes No If yes, to whom?
10. To whom shall the compensation be paid?	Company name: Address: Contact person (name and e-mail address):
To which account shall the compensation be paid?	Account holder: Name of the bank: SWIFT address: Account number/IBAN number: Giro number (if applicable): Reference number (if applicable):

11. A signed assignment form – original document – is attached:	Yes No If no, please state the reason:
Certificate of registration or other document evidencing that the assignment form has been signed by an authorized signatory is attached:	Yes No Has previously been submitted to EKN
12. A signed exporter’s affirmation – copy or original document - is attached:	Yes No Not applicable If no, please state the reason:
Certificate of registration or other document evidencing that the exporter’s affirmation has been signed by an authorized signatory is attached:	Yes No Has previously been submitted to EKN
13. Demand letter/s to the buyer/borrower is/are attached:	Yes No If no, please state the reason:
14. Demand letter/s to guarantor is/are attached:	Yes No Not applicable If no, please state the reason:
15. Describe the measures which have been taken to prevent/minimize loss:
16. The following documents are attached: Contract Order/order confirmation Invoice/s Bill/s of exchange - original document/s Record of protest of the BoE’s – original document/s Bankruptcy order Document proving lodgement of claim in bankruptcy or other insolvency proceedings Proof of deposit of payment to a local bank or similar awaiting transfer	Yes No Has previously been submitted to EKN Not applicable Yes No Has previously been submitted to EKN Not applicable Yes No Has previously been submitted to EKN Not applicable Yes No Has previously been submitted to EKN Not applicable Yes No Has previously been submitted to EKN Not applicable Yes No Has previously been submitted to EKN Not applicable Yes No Has previously been submitted to EKN Not applicable Yes No Has previously been submitted to EKN Not applicable

ADDITIONAL INFORMATION

1. Total outstanding amount (please attach the payment plan):
2. Additional documentation supporting the claim on the buyer/borrower (if applicable):
3. Summary of correspondence with the buyer/borrower and the guarantor (if any) regarding the outstanding amount/s:
4. Contact details of buyer/borrower and guarantor (if any):

We confirm the following:

We have fulfilled our contractual obligations towards the buyer/borrower:

Advance payment has been received (if applicable):

The buyer/borrower/guarantor has not presented any counter-claim or set-off claim:

Guarantee holder’s signature

Date
Company name	Contact person (name, e-mail address and phone number)
Signature	Printed name