Name * CIF/Company number * Telephone * E-mail * Website * Activity * Number of employees * Consolidated turnover (last 12 months) * € Have you been trading for the last two years? * Yes No Have you made profit in the last year? * Yes No Have you declared a positive net worth in your latest annual accounts (total assets exceed total liabilities)? * Yes No Did your accountant qualify their opinion in your latest filed annual report and accounts? * Yes No Does the company or any affiliated societies have any assets in the USA or Canada, or does the company’s turnover include any turnover from USA or Canada? * Yes No Does the company or any affiliated societies expects to lay off any employees in the next 12 months? * Yes No Are all disciplinary actions or employee subject to a prior review and approval by human resources and administrators? * Yes No Are all duties segregated so that at least dual control exists on signing cheques, issuing instructions for disbursement of assets or funds, fund transfer procedures and investments? * Yes No In the last five years, have there been any claims and or investigations made against company, its directors, officers or employees which may have been covered by this policy it been in force? * Yes No After enquiry, are the company or its directors officers or employees aware of any fact, circumstance, allegation or incident which may give to a claim under the proposed policy? * Yes No LOPDGDD 3/2018: OP DE BEECK & WORTH CORREDURIA DE SEGUROS S.L. will use your data to process the provision of information requested by completing this form. You can access, rectify or eliminate your personal data, as well as exercise other rights as explained in the privacy policy. I have read and accept the terms of the Privacy policy. Terms & Conditions * Submit
