supplementary information for the lease limit application

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SUPPLEMENTARY INFORMATION FOR THE LEASE LIMIT APPLICATION
1. Applicant’s data
Company’s name
Company’s registered office
(address, phone)
NIP (VAT) and REGON numbers
Contact person
2.
PPROPERTIES HELD
Address
Property
Register no.
Type of property
ha
Total mortgage
encumbrances
Market value
3. Company’s business activities:
............................................................................................................
............................................................................................................
Share of the range of goods in sales
Sale of farming machinery
[%] share in revenue
4. Capital/ organisational/ personal relations within Group of Companies:
Company’s name and address
Type of relation
[%] of shares
Equity in [PLN k]
5. Number of persons employed: . . . . . . . . . . . .
6. Sale structure:
DOMESTIC: . . . . . . . . . . . . %
EXPORT: . . . . . . . . . . . . %
7. Major customers
Company’s name/ country
Products
[%] share
in sales
Terms
of payment
[days]
How long has
been the cooperation? [years]
Individual customers
IKB Leasing Polska Sp. z o.o. • ul. Seweryna Mielżyńskiego 14 • Okrąglak • 61-725 Poznań
Tel.: +48 61 84 60 310 • Fax: +48 61 84 60 329 • [email protected] • www.ikb-leasing.pl
Członkowie Zarządu: dr Wilfried Barth, Peter Hartmann, Anna Kamińska-Skrzypczak, Adam Górczyński
Kapitał zakładowy 16.000.000,- PLN • NIP: 778-13-70-639 • mBank S.A. O/Poznań 58 1140 1124 0000 5470 0200 1001
Sąd Rejonowy Poznań - Nowe Miasto i Wilda w Poznaniu, VIII Wydział Gospodarczy KRS • nr KRS 0000002358
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8. Major suppliers:
Name
Products
[%] share in
purchases
Terms
of payment
How long has
been the cooperation? [years]
9. Major competitors and company’s market position (strengths/weaknesses):
............................................................................................................
............................................................................................................
............................................................................................................
............................................................................................................
............................................................................................................
10. Existing credits and loans as of 31-12-2014
(corresponding period for the financial data submitted):
Credit / loan type
Credit given
Lender
Monthly
instalment
Current debt
Maturity date
Current debt
Lease
expiration
11. Existing leases (except IKB Leasing Polska Sp. z o.o.) as of 31-12-2014
Lessor
Leased assets
Monthly
instalment
12. Receivables structure (paid on time/ overdue) as of 31-12-2014
Total
Current
Including overdue
items up to 30 days
Including overdue
items
30 - 90 days
Including
overdue items over
90 days
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13. Liabilities structure (paid on time/ overdue) as of 31-12-2014
Total
Current
Including overdue
items up to 30 days
Including
overdue items
30 - 90 days
Including overdue
items over 90 days
14. For any loss occurred in the last full or current accounting period, specify the reasons ............................................................................................................
............................................................................................................
............................................................................................................
............................................................................................................
15. Statement:
I hereby represent that we have/have not any due liabilities to the Social Insurance Institution [ZUS] or Inland
Revenue and we are/are not a party to any arrangements for payment of such liabilities to any of these two
bodies.
16. I apply for a limit of EUR/PLN …………………… for the following objects:
............................................................................................................
............................................................................................................
17. Attachments:
Yes
a
b
c
d
e
No
Balance Sheet and Income Statement for 2012, 2013 and
up-to-date
PIT tax returns for 2012, 2013
No arrears certificates issued by ZUS and Inland Revenue
This filled in Supplementary Information including information on assets and liabilities except those relating to the
business conducted, plus signed data base consents
Licensed auditor’s opinion and report, financial statements
and notes to the financial statements*
*where applicable
................................................
date, signed
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Information on assets and liabilities except those relating to the business conducted
Full name
Address, phone
Pesel ID no.
Marital status (separation of property)
Company’s name
(address, phone)
SHARES IN OTHER ENTITIES
Number of
shares
Entity’s name and address
Nominal
value
Estimated current total market value
REAL PROPERTY
Type of property
Address
Property Register no.
Date of purchase
Market value
Total mortgage
encumbrances
Other property (machines, devices, movable property above PLN 100 k)
Type
Estimated market value
Encumbrances
Receivables (e.g. loans extended)
Debtor’s name and address
Type of receivables
Total amount of
receivables
Due date
Collateral
4
Loans/ credits/ leases/ warranties, guarantees given
Lender’s name and address
Type of liability
Total liability
Monthly
instalment
Maturity date
Collateral
Court, enforcement, composition, bankruptcy, restructuring proceedings
- personal or relating to businesses conducted
Type of proceeding
Main creditors
Total liability
covered by the
proceeding
Term
Guarding
Equipment
Aware of civil and criminal liability, I represent that all information provided by me in the personal financial
statement is true and correct.
................................................
Place, date
................................................
Signed by the person making the statement
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supplementary information for the lease limit application

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