Form EIB 95-10 EIB 95-10 Application for Long-Term Loan or Guarantee

OMB 3048-0013
Expires 3-312007

Export-Import Bank
of the United States

APPLICATION
FOR LONG-TERM
LOAN OR GUARANTEE

This application is to be used for direct loan and guarantee transactions with financed amounts over $10 million (excluding
financed premium), typically with tenors over seven years. It is also to be used for certain Ex-Im Bank products and programs regardless of transaction size or tenor including: Large Aircraft, Limited Recourse and Structured Financing, and
Tied Aid. (To request a Credit Guarantee Facility, please complete the Medium-Term application.)
Additional information on how to apply for Ex-Im Bank long-term loans and guarantees can be found at Ex-Im Bank’s
web site http://www.exim.gov/tools/how_to_apply.html
Send this completed application to Ex-Im Bank, 811 Vermont Avenue, NW, Washington, DC 20571. Ex-Im Bank will
also accept e-mailed PDF and faxed applications. Please note that applications must be PDF scans of original applications
and all required application attachments. (Fax number 202.565.3380, e-mail [email protected]). Hard copies
of required supporting documentation may still be required for limited recourse and structured financing requests.

APPLICATION FORM
1. COMMITMENT OR FINANCING TYPE REQUESTED
A. Product  Comprehensive Guarantee
 Political Risk Guarantee
 Direct Loan
 Preliminary Commitment - See Preliminary Commitment Fact Sheet for eligibility criteria.

A justification for a Preliminary Commitment is to be attached. (http://www.exim.gov/pub81.html)
B Conversion of a Preliminary Commitment or a Letter of Interest
 No
 Yes. The Ex-Im Bank reference number is:
C. Resubmission



Check if this is a resubmission of an application that was previously deemed
incomplete or was withdrawn for other reasons. The Ex-Im Bank reference
number is:

2. PARTICIPANTS::
Applicant name:

Duns #:

Contact person:

Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Nine-digit zip code:

Country:

Taxpayer ID #:

Number of employees:
Applicant’s role in the transaction:  exporter  buyer/ borrower  lender
( if lender is applicant, lenders mandate must be attached)

Primary contact point for Ex-Im Bank inquiries on this transaction:  exporter  lender  borrower

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Exporter. The exporter is the U.S. entity that contracts with the buyer for the sale of the U.S. goods and
services.
•

 Check if the exporter is the applicant. Otherwise, complete the information below for each exporter,

including ancillary service providers.
Exporter name:

Duns #:

Contact person:

Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Nine digit zip code:

Taxpayer ID #:
Number of employees:

Supplier. The supplier is the U.S. company that manufactures the goods and/or performs the services to
be exported.
•

 Check if the supplier is also the exporter. Otherwise, complete the information below for each supplier,

including ancillary service providers.
Supplier name:

Duns #:

Contact person:

Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Nine digit zip code:

Taxpayer ID #:
Number of employees:

Borrower. The borrower is the entity that agrees to repay the loan.


Check if the borrower is the applicant. If not, complete the information below.

Borrower name:

Duns #:

Contact person:

Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Postal code:

Taxpayer ID #:
Country:

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Guarantor. The guarantor is the person or entity that agrees to repay the credit if the borrower does not.
Complete the information below for each guarantor if a guarantor is offered or required.
Guarantor name:

Duns #:

Contact person:

Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Postal code:

Country
Buyer.

The buyer is the entity that contracts with the exporter for the purchase of the U.S. goods and services.
Check if the buyer is also the • borrower or • guarantor. Otherwise, complete the information below.

Buyer name:

Duns #:

Contact person:

Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Postal code:

Country:
End-user.

The end-user is the foreign entity that uses the U.S. goods and services.
Check if end-user is also the  borrower or  guarantor or  buyer. Otherwise, complete the
information below.

End-user name:

Duns #:

Contact person:

Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Postal code:

Country:
Lender.

The lender is the company that extends the Ex-Im Bank guaranteed or insured loan to the Borrower.
Check if the lender is the  applicant. Otherwise, complete the information below.

Lender name:

Duns #:

Contact person:

MGA#
Phone #:

Position title:

Fax #:

Street address:

E-mail:

City:

State/Province:

Nine digit zip code:

Country:

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3. DETAILS OF COVERAGE REQUESTED
A.. Special Features Requested
Check the boxes for the coverage that apply to the transaction. View the fact sheets describing the
coverage on Ex-Im Bank’s web site as noted below. Complete and attach the requested forms.
Large Aircraft
Attachment A required
Foreign Currency Guarantee
(specify currency)
http://www.exim.gov/products/
guarantee/foreign_curr.html

8 Used Equipment
Attachment E required

http://www.exim.gov/products/
ebd-m-13.html

Structured Finance
Attachment G required

Local Cost Support
http://www.exim.gov/products/
policies/local_cost.html

Co-Financing with Foreign
Export Credit Agency
Attachment H required
http://www.exim.gov/pub/
txt/95-10h.doc

8 Nuclear

Environmental Exports Program

http://www.exim.gov/products/
policies/nuclear.html
Nuclear-screening document
must be submitted with application

http://www.exim.gov/products/
policies/used_equip.html

8 Ancillary Service Fees

Project Finance
Attachment F required

8 4-month interest rate hold
(Direct loans only)

http://www.exim.gov/products/
special/environment.html

Captialization of Interest
During Construction

Tied Aid Program
Attachment C required

Finance Lease Structure
http://www.exim.gov/products/
insurance/leasing.html

Military/Security/Police
http://www.exim.gov/products/
policies/military.html

Engineering Multiplier Program
http://www.exim.gov/
ebd-m-03.html

Other __________________

Other

4. TRANSACTION DESCRIPTION
a) Describe Goods and Services. Include make, model, manufacturer/supplier, SIC codes or NAICS (if known)
of goods and services, number of units, values, and estimated U.S. and foreign content. This section does not
need to be completed if the exporter attached a Content Report.

b) Describe the purpose of the transaction. Include answers to the following: Will the goods be used to create or
expand produc tion capacity for an exportable product? Are the goods and services destined for an identifiable project?
If so, provide information on the total estimated project cost in US dollars. Also provide information as to other sources
of financing for the project, including working capital.

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c) Indicate whether an application for support of this export contract or a related project has been filed with the Agency
for International Development, Maritime Administration, Overseas Private Investment Corporation, Trade Development
Agency or a multilateral financing agency. If so, include a brief description of the additional support.

5. REQUESTED FINANCING AMOUNTS AND STRUCTURE
Ex-Im Bank support is based on the value of the eligible goods and services in the exporter’s supply contract(s) or
purchase order(s). The total level of support will be the lesser of: 85% of the value of all eligible goods and services; or
100% of the U.S. content included in all eligible goods and services in the exporter’s supply contracts. In addition, ExIm Bank may also finance certain local costs, ancillary services as approved, and the exposure fee/premium. Fill out
the chart below to determine estimated eligible amounts.
Definition

US$

Supply Contracts
or Purchase
Orders

The aggregate price of all goods and services in all
the supply contract(s) or purchase order(s), including
local costs, ancillary services, and excluded goods
and services. Break out ancillary services in Aii.

Ai

B

Excluded Goods
and Services

C

Total Local Costs

The aggregate price of all goods and services that are
not eligible for or are excluded from Ex-Im Bank support (e.g. goods not shipped from the U.S. and
excluded ancillary services). Local costs should not
be included in this line.
The aggregate price of all goods manufactured in the
end-user’s country and all services provided by residents of the purchaser’s country. Ex-Im Bank may be
able to finance these amounts up to 15% of D below.

D

Net Contract Price

A minus B minus C

E

Eligible Foreign
content

The aggregate cost of any goods produced or manufactured outside the U.S, or services provided by
third country personnel or foreign freight costs and
foreign insurance included in the net contract price
(line D), (e.g. foreign items shipped from the US)

F

U.S. Content

D minus E

G

Cash Payment

This amount must be the greater of E or 15% of D

H

Local Cost
Financing

This can be no more than 15% of D

I

Financed
Amount Requested
(Excluding
Exposure Fee)

A

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D minus G plus H

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Aii

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A. Exposure Fee . Check one box.
 Ex-Im Bank to finance the fee, which will be paid as the credit is drawn down.
 Ex-Im Bank to finance the fee, which will be paid up front.
 Ex-Im Bank will not finance the fee, and it will be paid as the credit is drawn down.
 Ex-Im Bank will not finance the fee, and it will be paid up front.

B. Transaction Structure.
i. Principal Repayment Term. _______(years). Unless otherwise requested, equal installments of principal will
be repaid semi-annually beginning six months after the starting point.
ii Starting Point. The starting point is generally the event that marks the fulfillment of the exporter’s contractual
responsibility. See Ex-Im Bank’s fact sheets on starting points and reach-back policies at www.exim.gov.
(Check
one box.)
 Shipment (single shipment)
 Services Completion.
 Final Shipment (multiple shipments)
 Completion of Installation. Specify date:
 Mean Shipment (multiple shipments)
 Project Completion. Specify date:
 Other
iii Shipment Period. Shipments will be completed and/or services will be performed from:
[
] (month/year) to [
] (month/year) excluding any acceptance, retention,
or warranty period.
iv. Interest rate.
The interest rate to be charged on the guaranteed loan is:

6. REASON FOR REQUESTING EX-IM BANK SUPPORT..
Ex-Im Bank will finance the export of U.S. goods and services if it can be demonstrated that Ex-Im Bank
support is necessary for the transaction to proceed. Check one of the boxes below describing why support
is necessary.
 The exporter is aware that foreign companies are competing, or are expected to compete for the sale. Provide

company name, country, and (if known/applicable) the supporting export credit agency.

 The exporter is aware that foreign companies manufacture comparable goods and services that are sold in the

buyer’s market with export credit agency support available. Provide company name, country, and (if known/
applicable) the supporting export credit agency.

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There is limited availability of private financing (from either external or domestic sources).

Indicate how financing is constrained by checking the appropriate box.




No availability of economically viable interest rates on terms over one to two years.
Financial institution lending capacity limits reached for either borrower and/or country.
Other (please describe)

7. CREDIT INFORMATION
The credit information outlined in the following is attached.

Large Aircraft (Attachment A)

Long-Term and Structured Transactions ( Attachment G)

Limited Recourse Project Finance (Attachment F)

8. OTHER INFORMATION AND CERTIFICATIONS
A. General Information - Provide the following:
 Credit Agency report(s) on the exporter(s). If exporter has a credit rating of BBB or better, this is not required.
 Annex A to the Master Guarantee Agreement (Guarantees only) at http://www.exim.gov/pub/pdf/mt-anx-exec.pdf
 Lender’s mandate letter (required when applicant is a financial institution).
 Environmental Screening (attachment B).
B. Supply Contracts Between the Exporter and Buyer.
 Sales contract(s), pro forma invoice(s), or purchase order(s) are attached.
 No contract is attached. (Project Finance and Preliminary Commitments only)

C. Commitment Fee Agreement.
A commitment fee accrues starting 60 days after the authorization of a final commitment and is payable semiannually
in arrears on a schedule determined at the time of authorization. The commitment fee is 1/8 of 1% per annum on
the un-disbursed and un-cancelled balance of a guaranteed loan or 1/2 of 1% per annum for a direct loan. Choose
one of the options below regarding the payment of the commitment fee:
 The applicant is the borrower, and by signing the application, is irrevocably committing to pay the commitment fee.
 The applicant is the guaranteed lender, and is (check one):


signing the application which irrevocably commits it to pay the fee, or
 signing the application and enclosing with it an Ex-Im Bank standard form fee letter from the borrower
(at http://www.exim.gov/pub/pdf/mt-anx-exec.pdf). This letter irrevocably commits the borrower to pay the fee.
 The applicant is the exporter, and is signing the application and enclosing with it an Ex-Im Bank standard form
fee letter from the  borrower or  guaranteed lender (at http://www.exim.gov/pub/pdf/mt-anx-exec.pdf).
This letter irrevocably commits the borrower or guaranteed lender to pay the fee.
D. Content Report
Ex-Im Bank does not require the Content Report at the time of application. Processing of, and the decision on, the
application will not be delayed or affected by the submission or absence of the report. A Cause Report EBD-M-55
is requested at the end of each calendar year to describe the nature and reason for the inclusion of any good and
services with 50% or more foreign content in the good or service.
E. Anti-Lobbying Disclosure form
Please refer to the Anti-Lobbying Declaration/Disclosure forms (at http://www.exim.gov/pub/pdf/95-10d.pdf ) and
include a signed copy of the appropriate form(s) with your application.

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F. Certifications
The applicant certifies that the facts stated and the representations made in this application and any attachments to
this application are true, to the best of the applicant’s knowledge and belief after due diligence, that the applicant has not
omitted any material facts. The applicant certifies that neither it, nor its principals, have with in the past three years been
a) debarred, suspended, declared ineligible from participating in, or voluntarily excluded from participation in, a covered
transaction, b) formally proposed for debarment, with a final determination still pending, (c) indicted, convicted or had a
civil judgment rendered against it for any of the offenses listed in the Regulations, (d) delinquent on any substantial debts
owed to the U.S. Government or its agencies or instrumentalities as of the date of execution of this application; or (e) the
applicant has received a written statement of exception from Ex-Im Bank attached to this certification, permitting participation in this Covered Transaction despite an inability to make certifications a) through d) in this paragraph. We further
certify that we have not and will not knowingly enter into any agreements in connection with the Goods and Services with
any individual or entity that has been debarred, suspended, declared ineligible from participating in, or voluntarily excluded from participation in a Covered Transaction. All capitalized terms not defined herein shall have the meanings set forth
in the Government-wide Non-procurement Suspension and Debarment Regulations - Common Rule (Regulations). The
applicant is not listed on any of the publicly available debarment lists of the following international financial institutions:
World Bank Group, African Development Bank, Asian Development Bank, European Bank for Reconstruction and
Development and the Inter-American Development Bank.
In addition, the applicant certifies that neither the applicant nor anyone acting on its behalf, such as agents, has
engaged,or will engage, in any activity in connection with this transaction that is a violation of the Foreign Corrupt Practices
Act of 1977, 15 U.S.C. 78dd-1 et seq. (which provides for civil and criminal penalties against companies and individuals
who directly or indirectly make or facilitate corrupt payments to foreign officials to obtain or keep business). Further, the
applicant has not engaged, and will not engage, in any activity in connection with this transaction that is a violation of the
Arms Export Control Act, 22 U.S.C. 2751 et seq., the International Emergency Economic Powers Act, 50 U.S.C. 1701 et
seq., or the Export Administration Act of 1979, 50 U.S.C. 2401 et seq. The applicant has not been found by a court of the
United States to be in violation of any of these statutes within the preceding 12 months, and to the best of its knowledge,
the performance by the parties to this transaction of their respective obligations does not violate any other applicable law.
The applicant certifies that neither the applicant nor anyone acting on its behalf in connection with this transaction is currently under charge or has been, within the past 5 years, convicted in any court or subject to national administrative
measures of any country for bribery of foreign public officials.
The applicant certifies that the representations made and the facts stated in this application and its attachments are true,
to the best of its knowledge and belief, and it has not misrepresented or omitted any material facts. It further understands
that these certifications are subject to the penalties for fraud against the U.S. Government (18 USC 1001, et. seq.).
9. NOTICES
The applicant is hereby notified that information requested by this application is done so under authority of the ExportImport Bank Act of 1945, as amended (12 USC 635 et. seq.); provision of this information is mandatory and failure to provide the requested information may result in Ex-Im Bank being unable to determine eligibility for support. If any of the information provided in this application changes in any material way or if any of the certifications made herein become untrue,
the applicant must promptly inform Ex-Im Bank of such changes.
The information provided will be reviewed to determine the participants’ ability to perform and pay under the transaction
referenced in this application. Ex-Im Bank may not require the information and applicants are not required to provide
information requested in this application unless a currently valid OMB control number is displayed on this form (see upper
right of each page).
Paperwork Reduction Act Statement: We estimate that it will take you about 2 hours to complete this form. This
includes the time it will take to read the instructions, gather the necessary facts and fill out the form. However, you are
not required to provide information requested unless a valid OMB control number is displayed on the form. If you have
comments or suggestions regarding the above estimate or ways to simplify this form, forward correspondence to Ex-Im
Bank and the Office of Management and Budget, Paperwork Reduction Project, Washington, D.C. 20503.
Applicant (company) name:
Name and tittle of authorized officer:
Signature of authorized officer:
Date:
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