EIB 95-10 Application for Long-Term Loan or Guarantee, Attachment

OMB No. 3048-0013
Expires 4-30-2007

LONG TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT H: Co-Financing with Foreign Export Credit Agency
I.

Parties:

Identify the name of the co-financing Foreign Export Credit Agency, and if known, the contact person(s),
their phone and fax numbers, and e-mail addresses:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Describe any relationships between any of the parties in the transaction except as described in Attachment
G, Credit Information or 6.j) of EIB92-48.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
II.

U.S. Supply Contract/Purchase Order Information in Dollars:
U.S. Content included in Supply Contract(s)
Eligible Foreign Content included in Supply Contract(s)
Local Costs (if any) included in Supply Contract(s)
Ancillary Services (if any)
Total Export-Import Bank Portion

III.

$____________
$____________
$____________
$____________
$____________

Non-U.S. Exporter/Supplier Information:
Non-U.S. Exporter(s)/Supplier(s)
With Address and Country of Origin

Description of their Goods and Services

_______________________________
_______________________________
_______________________________

_________________________________
_________________________________
_________________________________

_______________________________
_______________________________
_______________________________

_________________________________
_________________________________
_________________________________

_______________________________
_______________________________
_______________________________

_________________________________
_________________________________
_________________________________

Non-U.S. Supply Contract(s)/Purchase Order(s) Information in Dollars
Foreign ECA Content included in Supply Contract(s)
Eligible Foreign Content included in Supply Contract(s)
Local Costs (if any) included in Supply Contract(s)
Other Services (if any) not included in Supply Contract(s)
Total Foreign ECA Portion

IB Form 95-10 (attachment H)
Revised 1/07

$ ___________
$____________
$____________
$____________
$____________

LONG TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT H: Co-Financing with Foreign Export Credit Agency
IV.

Financed Amount Requested (excluding Exposure Fee):
This chart is to be completed with respect to those Goods and Services included in the Supply Contract(s) for
which financing is requested from Ex-Im Bank. See Foreign Content Policy for Medium- and Long-Term

Exports: http://www.exim.gov/pub/pdf/ebd-m-04a.pdf

1.
2.
3.
4.
5.

Content Sourced in the ECA Country
Eligible Foreign Content
Ancillary/Other Services (if any)
Less Cash Payment
Local Costs (if any)

Ex-Im Bank
$
(

Foreign ECA
$
)

(

Total Financed/Insured
$
)

(

Total Financed/Insured Amount Requested
(excluding Exposure Fee/Insurance Premium)

V.

Other Information:
Describe any non-ECA financing for the Supply Contract(s):
________________________________________________________________________
________________________________________________________________________

Certification:
The applicant consents and certifies that it has obtained the consent of the other transaction participants to
the disclosure by Ex-Im Bank of any information relating to this transaction to the co-financing Foreign
Export Credit Agency, to the extent permitted by applicable law.

Signed ________________________________________________ Dated __________________
Print Name:
Title:
Firm Name:

IB Form 95-10 (attachment H)
Revised 1/07

)