Form EIB 03-02 EIB 03-02 Application for Medium-Term Insurance or Guarantee

OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States

Print Form

APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE

This application is to be used for insurance and guarantee transactions with financed amounts of $10 million or less
(excluding financed premium) and repayment terms between eighteen months and seven years. Applications for other Ex-Im
Bank products can be found on Ex-Im Bank’s web site under the “Apply” section.
Additional information on how to apply for Ex-Im Bank medium-term insurance or guarantees can be found at Ex-Im Bank’s
web site http://www.exim.gov/tools/how_to_apply.html.
An online version of this application is available on Ex-Im Bank’s web site. Ex-Im Bank encourages customers to apply online, as it will facilitate our review and allow customers a faster response time. Additional information on how to apply for
Ex-Im Bank insurance can be found at Ex-Im’s web site http://www.exim.gov.
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 the applications must be PDF scans of original applications and all
required application attachments. (Fax number 202.565.3675, e-mail [email protected]).

APPLICATION FORM
Applicant name: _______________________________Duns#:_________________________________________________
Contact person: ________________________________Phone#:________________________________________________
Position Title:

________________________________Fax#:__________________________________________________

Street address: _________________________________E-mail: ________________________________________________
City: ___________________State/Province: _______________ Nine-digit Zip Code: _______________________________
Country: ______________________________________NAICS Code: ___________________________________________
Total number of employees: _______________________Total Revenues:________________________________________
Check if this is a minority owned business
Check if this is a women owned business

Broker (Insurance Only)



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Check if there is no broker 

Broker name: _________________________________________________ Ex-Im Bank Broker#:______________________
Contact person: ________________ Phone # ______________Fax#:___________________E-mail: ____________________
1. GENERAL QUESTIONS
Insurance
A. Product
Finance Lease Guarantee
Loan Guarantee. Enter MGA# if known __________________
B. Coverage type
Comprehensive risk
Political risk
C. Conversion of a Preliminary Commitment or a Letter of Interest
No
Yes. The Ex-Im Bank reference number is: _______________
D. 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: _________________________
E. Renewal
CGF (Credit Guarantee Facility)
MTR (Medium-Term Repetitive Insurance Policy)
F. Primary contact point for Ex-Im Bank inquiries on this transaction:
Exporter
Broker (Insurance only) Lender/Lessor
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OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
2. SPECIAL COVERAGES
Check the boxes for the coverage(s) that apply to the transaction. View the fact sheets describing the coverage(s) on Ex-Im
Bank’s website as noted below. Complete and attach the requested forms.
Pre-shipment Cover
Used Equipment
Co-Financing with Foreign Export
Attachment II – Pre-shipment
Attachment III - Used Equipment
Credit Agency
Questionnaire required
Information and Questionnaire
Attachment H required
required
http://www.exim.gov/tools/appsforms/
EIB95-10attachmentH.pdf
Local Cost Support
www.exim.gov/products/policies/local
_cost.html

Foreign Currency Coverage
(specify currency) _______
Supply contract denominated in.
US$
Foreign currency

Ancillary Service Fees
www.exim.gov/products/ebd-m13.html

Credit Guarantee Facility
www.exim.gov/products/credit_guar.h
tml

Foreign Dealer Insurance Policy
Attachment IV Required

Leasing
Specify
Guarantee
www.exim.gov/tools/appsforms/leaseg
uar.html
Insurance
http://www.exim.gov/products/insuran
ce/leasing.html

Environmental Exports Program
www.exim.govv/products/special/envi
ornment.html
Environmentally Beneficial
Renewable Energy
Military/Security/Police
http://www.exim.gov/products/policies
/military.html

Other ________________

3. PARTICIPANTS:
What is the Applicant’s role in the transaction?

Exporter

Buyer/borrower/lessee

Lender/lessor?

Exporter: The exporter is the U.S. entity that contracts with the buyer for the sale of the U.S. goods and services. In the case
of a finance lease, if the lessor is a U.S. entity and takes title to the goods and services for lease to the foreign lessee, the
lessor is the exporter.
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:________________________________Postal code:________________________
NAICS Code: __________________ Total number of employees: ____________ Total Sales: ________________________
Check if this is a minority owned business
Check if this is a women owned business

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OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
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#:______________________________________________
Position title:_____________________________________Fax:#________________________________________________
Street address: ____________________________________E-mail: _____________________________________________
City: ___________________________State:________________Nine-digit Zip Code:_______________________________
NAICS Code: __________________ Total number of employees: ____________ Total Sales: ________________________
Check if this is a minority owned business
Check if this is a women owned business

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Borrower or Lessee: The borrower is the entity that agrees to repay the loan. The lessee is the entity that agrees to lease
the goods and services from the lessor and pay rent under a finance lease.
Check if the borrower/lessee is the applicant. If not, complete the information below.
Borrower’s/Lessee’s name: ______________________________________________________________________________
Contact person: ___________________________________ Phone#:_____________________________________________
Position title: _____________________________________Fax#:_______________________________________________
Street address:____________________________________E-mail: ______________________________________________
City: __________________________State/Province: _________________________________Postal code:______________
Country:_____________________________________________________________________________________________
Guarantor: The guarantor is the person or entity that agrees to repay the credit if the borrower or lessee does not. Refer to
the Medium-Term Credit Standards (at http://www.exim.gov/tools/credit_stds.html) to determine in what situations personal
or corporate guarantors are required for medium-term transactions.
Check to indicate whether
There is no guarantor
The guarantor is an individual
The guarantor is a financial institution
The guarantor is a
corporation. Complete the information below for each guarantor.
Guarantor name: _____________________________________________________________________________________
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
guarantor. Otherwise, complete the information below.
buyer is also the borrower/lessee or lessor or
Buyer name: ________________________________________________________________________________________
Contact person: ___________________________________Phone#:____________________________________________
Position title: _____________________________________Fax#:______________________________________________
Street address:____________________________________E-mail: ____________________________________________
City: _________________________State/Province: _________________ Postal code:_____________________________
Country: ___________________________________________________________________________________________
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OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
End-user: The end-user is the foreign entity that uses the U.S. goods and services.
Check if end-user is

The borrower/lessee o r

Guarantor or

Buyer. Otherwise, complete the information below.

End-user name: _______________________________________________________________________________________
Contact person: ___________________________________Phone#:______________________________________________
Position title: _____________________________________Fax#:________________________________________________
Street address:____________________________________E-mail: ______________________________________________
City: _________________________State/Province: _______________Postal code:_________________________________
Country: _____________________________________________________________________________________________
Lender/Lessor: The lender is the company that extends the Ex-Im Bank guaranteed or insured loan to the Borrower. The
Lessor is the company that extends the Ex-Im Bank guaranteed finance lease to the Lessee.
Check if the lender/lessor is the applicant. Otherwise, complete the information below.
Lender’s/Lessor’s name:________________________________________________________________________________
Contact person: ___________________________________Phone#:______________________________________________
Position title: _____________________________________Fax#:________________________________________________
Street_address:____________________________________E-mail: ______________________________________________
City: ____________________________State/Province: ____________________Postal code:_________________________
Country: _____________________________________________________________________________________________
Agent:
An agent is a business entity or individual, usually located in the country of the borrower or buyer, who has assisted in the
sourcing, packaging, and/or preparation of a request for support from Ex-Im Bank, and who will receive compensation in
some form for their services.
No
Is an agent involved in this transaction? Yes
If yes, add the agent information below:
Agent’s legal name: ________________________________Province:____________________________________________
Contact person: __________________________________Country:______________________________________________
Position title: ____________________________________E-mail: ______________________________________________
Street address: ___________________________________Phone:_______________________________________________
City: _____________________________Postal code: ___________________________Fax:_________________________
Primary Source of Repayment (PSOR)
The PSOR is the entity whose financial statements form the basis of Ex-Im Bank’s evaluation of reasonable assurance of
repayment, i.e. the entity whose financial statements Ex-Im Bank uses to calculate the ratios for medium-term credit
standards compliance. For this transaction, indicate whether the PSOR is:
the buyer
the corporate guarantor, or
business combination, (e.g. the consolidated or combined financial statement of the buyer and one or more corporate
guarantors.) If business combination, indicate which entities comprise the combination
____________________________________________________________________________________________________
Is the PSOR a financial institution?
Yes
No
Select the risk category of the PSOR:
Sovereign
Private
Public Non-sovereign
Yes
No
Does the PSOR have a bond rating?
If yes, indicate the name of the rating agency, rating, and the date of the rating. _____________________________________
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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
4. TRANSACTION DESCRIPTION
a)
Describe the U.S. goods and service(s). Include make, model, manufacturer/supplier or NAICS 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 attaches a Content Report (www.exim.gov/pub/pdf/ebd-m-58.pdf) or if the request is for a Credit Guarantee Facility.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Check if the goods and services or their use meet Exim Bank's requirements for an environmentally beneficial determination.
Check if the goods and services or their use meet Exim Bank's requirements for a renewable energy determination.

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

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

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OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
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, Ex-Im 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

Supply Contracts or Purchase Orders
[If the lessor is a U.S. entity and
takes title to the U.S. goods and
services for lease to a foreign lessee,
the finance lease is the supply
contract]

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 A(ii).

B

Excluded Goods and Services

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.

C

Total Local Costs

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 30% 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 cost and foreign insurance included in the
net contract price (line D), (e.g. foreign items
shipped from the U.S.).

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 Requested

This can be no more than 15% of D

I

Financed Amount Requested
(Excluding Exposure Fee)

D minus G plus H

A

EIB 03-02
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6

A(i)

US$

A(ii)

0.00

0.00

0.00

OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
A.

Exposure Fee (Guarantees)/ Premium (Insurance) Check one box.
Ex-Im Bank to finance the fee/premium, which will be paid as the credit is drawn down.
Ex-Im Bank to finance the fee/premium, which will be paid up front.
Ex-Im Bank will not finance the fee/premium, and it will be paid as the credit is drawn down.
Ex-Im Bank will not finance the fee/premium, and it will be paid up front.

B. Transaction Structure:
i. Principal Repayment Term/Finance Lease: _______(years). Unless otherwise requested, equal installments of principal
will be repaid semi-annually beginning six months after the starting point. In the case of a finance lease, unless otherwise
requested, rent will be calculated based on equal installments of principal, paid 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.)
Services Completion.
Shipment (single shipment)
Final Shipment (multiple shipments)
Completion of Installation. Specify date:___________
Mean Shipment (multiple shipments)
Project Completion. Specify date:________
Consolidation Date (Foreign Dealer Insurance Policy only)
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. If shipment is planned
for a certain number of days after Ex-Im Bank authorization, so note: ____________________________________________
iv. Promissory Notes/Lease Supplements: For transactions with multiple shipments indicate:
There will be one promissory note per shipment.
Disbursements will be consolidated into one promissory note.
(Finance lease only) There will be one lease supplement per shipment.
(Finance lease only) Lease deliveries will be consolidated under one lease supplement.
v. Interest rate:
The interest rate to be charged on the guaranteed/insured loan or used to calculate the rent under a finance lease 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.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
There is limited availability of private financing available from either external or domestic sources.

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OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
7. CREDIT INFORMATION
The information requested in Attachment I: Credit information is attached.
8. OTHER INFORMATION, NOTICES 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 www.exim.gov/tools/appsform/documents/MTMGAAnnexes.pdf
Annex A to the Medium-Term Master Guarantee Agreement – Finance Lease (Finance Lease Guarantees only)
Lender’s mandate letter (require when applicant is a financial institution)
B. Supply Contracts Between the Exporter and Buyer
Sales contract(s), pro forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction between the
exporter and buyer are attached.
The exporter(s) are not the manufacturers of the goods nor the producers of the services to be exported; the Sales contract(s),
pro forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction between the supplier(s) and exporter(s)
are attached; AND the Sales contract(s), pro forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction
between the supplier(s) and buyer are attached.
C. Anti-Lobbying Disclosure Form
Please refer to the Anti-Lobbying Declaration/Disclosure forms attached as Attachment V and, if applicable, the
Disclosure Form available at http://www.exim.gov/pub/ins/pdf/lll.pdf and include a copy of the signed form(s) with
your application. This requirement applies both to applicants and recipients who are not the applicant for a final
commitment.
The disclosure requirements do not apply where the U.S. Government-financed portion is $150,000 or less. Nor do
they apply to foreign governments, their instrumentalities or their wholly-owned companies.
D. Commitment Fee/Facility Fee Agreement (Guarantees and Credit Guarantee Facilities only)
A commitment fee, applicable only to guaranteed and direct loans, accrues starting 60 days after the authorization of a final
commitment and is payable semi-annually 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 and ½ of 1% per annum for a
direct loan.
A facility fee, applicable only to a credit guarantee facility (and in lieu of a commitment fee), is 1/16 of 1% of the principal
amount of the facility, due in full at the time of authorization of a final commitment, and payable in two equal installments
due approximately 90 and 270 days from the date of authorization of the final commitment.
Choose one of the options below regarding the payment of the commitment or facility fee:
This question is not applicable because this application is a request for insurance coverage.
The applicant is the borrower and by signing the application is irrevocably committing to pay the commitment or
facility fee.
The applicant is the guaranteed lender or the exporter, 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. This standard form fee letter is attached as Attachment VI. This letter irrevocably
commits the borrower to pay the fee.

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OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
E. Certifications
The applicant certifies that neither it, nor its Principals, have within the past 3 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 undersigned 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.
The applicant further certifies that it has not and will not knowingly enter into any agreements, in connection with the
products and services to be exported in the transaction described herein, with any individual or entity that has been
debarred, suspended, declared ineligible from participating in, or voluntarily excluded from participation in a Covered
Transaction. The term “Covered Transaction” shall have the meaning set forth in the Ex-Im Bank Debarment Regulations.
"Debarment Regulations" shall mean, collectively: (1) the Export-Import Bank's Nonprocurement Debarment and
Suspension regulations, 2 C.F.R. Part 3513, adopting by reference, the OMB Guidelines to Agencies on Governmentwide
Debarment and Suspension (Nonprocurement), 2 C.F.R. Part 180; and (2) the Debarment, Suspension, and Ineligibility
provisions of the Federal Acquisition Regulation, 48 C.F.R. 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.
Further, the applicant certifies that the representation made and the facts stated in this document and any attachments are
true, to the best of its knowledge and belief, and it has not misrepresented or omitted any material facts, and if any of the
certifications made herein become untrue, Ex-Im Bank will be promptly informed of such changes. The applicant further
understands that these certifications are subject to the penalties for fraud against the U.S. Government (18 U.S.C. 1001 et seq.).
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 U.S.C. 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. 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 lower
left of each page).
Public Burden Statement: Reporting for this collection of information is estimated to average 1 hour per response,
including reviewing instructions, searching data sources, gathering information, completing, and reviewing the application.
Send comments regarding the burden estimate, including suggestions for reducing it, to Office of Management and Budget,
Paperwork Reduction Project OMB# 3048-0009, Washington, D.C. 20503.
Applicant Name: _______________________________________________________________________________
Name and title of authorized officer: ________________________________________________________________
Signature of authorized officer: ____________________________________________________________________
Date: _________________________________________________________________________________________
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OMB 3048-0014
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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
Attachment I: Credit Information Requirements
1. INFORMATION ON THE BORROWER:
If the primary source of repayment for the transaction is a corporate guarantor provide only 1a), 1b) and 1 c)
on the borrower;
If current information (within the last six months) as described below is on file at Ex-Im Bank, indicate
Guarantee or Policy #_________________________________________________________
If the primary source of repayment is the borrower, provide the information noted in 1 a) – 1 g) below (note
optional information described in part 3):
a) Company description and ownership
Provide a concise description of the company origin, legal status, facilities, business activities and primary
markets.
Provide the name of each owner of at least 10% of company shares and his/her ownership percent.
b) Related party information
Provide names and a brief description of subsidiaries, parent company, and/or commonly owned companies
(“related parties”).
Indicate which, if any, of the related parties account for more than 25% of the borrower’s sales or purchases
during the last fiscal year.
Indicate which, if any, related parties extend loans to the borrower or to whom the borrower extends loans, if
loans are material to the borrower. Materiality is defined as 10% of the borrower’s total assets.
Provide details of guarantees given on behalf of related parties by the borrower, if loans are material to the
borrower.
c) Credit agency report
Provide a credit agency report on the borrower not older than six months from date of application,
or
Check if credit agency report is not applicable because the borrower is a financial institution
(bank), or a foreign government agency.
d) Creditor Bank or Supplier References
Provide a creditor bank reference prepared within six months of the application date. Report should include
bank name, address, and length of relationship, amount, currency, and terms of secured and unsecured credit
and repayment experience.
If the borrower does not have any financial institution creditors, provide two supplier references.
Supplier references should be dated within six months of the application and include years of credit
experience, annual sales, the terms of sale, the amount of the last sale, the recent high credit, the amount
currently outstanding, details on any past due amounts, and repayment experience.
e) Financial Statements
There are certain requirements for all financial statements, regardless of the amount of the transaction.
These are as follows:
i) Provide financial statements for the previous three fiscal years, as well as interim statements if the latest fiscal
year end statements are dated more than nine months from the date of application. When interim statements are
provided, also provide interim statements for the same interim period for the previous year (for comparative
purposes).

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OMB 3048-0014
Expires 10-31-2009

Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
ii)
A summary of significant accounting principles must accompany all financial statements. These should
outline, at a minimum, the depreciation methods and rates, valuation methods for inventory, fixed assets and
investments and the inflation accounting method used, if any. For construction companies, a description of the
revenue recognition method should be included. Additionally, financial statements should break out depreciation
expense, gross interest expense, tax expense and current maturities of long-term financial institution or supplier
debt, if any.
For all financial statements that present combined or consolidated results, provide the percentage of total
iii)
assets, total liabilities, tangible net worth, sales, and net income represented by each entity that is participating in the
transaction as the buyer, borrower, guarantor or end-user. A combining/consolidating worksheet would have all this
information.
There are certain additional financial statement information requirements that depend on the amount of the
financing request as follows:
For financed amounts of up to and including $1 million: Audited financial statements are preferred but not
iv)
required for non-financial institutions. Audited statements are required for financial institutions. While English
language statements are preferred, Ex-Im Bank will accept Spanish language financial statements.
v) For financed amounts of greater than $1 million up to and including $5 million: While English language
statements are preferred, Ex-Im Bank will accept Spanish language financial statements. Financial statements must
be audited by an external independent auditor.
vi) For financed amounts of greater than $ 5 million: Financial statements must be audited by an external
independent auditor. Statements must be in English.
f) Market indications, if available, are as follows:
Name of rating agency: ________________________________ Rating:____________ Date: __________
Include the debt rating reports issued by the rating agency, and if applicable, the prospectus for a debt or equity offering
during the two years prior to the application dates.
g) Supplemental Credit Questions
Provide the answers to the questions listed in Attachment C to the Medium-Term Credit Standards for transactions of
greater than $5 million up to and including $10 million where the primary source of repayment is a non-financial institution
that does not have market indications. These questions are located on Ex-Im Bank’s web site at
http://www.exim.gov/pub/pdf/ebd-m-39.pdf.
2. INFORMATION ON THE CORPORATE GUARANTOR (S):
Not applicable. Refer to the Medium-Term Credit Standards at http://www.exim.gov/pub/pdf/ebd-m-39.pdf to determine
in what situations corporate guarantors are required for medium term transactions.
If the corporate guarantor is not the primary source of repayment, provide 1 a), and 1 b) and 1 c) as described above.
If the corporate guarantor is the primary source of repayment, provide the information noted in 1 a) – 1 g)

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE

3. OPTIONAL ITEMS WHICH THE APPLICANT MAY ATTACH. (These may expedite the processing of your
application).
Financial spreads on the borrower and/or guarantor designated as the primary source of repayment. See Ex-Im Bank’s
website for spreading conventions, which should be used as guidelines.
Calculation of the financial performance criteria of Ex-Im Bank’s Medium-Term Credit Standards on the borrower or
guarantor designated as the primary source of repayment.
Mitigating factors for any of the performance criteria that are not met.
Supplemental credit questions as detailed in 1 g) for deals of less than $5 million.
Translations of Spanish language financial statements, if applicable.
Explanations of any adverse information contained in the credit report, references and/or financial statements, including
interims.

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
Attachment II: Pre-shipment Questionnaire
Complete this fo rm o nly if you are requ esting pre-sh ipment in surance coverage for yo ur transactio n.
Details on pre-shipment coverage can be found at http://www.exim.gov/pub/ins/pdf/eib01-04.pdf.
Details of Coverage Requested:
a) Provide the reason pre-shipment coverage is being requested: _______________________________________________
b) Indicate the date the contract was executed or the anticipated date of signing: ___________________________________
c) Indicate the estimated period between the contract date and the final shipment date of items: _______________________
d) Provide a schedule of any progress payments made or to be made by the borrower during the pre-shipment period, or
indicate none:
_________________________________________________________________________________________________

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
Attachment III: Used Equipment Information and Questionnaire
USED AND REFURBISHED EQUIPMENT
Equipment that has been previously owned or placed into service is generally eligible for support under Ex-Im
Bank's loan, guarantee and insurance programs, provided certain criteria are met. To be eligible for Ex-Im Bank
support, used equipment, including equipment that has been refurbished in the U.S., must meet the following eligibility
criteria:
1
To be considered U.S. content, the used equipment must be of original U.S. manufacture, AND, if previously
exported, must have been in use in the U.S. for at least one year prior to export.
2
The U.S. costs associated with the refurbishment of the equipment are eligible for Ex-Im Bank support, provided
they meet Ex-Im Bank's foreign content policy parameters. Ex-Im Bank can support the lesser of 85 percent of the
U.S. Contract Price of the item or 100% of the actual U.S. content of the item provided that (a) the item is shipped from the
U.S. and (b) the foreign content of the item does not exceed 50 percent of the item's total production cost.
3.
If the used equipment is of either original foreign manufacture or original U.S. manufacture, previously exported
and has not been in use in the U.S. for at least one year prior to its proposed export, then Ex-Im Bank will treat it as foreign
content and the following applies:
a. If the equipment is to be refurbished, the used equipment procurement cost is considered eligible foreign
content provided that this cost is less than 50 percent of the total procurement and refurbishment cost.
b. If the foreign content of the used equipment exceeds 50 percent of the cost associated with the procurement and
refurbishment of the equipment, then only the U.S. refurbishment portion will be considered eligible for Ex-Im Bank support.
4.
Previously exported goods that benefited from Ex-Im Bank financing in the past will be considered eligible for ExIm Bank support provided that the original financing has been paid in full and that the equipment has been in use in the U.S.
at least one year.
5.
The repayment term that Ex-Im Bank offers for used and refurbished equipment will be consistent with Ex-Im
Bank's international agreements for repayment terms based on contract value. Ex-Im Bank, at its sole discretion, will
determine the remaining useful life of such equipment.
a. If the remaining useful life of the equipment is at least half the useful life of equivalent new equipment, then ExIm Bank may support a repayment term equal to that offered new equipment.
b. If the remaining useful life of the equipment is less than half the useful life of equivalent new equipment, then ExIm Bank may support a repayment term equal to the useful life remaining.
c. If the sale includes more than one item, including a mixture of new and used items, a weighted average of the
useful lives of all the items will be calculated by applying the rules of 5(a) and 5(b) above.
6.
Foreign Content for used pieces should be determined by contacting the original manufacturer to ascertain the value
on a percentage basis of foreign components contained in the equipment during the manufacturing process. This percentage
should be applied to the supplier’s purchase price to determine the current value of foreign components. This value should
then be adjusted to account for the value of any additional foreign components installed during the refurbishment process.

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
USED EQUIPMENT QUESTIONNAIRE
Complete a separate questionnaire for each item of used equipment.
1. Product information
Provide name and description of used equipment: _________________________________________________________
Equipment History
a) year manufactured: ________________ b) hour meter reading: ______________ c) mileage: ______________ d) where is
equipment located? __________________ e) how long has the equipment been there?: __________________
Is the product under warranty? _____Yes _____No
Term________ Description _________________________
Has the equipment been rebuilt/reconditioned?
By whom? __________________________ Location: ______________________ Date: ______________
Does this equipment have an independent mechanical certification, evaluation, or assessment? ___Yes ____No
Term: _______ _______ Description: ___________________________________ Has the equipment been rebuilt or
reconditioned? Is the product under warranty?
2. Export/Import History
Was the equipment previously exported? _____Yes ____No
Did Ex-Im Bank provide support? ____Yes ____No If yes, provide details.
Was the equipment imported to the U.S.?_____Yes ____ No
3. Prices and Costs
Contract price: $ ____Foreign content included in the contract price: $________
U.S. supplier's purchase price: $______________ Purchase Date: ________________
Cost of rebuilding/reconditioning: $________ Cost of spare parts included: _______
Description of rebuilding and/or spare parts__________________________________
4. Used Aircraft Only.
Have all airworthiness directives been completed? ___Yes ___No
If no, describe the regulation or directive permits required for continued operation of the
aircraft:______________________________________________________________________________________________
Number of cycle hours remaining on the airframe and engines: __________________________________________________
Months remaining before next maintenance "C" and "D" checks: ________________________________________________
Names of each previous owner and lessee with the corresponding acquisition dates: _________________________________
Signature: _____________________________________ Date: ______________________ Title: ______________________
Name: ________________________________________
Broker: __________________________ Administrator (if applicable): ______________
(For insurance program):
If you have questions about this questionnaire, please contact the Business Development Division (Telephone: 202.565.3900
or Fax: 202.565.3931). For questions concerning large aircraft, please contact the Transportation Division (Telephone:
202.565.3550 or Fax: 202.565.3558).

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
Attachment IV: Supplemental Information Requirements for Foreign Dealer Insurance Policy
I. Requested Financing Amounts and Structures
For S upply C ontracts o r Pu rchase O rders A mount i dentified i n It em 5.A of t he ap plication, pl ease i ndicate am ounts
requested for each of the following (total must accumulate to the amount in Item 5.A):
o
Short-term only (for capital goods that will not be refinanced on a medium-term basis together with spare
parts and other non-capital items):
$_______________
o
Medium-term (for capital goods that will be refinanced on a medium-term basis): $_______________

II. Dealer Information
Do you or the exporter (please specify) have a distribution agreement with the proposed dealer? If so, is this an exclusive
relationship? ____________________________________________________________________
How long have you or the exporter (please specify) been working with the proposed dealer?
_________________________________________________________________________________________
For how long, if at all, have you or the exporter extended credit to this dealer? _______________________
What, if any, credit limits have been established? At what terms?
A) Parts _____________ B) Equipment ____________
Are guarantees or collateral required to support this credit? ________________________________________
Is a minimum level of sales per year required from this dealer? __________________________________
What financial and credit criteria have you established to qualify the dealer?
_______________________________________________________________________________________
How often do you conduct a credit review of this dealer? _____________

What are the terms extended by the dealer to

its customers? _________________________________________________________________
What warranty support is provided to the dealer? _____________________________________________
How far past due must the dealer be before shipments are discontinued?
__________________________________________________________________________________________

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
Attachment V: Anti-Lobbying Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that: If any funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee if a Member of Congress in connection with this commitment providing for the
United States to insure or guarantee a loan, the undersigned shall complete and submit Standard Form-LLL, “Disclosure of
Lobbying Activities” (available at www.exim.gov/pub/ins/pdf/lll.pdf) in accordance with its instructions. Submission of this
statement is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any
person who fails to file the required statement shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
Signature ___________________________________________________________________________________________
Title _______________________________________________________________________________________________
Date _______________________________________________________________________________________________

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
Attachment VI: Form of Fee Letter
This attachment is to be filled out in the following circumstances:
• the application is for a guarantee or a credit guarantee facility
• the applicant is the guaranteed lender or the exporter, and
• the applicant is signing the application but the borrower is committing to pay the commitment or facility fee.
[Letterhead of Borrower]

D

ate________________

Export-Import Bank of the United States
811 Vermont Avenue, N.W.
Washington, D.C. 20571
Attention: Vice President – Trade Finance and Insurance Division
[Lender]/ [Exporter] 1
[Address]
Re:

Undertaking with Respect to Ex-Im Bank Commitment/Facility 2 Fees

Ladies and Gentlemen:
On [date of Ex-Im Bank Application referred to below], [Lender]/[Exporter] 3 submitted a Preliminary
Commitment/Final Commitment 4 application form (the “Ex-Im Bank Application) to the Export-Import Bank of the United
States in connection with the Lender’s proposal to extend financing to [Borrower] (the “Borrower”), to be guaranteed by ExIm Bank, in support of the acquisition of the goods and/or services described below (the “Goods and Services”) for a Net
Contract Price of U.S.$______________. 5
Description of Goods and Services:
__________________________________________________ 6

_

In order to induce Ex-Im Bank to provide its final commitment with respect to the transaction covered by the Ex-Im
Bank Application, the Borrower hereby undertakes unconditionally that, if Ex-Im Bank issues a final commitment to provide
its guarantee with respect to such transaction, the Borrower will pay or cause to be paid to Ex-Im Bank a guarantee
commitment fee (for a guaranteed loan) or the facility fee (for a credit guarantee facility), as the case may be, with respect to
the transaction, whether or not the transaction is consummated (including, without limitation, whether or not any credit or
facility agreement is executed or any promissory note is issued). [Ex-Im Bank’s commitment fee shall be paid on the
uncancelled and undisbursed balance of the export financing credit that the Lender proposes to establish in connection with
the transaction.]/ [Ex-Im Bank’s facility fee shall be determined as of the date of final commitment.] 7 The amount of the
applicable fee or the basis for calculating the amount, and the payment dates, shall be specified in the relevant notice of final
commitment delivered by Ex-Im Bank to the Lender, with a copy to the Borrower.
1

Delete as appropriate.
Delete as appropriate.
Delete as appropriate.
Delete as appropriate.
Provide “Contract Price” on Goods and Services listed in Item 5 of the Ex-Im Bank’s Application.
Provide “Goods and Services Description” on Goods and Services listed in Item 4 of the Ex-Im Bank Application.
Delete as appropriate.

2
3
4
5
6
7

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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
The Borrower acknowledges and agrees that[, unless the Borrower has canceled in writing any remaining
undisbursed balance of the guaranteed loan, Ex-Im Bank’s commitment fee shall continue to accrue and become due and
payable as described above during any period in which the Lender’s utilization of the Ex-Im Bank’s guaranteed facility is
suspended.]/ [the facility fee shall be due and payable as described above, notwithstanding cancellation of the relevant credit
guarantee facility.] 8
This undertaking with respect to the [commitment]/ [facility] 9 fees due to Ex-Im Bank shall be governed by, and
construed and enforced in accordance with, the laws of the State of New York.
V

ery truly yours,
[BORROWER]

By
N

ame

Title
Title

8

Delete as appropriate.
Delete as appropriate.

9

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________________
Signature
________________
Print
________________