Form EIB 11-04 EIB 11-04 Co-Financing with Foreign Credit Agency

Co-Financing with Foreign Export Credit Agency

OMB 3048-0037
Expires 4/30/2012

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 E, Credit Information:

II. U.S. Supply Contract/Purchase Order Information in Dollars:
U.S. Content included in Supply Contract(s)

$

Eligible Foreign Content (if any) 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 in Dollars:
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

$

Foreign ECA Content included in Supply Contract(s)

$

Eligible Foreign Content (if any) 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

$

EIB-11-04
Revised 09/2011

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Co-Financing with Foreign Export Credit Agency

OMB 3048-0037
Expires 4/30/2012

IV. Financed Amount Requested in Dollars (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

Ex-Im Bank

Foreign ECA

Total Financed/Insured

1. Content Sourced in the ECA Country $

$

$

2. Eligible Foreign Content (if any)

$

$

$

3. Ancillary/Other Services (if any)

$

$

$

4. Less Cash Payment

$(

) $(

) $(

$

$

$

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

$

$

5. Local Costs (if any)

)

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

Certification:
The applicant consents to, and certifies that it has obtained the consent of the other transaction participants (e.g., borrower, guarantor,
lender, exporter, consultants, etc.), to the disclosure by Ex-Im Bank of any information (including documents) relating to this transaction to
the co-financing Foreign Export Credit Agency. If the co-financing Foreign Export Credit Agency shall agree to co-finance (i.e., share in the
risk of) the transaction, this consent to release transactional information shall include such information throughout the life of the transaction.

Signed ________________________________________________ Dated __________________

Print Name:
Title:
Firm Name:

Paperwork Reduction Act Statement: We estimate that it will take you about 15 minutes 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, OMB # 3048-0037 Washington, D.C. 20503.

EIB-11-04
Revised 09/2011

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