Form EIB 11-05 EIB 11-05 Exporter's Certificate for Loan Guarantee & Medium Term

OMB 3048-XXXX
Expires: xx/xx/xx 

FORM OF EXPORTER’S CERTIFICATE

Name and U.S. Street Address of Exporter:

Date:

, 20__

RE:

Ex-Im Bank Credit/Guarantee/Insurance Number:
Purchaser:
Supply Contract/Purchase Order No.(s)

Check one:

□ Initial Exporter’s Certificate
□ Amended Exporter’s Certificate. The following has changed: [specify]

We understand that the Export-Import Bank of the United States ("Ex-Im Bank") provides credit support to promote
U.S. export sales, and that Ex-Im Bank will determine the scope of its support for our sale to the Purchaser based on
the information provided below. To aid in this determination, we, the Exporter, hereby certify:

PART A: CONTENT

1.
Content. This information is based on our best efforts to assess the value of the goods and services (“Goods
and Services”) to be provided under the above-referenced supply contract(s) or signed purchase order(s) with the
Purchaser (the “Supply Contract(s)/Purchase Order(s)”). Content changes may need to be reported via an amended
Exporter’s Certificate (see Part C below). Check one:

□ The Goods and Services contain only U.S. Content: the U.S. Content Percentage is 100% (i.e.,
no Foreign Content, Local Costs, or Excluded Goods and Services (defined below)). Please
do not complete the chart if this box is checked.

□ The Goods and Services contain less than 100% U.S. Content. Please complete the chart if
this box is checked.

A.
B.
C.
D.
E.
F.

G.
H.
I.

Supply Contract/ Purchase
Order(s)
Excluded Goods and
Services
Contract Price
Local Costs
Net Contract Price
Foreign Content

U.S. Content
U.S. Content Percentage
Disbursement Percentage

Definition
The aggregate price of all Goods and Services in the Supply Contract/ Purchase Order(s).

The aggregate price of all Goods and Services that are not eligible for (or excluded from) Ex-Im
Bank support (e.g., goods not shipped from the U.S.)

A minus B

The aggregate price of all Goods originated/manufactured in the Purchaser’s country and all
Services provided by residents of the Purchaser’s country.

C minus D

The aggregate cost to the Exporter of any Goods (or components thereof) that were produced or
manufactured outside the U.S., Services provided by third country-resident personnel, and
foreign freight costs and foreign insurance included in the Net Contract Price for Goods exported
from the U.S. (Such amount shall not include any Local Costs.)

E minus F

G divided by E, expressed as a percentage.

USD

%

Initial Exporter’s Certificate: input the lower of (i) 85% and (ii) the percentage in H. Amended
Exporter’s Certificate: input the percentage obtained from the Disbursement Percentage
Calculator page (if any).

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OMB 3048-XXXX
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FORM OF EXPORTER’S CERTIFICATE

PART B: CERTIFICATIONS

We hereby certify, as to ourselves and the Ex-Im Bank-approved Goods and Services sourced
from the U.S. and the Purchaser’s country, as follows:
1. 15% Cash Payment. We (i) have received (or will receive) payment for at least 15% of the
Net Contract Price, and/or (ii) have financed (or will finance) such amount at market rates. We
have submitted (or will submit) evidence of payment of our invoices. (For 100% U.S. Goods and
Services, “Net Contract Price” means the aggregate price of such Goods and Services.)
2. Invoices and Shipment. We have provided (or will provide) copies of (i) invoices describing
the Goods and Services and (ii) signed, clean, onboard bills of lading evidencing that the Goods
included in the Net Contract Price have been shipped from the U.S. to the Purchaser’s country.
For Services, progress payments for Goods prior to shipment, and/or Local Costs, the value of the
work performed at the time the invoices therefor are submitted for payment shall equal or exceed
the amount so invoiced (or we have obtained Ex-Im Bank’s prior consent to an alternative
arrangement).
3. Suspension and Debarment. We and each of our Principals individually, have not 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
us 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
certification; or we have 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). In addition, we are 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.
4. Other Payments; Legal Compliance. Without Ex-Im Bank’s written consent, a copy of which
is attached, we have not and will not agree to, offer to, cause to, or arrange for, directly or
indirectly, any payment, discount, allowance, rebate, commission, fee or other payment in
connection with the sales of the Goods and Services under (or obtaining) the Supply
Contract/Purchase Order(s) or Ex-Im Bank Credit/Guarantee/Insurance, except for a) payment of
manufacturing costs or for the purchase of the Goods, b) the regular remuneration of our regular
full-time directors, officers and employees; c) regular commissions or fees, if any, to our regular
sales agent, broker or representative and readily identifiable on our books and records as to
amount, purpose and recipient; d) any discounts, allowances, or rebates to the Purchaser that are
disclosed in our invoices; or e) any letter of credit or other fees paid to commercial banks or any
payments made to Ex-Im Bank in connection with the Ex-Im Bank Credit/Guarantee/Insurance.

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FORM OF EXPORTER’S CERTIFICATE

In addition, neither we nor anyone acting on our behalf, such as agents, have 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, neither we nor anyone acting on our behalf in connection with this transaction are
currently under charge or have been, within the past 5 years, convicted in any court or been
subject to national administrative measures of any country for bribery of foreign public officials.
To the best of our knowledge, the Supply Contract/Purchase Order(s) and the performance by
the parties of their respective obligations thereunder does not violate any applicable law.
5. Munitions List. Except as described on our attached statement, none of the Goods and
Services are on the U.S. Munitions List (part 121 of Title 22 of the Code of Federal Regulations).

PART C: CHANGES AND EX-IM BANK RELIANCE

6. Changes to Certifications. With respect to Part A, we will promptly complete and submit an
Amended Exporter’s Certificate if there has been a “material change” in the U.S. Content
Percentage (together with a copy of the completed “Disbursement Percentage Calculator” found
at www.exim.gov/tools/disbcalc.html) prior to any further presentation of invoices for payment.
A “material change” in the U.S. Content Percentage occurs if (a) the U.S. Content Percentage has
decreased by more than 5% (as compared to the U.S. Content Percentage reported in the initial
Exporter’s Certificate) and (b) aggregate foreign content is over 20% (i.e., the new U.S. Content
Percentage is less than 80%).
With respect to Parts B or C, if any of the certifications made therein become untrue, we will
promptly submit an amended Exporter’s Certificate, noting the changes and with any required
attachments, prior to any further presentation of invoices for payment.
7. Ex-Im Bank Reliance. With knowledge that Ex-Im Bank will rely on the certifications and
representations made in this Exporter’s Certificate, we agree we are liable for any damages
suffered by Ex-Im Bank’s reliance. We understand that these certifications are subject to the
penalties for fraud provided in Article 18 U.S.C., Section 1001. We agree that presentation of
invoices for payment under the Ex-Im Bank Credit/Guarantee/Insurance is a confirmation by us
of the information and certifications made herein. By his signature, the person signing this
Exporter’s Certificate on behalf of the Exporter represents that he is fully authorized to do so.
We agree to provide additional information with respect to any of the matters covered in this
Exporter’s Certificate upon Ex-Im Bank’s reasonable written request.
[EXPORTER]

By:
(Authorized Officer or Employee)
Name:
Title:

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INSTRUCTIONS TO EXPORTERS:

Part A: Content
The information provided in Part A will be used to determine the total amount of Ex-Im Bank
guarantee, loan or insurance support for a transaction. Please refer to Ex-Im Bank’s Fact Sheets
on
Foreign
Content,
Local
Costs,
and
Ancillary
Services
at
http://www.exim.gov/products/index.html for a further explanation of Ex-Im Bank’s content and
cover policies.

Part B: Certifications
The certifications in Part B cover those Goods and Services sourced from U.S. (or the Purchaser’s
country) and approved as eligible for coverage under an Ex-Im Bank Credit/Guarantee/Insurance.
If you have any question about what Goods and Services are approved by Ex-Im Bank, please
contact your Ex-Im Bank credit officer. For Long-Term transactions (credit over $10MM or
more than 7 years repayment), such “Goods and Services” are those listed in the current
Acquisition List submitted by the Borrower to Ex-Im Bank.

Initial Exporter’s Certificate
The Exporter’s Certificate must be completed by the Exporter and presented prior to the
borrower’s first request for disbursement related to that exporter’s invoices under the Ex-Im
Bank-supported credit. Exporter’s Certificates are also to be completed by U.S. and non-U.S.
providers of ancillary services (such as banking, financial advisor, technical consultant, and legal)
that have been approved by Ex-Im Bank for financing under the Ex-Im Bank
Credit/Guarantee/Insurance.

Amended Exporter’s Certificates
If an Amended Exporter’s Certificate is required pursuant to Section 6 of the Exporter’s
Certificate, the Exporter should check the “Amended Exporter’s Certificate” box at the top of the
Certificate and note the change being reflected in the amended Certificate. The Exporter should
contact the lender under an Ex-Im Bank Guarantee/Insurance transaction, or Ex-Im Bank if an
Ex-Im Bank Credit, for instructions on where to send the Amended Exporter’s Certificate.

Please note that a change to Part A (Content) requires the Exporter to attach a copy of the
“Disbursement Percentage Calculator” to the Amended Exporter’s Certificate. The Calculator
allows the Exporter to calculate the new disbursement percentage for the transaction. The
Calculator (and instructions) are found at http://www.exim.gov/tools/disbcalc.html. Changes to
Sections 4 and 5 of Part B require the relevant Ex-Im Bank approval to be attached.

Links and Additional Information
For information regarding the Exporter’s Certificate (and other helpful facts), go to
http://www.exim.gov/.
Should you have any further questions regarding the Exporter’s
Certificate, please call Ex-Im Bank’s Operations Division at (202) 565-3470. For insurance
transactions, please contact your insurance broker or appropriate Ex-Im Bank regional office.

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FORM OF EXPORTER’S CERTIFICATE

Paperwork Reduction Act Statement: We estimate that it will take you about XX 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 # 3048XXXX Washington, D.C. 20503.

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