Form EIB 09-01 EIB 09-01 PaymentDefault Report

Print Form

OMB No. 3048-0028; Expires 08/31/2012

Export-Import Bank of the United States
Payment Default Report (Online)
Instructions:
•You are required to report all amounts that are overdue, even if full payment is
subsequently made by the obligor.
•Refer to your insurance policy or guarantee with respect to post-default
obligations, claim filing requirements, notice and other requirements.
•Prepare and file this default report ONLINE! at Ex-Im Online
Date of Notice:
Ex-Im Bank Guarantee/Insurance Policy number:
Guarantee/Policy Type:
Information about Installment in Default
1. Current outstanding loan balance:
2. Due Date/Payment Date of defaulted installment:
Installment number:
of
3. Amount due on Due Date/Payment Date:
Default cured on (insert date):
Partial payment(s) received
•in the total amount of:
•on date(s):
No payments received in respect of amounts in default
4.Reason(s) for non-payment (check all that apply):
Slow pay typical

Increase in accounts receivable
Lack of revenues
Natural Disaster

Poor management
Country/sector economic/political events
Foreign exchange/transfer problems
Equipment failure
Bankruptcy
Dispute
Other (specify):
5.Lender actions taken to correct the problem (check all that apply):
Contacts with buyer/borrower:
Letter sent

OMB No. 3048-0028; Expires 08/31/2012
Phone calls
Face-to-face meeting with borrower
Other (specify):
Cancel other lines of credit
Educate/inform borrower
Other (specify):
6.Borrower actions taken to correct the problem (check all that apply):
Agreed to pay defaulted amounts
Conditional agreement to pay defaulted amounts
condition/contingency (specify):
Cash flow management:
Revising cash flow projections
Improving receivables
Managing payables
Surviving shortfalls
Adjusting for business cyclicality and debt service
Company reorganization
Requested rescheduling of debt
Requested waiver (specify):
Other (specify):
7.Expectations of future performance for this borrower:
Expect resolution:
high probability
reasonable probability
low probability
Imminent claim likely
8.If any of the contact information for the Borrower (or Guarantor) has changed, please
provide current information:

Name of Lender/Insured:
Contact person:
Name:
Title:
Phone:
Email:
Paperwork Reduction Act Statement: We estimate that it will take you about 15 minutes per response 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 # 3048-0028 Washington, D.C. 20503.