Form EIB92-51 Application for Special Buyer Credit Limited (SBCL) unde

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Omb #3048-0015
Expires 9/30/2009

EXPORT-IMPORT BANK OF THE UNITED STATES
APPLICATION FOR SPECIAL BUYER CREDIT LIMIT (SBCL) UNDER MULTI-BUYER EXPORT CREDIT INSURANCE POLICIES
App. No.______________________
(Please Print or Type)
(Ex-Im Bank Use Only)

1.Insured/Exporter Name:

2. Broker (If none, state “None”)

Policy No:

State:

Brokerage:

Broker No:

Attn:

Tel No:

Attn:

Tel. No:

Fax No:

E-Mail:

Fax No:

E-Mail:

3. Reason for Application on this Buyer:
Policy carries no Discretionary Credit Limit (DCL)
Amount requested exceeds DCL
Country Limitation Schedule restricts your DCL in this market
Other______________________________
Renewal/Increase/Amendment of existing SBCL-Existing Final Shipment Date
4.

Buyer Name and Address:

5.

Guarantor Name and Address (If any):

File No.________________________
(Ex-Im Bank Use Only)
File No.________________________
(Ex-Im Bank Use Only)

6. (a) Products
New
Used (if used, attach Used Equipment Questionnaire EIB92-63).
(b) Products Description____________________________________________________________________
(c) Is each product produced or manufactured in the United States?
Yes
No
(d) Has at least one-half of the value, exclusive of price mark-up, been added by labor or material exclusively of United States origin?
Yes

No

(e) Are products listed on the United States Munitions List? (part 121 of Title 22 of the Code of Federal Regulations)

Yes

No

7. (a) Exporter and/or manufacturer name and address if other than insured:____________________________________________
8. (a) Credit Limit requested $ __________________________________________________________________
(b) Payment terms requested _______________________________________________________________________________
9. (a) Summary of credit experience with this buyer during current year and past two years, including uninsured experience:
Total sales each year
Highest amount outstanding at any time during the period
Payment terms

$___________ $___________ $____________
$___________ $___________ $____________

(b) Describe buyer's payment history (check one)
No prior experience

Prompt/Discount

1-30 days slow

31-60 days slow

more than 60 days slow

(c) Amount now owing $____________, as of_________________(Date).
(d) Amount now past due (indicate maturity dates and explanation). $_____________________________________________
(e) If past dues are due to foreign exchange problem does insured have evidence of local currency deposit on all payments due?
Yes
No
Not Applicable
(f) If buyer is new account, indicate whether negotiating sales or $ value of orders already received $____________________

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10. Describe any direct or indirect ownership interest or family relationship which exists between the insured and the buyer (or guarantor)
or between the supplier and the buyer (or guarantor). If none, state "None".
11. CREDIT AND FINANCIAL INFORMATION REQUIREMENTS * for Credit Limit Applications of:

Up to $50,000:
$50,001 to $100,000:

Credit Agency Report, or Trade Reference
Credit Agency Report and Trade Reference

$100,001 to $300,000: Credit

Agency Report and 2 Trade References

The Buyer’s audited or signed unaudited financial statements for the last 2 fiscal years may be substituted for the trade references.

$300,001 to $1million:

over $1 million:

Credit Agency Report and 2 Trade References and the Buyer’s audited or signed unaudited financial statements

for the last 2 fiscal years with notes.

Credit Agency Report and 2 Trade References and a Bank Reference and the Buyer’s audited or signed
unaudited financial statements for the last 3 fiscal years with notes.

* The applicant’s credit experience with the Buyer as completed in Question 9 may be substituted for a Trade Reference. If fiscal year end
statements are dated more than 9 months from the date of the application, the Buyer’s interim statements must be submitted. All references
and credit reports must be dated within 6 months of the application and show prompt credit experience for similar amounts and similar
terms as described in Ex-Im Bank’s Short Term Credit Standards for Buyers.
If the Buyer has a Market Rating you may submit the rating and date in place of the Credit and Financial Information. If a Financial
Institution (Bank) is the Buyer or a Guarantor or if a letter of credit is used no Credit and Financial Information is necessary.

NOTE: See Short Term Credit Standards (EIB99-09) for Buyers to determine the likelihood of approval.
12. CERTIFICATION OF PRODUCT USE AND REPRESENTATIONS:
The applicant certifies that neither it, nor its Principals, have within the past 3 years been i) debarred, suspended, declared ineligible from
a)
participating in, or voluntarily excluded from participation in a Covered Transaction, ii) formally proposed for debarment, with a final
determination still pending, iii) indicted, convicted or had a civil judgement rendered against it for any of the offenses listed in the Regulations, iv)
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 v) 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 i) through iv) 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 Non-procurement
Debarment and Suspension regulations, 2 C.F.R. Part 3513, adopting by reference, the OMB Guidelines to Agencies on Government wide
Debarment and Suspension (Non-procurement), 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.

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b)
The applicant hereby certifies to the Export-Import Bank of the United States that, to the best of its knowledge and belief, the
products* and services to be exported in the transaction described herein are principally for use as indicated below.(When a sale is made to
entities such as distributors primarily for resale, the principal user is considered to be the original purchaser (the distributor), and part A
should be checked. If, however, the applicant has knowledge or reason to believe that the products will be re-exported from the original
By the buyer in the country specified above.
buyer's country, please check part B.)
A
B
If not, name country where product will be principally used
_______________________ and by whom_____________________.
* NOTE: The Borrower, Guarantor, Buyer and End User must be foreign entities in countries for which Ex-Im is able to provide support,
see Ex-Im’s Country Limitation Schedule (CLS) at www.exim,.gov . There may not be trade measures against them under Section 201 of
the Trade Act of 1974, see http://dockets.usitc.gov/eol/public/ click on 201. There may not be trade sanctions in force against them. For a
list of products and countries with Anti-Dumping or Countervailing Duty sanctions see
http://205.197.120.60/oinv/sunset.nsf/AllDocID/96DAF5A6C0C5290985256A0A004DEE7D.
c)
The applicant certifies that the representations made and the facts stated by it in the application for the special buyer credit limit
are true, to the best of its knowledge and belief, and that it has not omitted any material facts. The applicant agrees that the
representations and facts shall form the basis of the credit limit if issued and that the truth of such representations and facts contained
herein shall be a condition precedent to any liability of Ex-Im thereunder. The applicant understands that this certification is subject to the
penalties for fraud provided in Article 18, United States Code, Section 1001.
By
Signature of Insured/Exporter Print Name and Title Date

Name of Umbrella Policy (EUS-)Administrator or EBS/EBM Policyholder (if any)
Note: Please answer all questions and sign application. Applications not completely filled out or not submitted with required financial and credit information will be
withdrawn.

Send, or ask your insurance broker, administrator, bank policyholder or city/state participant to review and send, this application to
Ex-Im Bank, 811 Vermont Avenue, NW, Washington, D.C. 20571 or an Ex-Im Regional Office.
The Ex-Im Bank website is

Notices: The applicant is hereby notified that information requested by this application is done so under authority of
the Export-Import Bank Act of 1945, as amended (12 USC 635 et. seq.); provision of this information is mandatory and
failure to provide the requested information may result in Ex-Im Bank unable to determine eligibility being for support.
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 upper right of each page).
Public Burden Statement: Reporting for this collection of information is estimated to average 1/2 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# 3048-0015, Washington, D.C. 20503.

EIB 92-51
Revised 01/07

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