Form EIB 92-36 EIB 92-36 Application for Issuing Bank Credit Limit (IBCL) Under L

OMB No. 3048-0016

Print Form
PENDING-2014
EXPORT-IMPORT BANK APPLICATION
of the UNITED STATES
FOR ISSUING BANK CREDIT LIMIT (IBCL)

UNDER LENDER OR EXPORTER-HELD POLICIES
App. Number

(Ex-Im Bank Use Only)
1. Applicant

Policy Number

2. Broker

State

(If none, state "None")

Attn.:

Tel #:

Attn.:

Tel #:

Fax #:

Email:

Fax #:

Email:

3. Issuing Bank (Legal name, address, city, country):

4. Is this application a resubmission of a previously submitted application?
5. Coverage option:

Comprehensive

YES

NO

Political only

6. Details of letters of credit (L/Cs) you wish to insure:
a. L/C Amount $
b. L/C number (if available)
c. L/C transaction type (for lenders only, check):
d. L/C tenor (enter):

Actual # of Days - or -

Usance Letter of Credit - or -

Refinanced Letter of Credit

Sight (check)

e. Expiry date of L/C:
f. What effective date do you require for the IBCL?
g. Importer Name:

City

Country

h. Exporter Name:

City

Country

i. Beneficiary Name:

Country

City

j. L/C Payment currency:
k. L/C Payment country: Country

EIB92-36
02/2011

Country

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OMB No. 3048-0016
PENDING-2014

7. Products*:
a.i. For exporters, are the products/services to be exported currently endorsed to your policy?
(If No, please submit a policy amendment to add the new product/service.)
YES
NO
a.ii. For lenders, describe the products/services to be exported
YES
b. Are the products on the Munitions Control List?
YES
NO
c. Are you exporting capital goods?
d. If Yes, please certify to the following:

NO

Section 2 (e) Ex-Im Bank’s Charter prohibits the Bank from supporting transactions that will result in the production
of an exportable good that is subject to trade measures or sanctions. I have reviewed the list of products and countries/
sectors subject to trade measures, including Anti-Dumping and Countervailing Duty sanctions available at http://www.usitc.
gov/trade_remedy/
YES
NO
(i) If there are trade measures, please provide comments below.

*The Borrower, Guarantor, Buyer and End User must be in countries where Ex-Im Bank is able to provide support, see Ex-Im’s (CLS) at
www.exim.gov. There may not be trade measures or sanctions against the good produced with the U.S. export under Section 201 of the
Trade Act of 1974. For a list of products and countries with Anti-Duping or Countervailing Duty sanctions, see section AD/CVD Orders
available at http://www.usitc.gov/trade_remedy/731_ad_701_cvd/investigations/active/index.htm. Trade sanctions are product and country
specific (i.e., all firms within a country are subject to the order, unless a specific firm is explicitly excluded).

Questions 8 and 9 are only applicable to lenders.
8. Applicant's experience with the issuing bank:
a. Do you extend insured or uninsured credit facilities to the L/C issuing bank?

YES

NO

b. If "Yes," provide details on the type, size, and usage of credit facilities extended to the L/C issuing bank:

c. If "Yes," does the L/C issuing bank consistently meet its credit obligations in accordance with the agreed terms?
YES

NO

9. Is the L/C issuing bank an affiliate of the applicant as defined in the policy?
If "Yes," please describe the relationship:

YES

NO

10. The following credit information on the L/C issuing bank may be required. Ex-Im Bank will notify you if any of these items are
required to process the application. At your option, you may attach copies of any of these items or others that you wish to submit with
the application.
A. Audited fiscal year-end financials statements for the past two (2) years, including notes. Interim financial statements may also be
required if the most recent fiscal year-end statements are more than 9 months old.
B. A bank reference dated within 6 months of the application from a correspondent bank. The reference should indicate if credit
lines are secured and the type of credit facilities offered.
C. Background information on the L/C issuing bank, including a description of the bank's operation and structure and a list of the
shareholders who directly or indirectly own 10% or more of the bank, with their corresponding ownership percentages.
D. Rating Agencies' reports on the L/C issuing bank.

EIB92-36
02/2011

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CERTIFICATIONS AND NOTICES

OMB No. 3048-0016
PENDING-2014

The Applicant (hereafter “Applicant” or “it”) CERTIFIES, ACKNOWLEDGES and COVENANTS to the Export-Import Bank of the United
States (hereafter “Ex-Im Bank”) that to the best of Applicant’s knowledge and belief, after due diligence, the statements set forth below are true
and correct. Any reference below to “this transaction” shall refer to either the individual transaction or the Ex-Im Bank program or Insurance
Policy that is the subject of the application, as appropriate.

A.

Neither Applicant, nor any of its Principals (as defined in the Debarment Regulations identified below), has, within the past 3 years, been:
1) debarred, suspended, declared ineligible from participating in, or voluntarily excluded from participation in a Covered Transaction (as defined in the
Ex-Im Bank and Government-wide debarment regulations, found at 2 CFR Part 3513 and 2 CFR Part 180, respectively) (collectively the “Debarment
Regulations”);
2) formally proposed for debarment from participating in a Covered Transaction, with a final determination still pending;
3) indicted, convicted or had a civil judgment rendered against it for any conduct or offenses described at 2 CFR § 180.800 in the Debarment
Regulations;
4) delinquent on any amounts due and owing to the U.S. Government or its agencies or instrumentalities as of the date of execution of this certification;
or
5) listed on any of the publically available debarment lists of the following international financial institutions: the World Bank Group; the African
Development Bank; the Asian Development Bank; the European Bank for Reconstruction and Development, and the Inter-American Development
Bank;
or
the Applicant has received a written statement of exception from Ex-Im Bank attached to this certification, permitting acceptance of this application
notwithstanding an inability to make all of the certifications in clauses 1) through 5) of this section A.

B.

Applicant has conducted and will conduct reasonable due diligence in connection with this transaction, including checking the System for Award
Management (https://www.sam.gov/portal/public/SAM/) (“SAM”) to determine if parties are excluded from U.S. Government transactions, and the
Specially Designated Nationals (“SDN”) List of the Department of the Treasury, Office of Foreign Assets Control (“OFAC”) (http://www.
ustreas.gov/offices/enforcement/ofac/sdn/). Applicant will not knowingly enter into any sales, leasing or financing agreements in connection with this
transaction with any individual or entity that is listed on the SAM or the SDN List (or is otherwise prohibited from conducting business with U.S. public
and private entities pursuant to OFAC Regulations).

C.

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 of 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 Form to Report Lobbying,” (http://
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.

D.

Neither Applicant nor any agent or representative acting on Applicant’s behalf, has or will engage in any activity in connection with this transaction that
is a violation of 1) the Foreign Corrupt Practices Act of 1977, 15 U.S.C. § 78dd-1, et seq.; 2) the Arms Export Control Act, 22 U.S.C. § 2751 et
seq., 3) the International Emergency Economic Powers Act, 50 U.S.C. § 1701 et seq., 4) the Export Administration Act of 1979, 50 U.S.C. §
2401 et seq., and, 5) the regulations issued by the OFAC. Applicant also certifies that neither Applicant nor any agent or representative acting on
Applicant’s behalf, has been found by a court of the United States to be in violation of any of the foregoing statutes or regulations 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 of the
foregoing or any other applicable law.

E.

Neither the Applicant nor any agent or representative acting on Applicant’s behalf in connection with this transaction is currently under charge or has
been, within the past 5 years, convicted in any court of any country, or subject to national administrative measures of any country, for bribery of public
officials.

F.

The representations made and the facts stated in this application and its attachments are true and Applicant has not misrepresented or omitted
any material facts. Applicant further covenants that if any statement(s) set forth in this application becomes untrue, or is discovered to have been
untrue when made, Applicant will promptly inform Ex-Im Bank of such change. Applicant further understands that in accepting or approving this
application, Ex-Im Bank is relying upon Applicant’s statements set forth in the application and on the foregoing certifications, and all statements and
certifications to Ex-Im Bank are subject to the penalties for false or misleading statements to the U.S. Government (18 USC § 1001, et. seq.).

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 being unable to determine
eligibility for support. If any of the information provided in this application changes in any material way or if any of the certifications made herein become untrue,
the applicant must promptly inform Ex-Im Bank of such changes. 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 upper right of each page). Ex-Im Bank reserves the right
to decline to process or to discontinue processing of an application.

Paperwork Reduction Act Statement: We estimate that it will take you about 1 hour per response 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 #3048-0016 Washington, D.C. 20503.

EIB92-36
02/2011

(Signature)

(Print Name and Title)

(Date)
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