Form EIB 95-10 EIB 95-10 EIB 95-10, Application for Long Term Loan or Quarantee

OMB
 3048-0013
10/31/2015

Export-Import Bank
of the United States

APPLICATION
FOR LONG-TERM
LOAN OR GUARANTEE

This application is to be used for direct loan and guarantee transactions with financed amounts over $10 million (excluding financed
premium), typically with tenors over seven years. It is also to be used for certain Ex-Im Bank products and programs regardless of
transaction size or tenor including: Large Aircraft, Limited Recourse and Structured Financing, and Tied Aid. (To request a Credit
Guarantee Facility, please complete the Medium-Term application.)
Additional information on how to apply for Ex-Im Bank long-term loans and guarantees can be found at Ex-Im Bank’s web site
http://www.exim.gov/tools/how_to_apply.cfm
Send this completed application to Ex-Im Bank, 811 Vermont Avenue, NW, Washington, DC 20571. Ex-Im Bank will also accept
e-mailed PDF and faxed applications. Please note that applications must be PDF scans of original applications and all required
application attachments. (Fax number 202.565.3380, e-mail [email protected]). Hard copies of required supporting
documentation may still be required for limited recourse and structured financing requests.

APPLICATION FORM
1. COMMITMENT OR FINANCING TYPE REQUESTED
A. Product

☐ Comprehensive Guarantee
☐ Political Risk Guarantee
☐ Direct Loan
☐ Preliminary Commitment - See Preliminary Commitment Fact Sheet for eligibility criteria. A justification
for a Preliminary Commitment is to be attached. (http://www.exim.gov/tools/how_to_apply.cfm#prelim)

B Conversion of a Preliminary Commitment or a Letter of Interest
☐ No
☐ Yes.
The Ex-Im Bank reference number is: _______________________________________
C. Resubmission

☐ Check if this is a resubmission of an application that was previously deemed incomplete or
was withdrawn for other reasons. The Ex-Im Bank reference number is: __________________

2. PARTICIPANTS:
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate
owner. For number of employees and sales volume, aggregate for the company and all its affiliates2, including corporate owners and subsidiaries.

* Applicant Legal Name:
Tradestyle:
*Street Address:
*City:
*Corporate Ownership:
* Does the Applicant have any affiliates2?
*Total Number of Employees:
Contact Person:
Position Title:

Duns #:
Taxpayer ID#:
Country:

*State:
Yes

*Zip + 4:
* Primary Industry NAICS1:
No

*Annual Sales Volume:
Email:
Phone:

1

Fax:

A company’s Primary Industry NAICS codes is the NAICS that accounts for the largest share of sales for the most recently completed fiscal year.
The full definition of “primary industry” is set forth at 13 C.F.R. § 121.107.
2 Affiliations exist when one individual or entity controls or has the power to control another or when a third party or parties control or have the power
to control both. Factors such as common ownership, common management, previous relationships with or ties to another entity, and contractual
relationships may cause affiliation. The complete definition of affiliation is found at 13 C.F.R. § 121.103.

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OMB 3048-0013
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*Minority-owned business:

Yes

No

*Woman-owned business:

Yes

No

Decline to Answer

*Veteran-owned business:

Yes

No

Decline to Answer

Decline to Answer

Applicant’s role in the transaction: ☐ exporter ☐ buyer/ borrower ☐ lender (if lender is applicant, lenders mandate must be attached)
☐ lender
☐ borrower
Primary contact point for Ex-Im Bank inquiries on this transaction: ☐ exporter
Exporter. The exporter is the U.S. entity that contracts with the buyer for the sale of the U.S. goods and services.

☐ Check if the exporter is the applicant. Otherwise, complete the information below for each exporter, including
ancillary service providers.
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate
owner. For number of employees and sales volume, aggregate for the company and all its affiliates2, including corporate owners and subsidiaries.

* Exporter Legal Name:
Tradestyle:
*Street Address:
*City:
*Corporate Ownership:

Duns #:
Taxpayer ID#:
Country:

*State:

* Does the exporter have any affiliates2?
*Total Number of Employees:
Contact Person:
Position Title:
*Minority-owned business:
Yes

Yes

*Zip + 4:
* Primary Industry NAICS1:

No
*Annual Sales Volume:
Email:
Phone:

Fax:

No

Decline to Answer

*Woman-owned business:

Yes

No

Decline to Answer

*Veteran-owned business:

Yes

No

Decline to Answer

Supplier. The supplier is the U.S. company that manufactures the goods and/or performs the services to be exported.

☐ Check if the supplier is also the exporter. Otherwise, complete the information below for each supplier, including
ancillary service providers.
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate
owner. For number of employees and sales volume, aggregate for the company and all its affiliates2, including corporate owners and subsidiaries.

* Supplier Legal Name:
Tradestyle:
*Street Address:
*City:
*Corporate Ownership:
Yes
*Does the supplier have any affiliates2?
*Total Number of Employees:
Contact Person:
Position Title:
*Minority-owned business:
Yes

Duns #:
Taxpayer ID#:
Country:

*State:

*Zip + 4:
* Primary Industry NAICS1:

No
*Annual Sales Volume:
Email:
Phone:

Fax:

No

Decline to Answer

*Woman-owned business:

Yes

No

Decline to Answer

*Veteran-owned business:

Yes

No

Decline to Answer

1

A company’s Primary Industry NAICS codes is the NAICS that accounts for the largest share of sales for the most recently completed fiscal year.
The full definition of “primary industry” is set forth at 13 C.F.R. § 121.107.
2 Affiliations exist when one individual or entity controls or has the power to control another or when a third party or parties control or have the power
to control both. Factors such as common ownership, common management, previous relationships with or ties to another entity, and contractual
relationships may cause affiliation. The complete definition of affiliation is found at 13 C.F.R. § 121.103.

2

Borrower. The borrower is the entity that agrees to repay the loan.

☐ Check if the borrower is the applicant. If not, complete the information below.
Borrower name: ___________________________________________ Duns #: __________________________________
Contact person: ___________________________________________ Phone #: _________________________________
Position title: _____________________________________________ Fax #: __________________________________
Street address: ____________________________________________ E-mail: __________________________________
City: ______________________ State/Province: ______________ Postal code:

________________________

Taxpayer ID #: ____________________________________________________________________________________
Country: _________________________________________________________________________________________
Guarantor. The guarantor is the person or entity that agrees to repay the credit if the borrower does not.
Complete the information below for each guarantor if a guarantor is offered or required.
Guarantor name: __________________________________________ Duns #: __________________________________
Contact person: ___________________________________________ Phone #: _________________________________
Position title: _____________________________________________ Fax #: __________________________________
Street address: ____________________________________________ E-mail: __________________________________
City: ______________________ State/Province: ______________ Postal code:

________________________

Country: _________________________________________________________________________________________

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Buyer. The buyer is the entity that contracts with the exporter for the purchase of the U.S. goods and services.

☐ Check if the buyer is also the ☐ borrower or ☐ guarantor. Otherwise, complete the information below.
Buyer name: _____________________________________________ Duns #: __________________________________
Contact person: ___________________________________________ Phone #: _________________________________
Position title: _____________________________________________ Fax #: __________________________________
Street address: ____________________________________________ E-mail: __________________________________
City: ______________________ State/Province: ______________ Postal code: ______________________________
Country: _________________________________________________________________________________________
End-user. The end-user is the foreign entity that uses the U.S. goods and services.
☐ Check if the end-user is also the ☐ borrower or ☐ guarantor or ☐ buyer. Otherwise, complete the information below.
End-user name: ___________________________________________ Duns #: __________________________________
Contact person: ___________________________________________ Phone #: _________________________________
Position title: _____________________________________________ Fax #: __________________________________
Street address: ____________________________________________ E-mail: __________________________________
City: ______________________ State/Province: ______________ Postal code: ______________________________
Country: _________________________________________________________________________________________
Lender. The lender is the company that extends the Ex-Im Bank guaranteed or insured loan to the Borrower.

☐ Check if the lender is also the ☐ applicant. Otherwise, complete the information below.
Lender name: ________________ Duns# ______________________ MGA #: _________________________________
Contact person: ___________________________________________ Phone #: _________________________________
Position title: _____________________________________________ Fax #: __________________________________
Street address: ____________________________________________ E-mail: __________________________________
City: ______________________ State/Province: ______________ Nine digit zip code: ________________________
Country: _________________________________________________________________________________________
Controlling Sponsor. The controlling sponsor is a person providing controlling direct private equity investment
(excluding investments made through publicly held investment funds, publicly held securities, public offerings, or
similar market vehicles) in connection with a financing.
☐ Check if the Controlling Sponsor is the ☐ applicant. Otherwise, complete the information below..
Sponsor Name: ___________________________________________ Duns #: __________________________________
Contact person: ___________________________________________ Phone #: _________________________________
Position title: _____________________________________________ Fax #: __________________________________
Street address: ____________________________________________ E-mail: __________________________________
City: ______________________ State/Province: ______________ Nine digit zip code: ________________________
Country: _________________________________________________________________________________________

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3. DETAILS OF COVERAGE REQUESTED
A. Special Features Requested
Check the boxes for the coverage that apply to the transaction. View the fact sheets describing the coverage on Ex-Im
Bank’s web site as noted below. Complete and attach the requested forms.

☐ Large Aircraft
Attachment A required

☐ Project Finance
Attachment F required

☐ Structured Finance
Attachment G required

☐ Foreign Currency Guarantee
(specify currency)
http://www.exim.gov/products/
guarantee/foreign_curr.cfm

☐ Local Cost Support
http://www.exim.gov/products/
policies/local_cost.cfm

☐ Used Equipment
Attachment E required
http://www.exim.gov/products/
policies/used_equip.cfm

☐ Nuclear
http://www.exim.gov/products/
policies/nuclear/envnucp.cfm
Nuclear-screening document must
be submitted with application

☐ Co-Financing with
Foreign Export Credit
Agency Attachment H
required
(last two pages
document)
☐this
Environmental Exports

☐ Ancillary Service Fees
http://www.exim.gov/products/
ebd-m-13.cfm

Program
http://www.exim.gov/products/
special/environment.cfm

☐ Capitalization of Interest
During Construction

☐ Tied Aid Program
Attachment C required

☐ Finance Lease Structure
http://www.exim.gov/products/
insurance/leasing.cfm

☐ Military/Security/Police
http://www.exim.gov/products/
policies/military.cfm

☐ Engineering Multiplier
Program http://www.exim.gov/
pub/pdf/ebd-m-03.pdf

☐ Other

☐ Other _______________

4. TRANSACTION DESCRIPTION
a) Describe Goods and Services. Include make, model, manufacturer/supplier, SIC codes or NAICS (if known) of goods and
services, number of units, values, and estimated U.S. and foreign content. This section does not need to be completed if
the exporter attached a Content Report.
__________________________________________________________________________________________________

__________________________________________________________________________________________________

b) Describe the purpose of the transaction. Include answers to the following: Will the goods be used to create or expand
produc- tion capacity for an exportable product? Are the goods and services destined for an identifiable project? If so,
provide information on the total estimated project cost in US dollars. Also provide information as to other sources of
financing for the project, including working capital.
__________________________________________________________________________________________________

__________________________________________________________________________________________________

c) Indicate whether an application for support of this export contract or a related project has been filed with the Agency for
International Development, Maritime Administration, Overseas Private Investment Corporation, Trade Development
Agency or a multilateral financing agency. If so, include a brief description of the additional support.
__________________________________________________________________________________________________

__________________________________________________________________________________________________

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5. REQUESTED FINANCING AMOUNTS AND STRUCTURE
Ex-Im Bank support is based on the value of the eligible goods and services in the exporter’s supply contract(s) or
purchase order(s). The total level of support will be the lesser of: 85% of the value of all eligible goods and services; or
100% of the U.S. content included in all eligible goods and services in the exporter’s supply contracts. In addition, Ex-Im
Bank may also finance certain local costs, ancillary services as approved, and the exposure fee/premium. Fill out the chart
below to determine estimated eligible amounts.
Definition

A

US$

Supply Contracts or
Purchase Orders

The aggregate price of all goods and services in all the
supply contract(s) or purchase order(s), including local
costs, ancillary services, and excluded goods and services.
Break out ancillary services in Aii.

Ai _____________

B

Excluded Goods and
Services

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

 ________________

services). Local costs should not be included in this line.

C

Total Local Costs

The aggregate price of all goods manufactured in the enduser’s country and all services provided by residents of the
purchaser’s country. Ex-Im Bank may be able to finance

 ________________

these amounts up to 30% of D below.

D
E

Net Contract Price

A minus B minus C

Eligible Foreign
content

The aggregate cost of any goods produced or manufactured outside the U.S, or services provided by third country personnel or foreign freight costs and foreign insurance

 ________________

included in the net contract price (line D), (e.g. foreign
items shipped from the US)

F
G

U.S. Content

D minus E

 ________________

Cash Payment

This amount must be the greater of E or 15% of D

 ________________

H

Local Cost
Financing Requested

This can be no more than 30% of D

 ________________

I

Financed
Amount Requested
(Excluding Exposure
Fee)

D minus G plus H

Aii _____________

 ________________

 ________________

A. Exposure Fee . Check one box.

☐ Ex-Im Bank to finance the fee, which will be paid as the credit is drawn down.
☐ Ex-Im Bank to finance the fee, which will be paid up front.
☐ Ex-Im Bank will not finance the fee, and it will be paid as the credit is drawn down.
☐ Ex-Im Bank will not finance the fee, and it will be paid up front.
B. Transaction Structure.
i. Principal Repayment Term.
(years). Unless otherwise requested, equal installments of principal
will be repaid semi-annually beginning six months after the starting point.

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ii Starting Point. The starting point is generally the event that marks the fulfillment of the exporter’s
contractual responsibility. See Ex-Im Bank’s fact sheets on starting points and reach-back policies at
www.exim.gov. (Check one box.)

☐
☐
☐
☐

☐ Services Completion.
☐ Completion of Installation. Specify date: ______________
☐ Project Completion. Specify date: _______________________

Shipment (single shipment)
Final Shipment (multiple shipments)
Mean Shipment (multiple shipments)
Other

iii Shipment Period. Shipments will be completed and/or services will be performed from:
[
] (month/year) to [
] (month/year) excluding any acceptance,
retention, or warranty period.
iv. Interest rate.
The interest rate to be charged on the guaranteed loan is: ______________________________________________

6. REASON FOR REQUESTING EX-IM BANK SUPPORT.
The basic rationale for Ex-Im Bank support is that the export of U.S. goods and services needs financing but there
are one or more obstacles to obtaining such financing. Please check all the boxes below that apply to this transaction,
to the best of your knowledge. Please also check the appropriate box to indicate which factor is most important.

a)

Export
 credit
 agency
 competition.

Most
 Important?

Are
 any
 non-­‐-­‐-­‐U.S.
 companies
 competing
 for
 this
 sale?
Yes
 ☐

No
 ☐

Don’t
 Know
 ☐

If
 yes,
 is
 the
 non-­‐-­‐-­‐U.S.
 competitor
 receiving
 support
 from
 any
 export
 credit
 agency
 for
 this
 sale?

Yes
 ☐

No ☐

If
 yes,
 please
 list
 the
 export
 credit
 agency:

b)
 Structural
 constraints.

Most
 Important?

Is
 commercial
 financing
 for
 this
 sale
 limited
 by
 bank
 requirements
 (such
 as
 maturity
 limits
 or
 capacity
 limits
 on
 the
borrower,
 industry
 or
 country)?
Yes
 ☐

No
 ☐

Don’t
 Know
 ☐

If
 yes,
 are
 the
 relevant
 limits
 related
 to
 risk
 or
 liquidity?

Yes
 ☐

c)

No
 ☐

Other ☐

Risk
 constraints

Most
 Important?

Is
 commercial
 financing
 for
 this
 sale
 limited
 because
 providers
 of
 commercial
 financings
 are
 unwilling
 or
 unable
 to
accept
 the
 commercial
 and/or
 political
 risks
 of
 the
 borrower
 or
 the
 country?
Yes
 ☐

No
 ☐

Don’t
 Know
 ☐

If
 yes,
 what
 risks
 are
 creating
 the
 limitation?

Yes
 ☐

No
 ☐

Other ☐

d)
 Other.

Most
 Important?

Is
 commercial
 financing
 for
 this
 sale
 limited
 because
 of
 other
 considerations?
Yes
 ☐

No
 ☐

Don’t
 Know
 ☐

If
 yes,
 please
 describe:

  ____________________________________________________________________________

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7. CREDIT INFORMATION
The credit information outlined in the following is attached.

☐ Large Aircraft (Attachment A)
☐ Long-Term and Structured Transactions ( Attachment G)
☐ Limited Recourse Project Finance (Attachment F)

8. OTHER INFORMATION AND CERTIFICATIONS
A. General Information - Provide the following:

☐ Credit Agency report(s) on the exporter(s). If exporter has a credit rating of BBB or better, this is not required.
☐ Annex A to the Master Guarantee Agreement (Guarantees only)
at www.exim.gov/tools/appsforms/documents/MTMGAAnnexes.pdf

☐ Lender’s mandate letter (required when applicant is a financial institution).
☐ Environmental Screening (attachment B).
B. Supply Contracts Between the Exporter and Buyer.

☐ Sales contract(s), pro forma invoice(s), or purchase order(s) are attached.
☐ No contract is attached. (Project Finance and Preliminary Commitments only)
C. Commitment Fee Agreement.
A commitment fee accrues starting 60 days after the authorization of a final commitment and is payable
semiannually in arrears on a schedule determined at the time of authorization. The commitment fee is 1/8 of
1% per annum on the
un-disbursed and un-cancelled balance of a guaranteed loan or 1/2 of 1% per annum for a direct loan. Choose one of
the
options below regarding the payment of the commitment fee:

☐ The applicant is the borrower, and by signing the application, is irrevocably committing to pay the commitment fee.
☐ The applicant is the guaranteed lender, and is (check one):
☐ signing the application which irrevocably commits it to pay the fee, or
☐ signing the application and enclosing with it an Ex-Im Bank standard form fee letter from the
borrower (at www.exim.gov/tools/appsforms/documents/MTMGAAnnexes.pdf). This letter irrevocably commits the
borrower to pay the fee.

☐ The applicant is the exporter, and is signing the application and enclosing with it an Ex-Im Bank standard form
fee letter from the ☐ borrower or ☐ guaranteed lender (at www.exim.gov/tools/appsforms/documents/MTMGAAnnexes.pdf).
This letter irrevocably commits the borrower or guaranteed lender to pay the fee.
D. Content Report
Ex-Im Bank does not require the Content Report at the time of application. Processing of, and the decision on,
the application will not be delayed or affected by the submission or absence of the report. A Cause Report
EBD-M-55 is requested at the end of each calendar year to describe the nature and reason for the inclusion of
any good and services with 50% or more foreign content in the good or service.
E. Anti-Lobbying Disclosure Form
Please refer to the Anti-Lobbying Declaration/Disclosure forms (see Attachment D in this
document) and include a signed copy of the appropriate form(s) with your application.

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F. Certifications
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 Excluded Parties List System (http://www.epls.gov/epls/search.do) (“EPLS”) 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 EPLS 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
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OMB 3048-0013
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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 2 hours 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 # 3048-0013 Washington, D.C. 20503.
Applicant (Company) Name: ___________________________________________________
Name and Title of Authorized Officer: ____________________________________________
Signature of Authorized Officer: ________________________________________________
Date: ______________________________________________________________________

10

Long-Term Loan or Guarantee Application
A TTACHMENT A: Large Aircraft Transactions

1.

OMB 3048-0013
10/31/2015

Financing Type Requested. Three financing options are available for new large aircraft transactions under the Large Aircraft Sector
Understanding (LASU), contained in the OECD Arrangement. All three options may be requested for a PC. Only one option may be
chosen for an AP. Check below the option(s) you are requesting. For used large aircraft transactions, complete No. 3 of the
Long-Term Loan or Guarantee Application.

~ Option 1:
  An Ex-Im Bank guarantee for up to 85% of the contract price.
Bank guarantee for 42.5% of the contract price coupled
~ Option 2: An Ex-Im

  with an Ex-Im Bank

  direct loan at the applicable
LASU interest rate for 42.5% of the contract price. The Ex-Im Bank direct loan is repaid during the later maturities.

~ Option 3: An Ex-Im Bank guarantee for 22.5% of the contract price coupled with an Ex-Im Bank direct loan at the applicable

LASU interest rate for 62.5% of the contract price. The Ex-Im Bank guaranteed loan and direct loan are repaid on a pari-passu basis.

2.

Spare Parts Financing. Indicate if any spare parts or spare engines are
included in the export sale and provide the requested information on these items.

3.

Credit Information. The information requested in this section is generally required for all applications. If the transaction
is secured with a sovereign guarantee, all or part of the detailed operational information requested in items E, F, and G below may not
be necessary. Likewise, if the airline is a repeat customer of Ex-Im Bank, much of the historical financial and operating information
may already have been provided to Ex-Im Bank, and additional information could be limited to updating the existing information. In
either situation, please contact the Transportation Division to discuss the possibility of limiting the amount of information required by
Ex-Im Bank. If any of the information listed in this section is not obtainable, Ex-Im Bank can discuss other options for credit analysis
with the applicant.
a.

Airline history and ownership, and background data on senior management/directors.

b.

Contract price of aircraft, net of all credit memoranda and other discounts extended by the suppliers of the airframe, engines, and
other components.

c.

Amount of buyer furnished equipment (BFE) included in the contract price, description of BFE, and location where BFE will be
installed.

d.

Reason for purchase (replacement or expansion of fleet), proposed routes, and suitability of aircraft model in terms of fleet makeup and intended routes.

e.

Description of each business segment of airline operations (passenger, freight, maintenance, catering, and other related
businesses), and the portion of revenue and operating profit attributable to each segment.

f.

Identification of major geographic markets and description of competitive position, market share, and strategy regarding
competition, yield management, and cost control in each market. Include the airline’s marketing plan and details of affiliations
and partnerships with other carriers.

g.

The operating statistics listed below or similar statistics containing the same general information for the most recent three years
and, if available, up to five years. Provide the listed statistics for domestic and international operations, as well as for each
geographic region or route type and each business segment.
ASKs (Available Seat Kilometers)

Load Factors

ATKs (Available Ton Kilometers)

Yield (passenger and cargo)

RPKs (Revenue Passenger Kilometers)

Aircraft Utilization Rate

RTKs (Revenue Ton Kilometers)

Number of Employees

Operating Expenses per Available Seat Kilometers
h.

Present and projected route structure, including basis for selecting new or expanded routes.

i.

Audited balance sheet, income, and cash flow statements and annual reports for the three most recent fiscal years, and interim
statements for the most recent period, if applicable. Annual statements must be prepared in accordance with internationally
accepted accounting principles and audited in accordance with international standards.

j.

Projected balance sheet, income, and cash flow statements for a five-year period, accompanied by supporting assumptions.

k.

Moody’s or Standard & Poors ratings, if available.

EIB Form 95-10 (attachment A)
Revised 01/07

11

P RELIMINARY/F INAL C OMMITMENT A PPLICATION
A TTACHMENT A: Large Aircraft Transactions

l.

4.

OMB 3048-0013
10/31/2015

Lender’s detailed term sheet of proposed financing structure (not required for Preliminary Commitments). Include relevant information
on the special purpose vehicle (SPV) for lease structures, including the domicile and proposed ownership of the SPV. If a tax lease
structure is contemplated, include a description and flow chart of the proposed tax lease structure.
Security Requirements. Ex-Im Bank will determine wheth er the security for a specific la rge aircraft transaction will be a sovereign
guarantee, a lien on the aircraft, or both. For large aircraft transactions in which the security includes the aircraft, Ex-Im Bank will
require that a valid and enforceable lien be placed on the aircraft to be financed. The information listed below concerning registration
and mortgages is required if Ex-Im Bank has no prior experience with asset-based structures in the airline's country or if the laws pertaining
to registration and mortgages have been amended. Please contact the Transportation Division to determine if such experience exists.
Supplemental information on these issues may be required during the processing of the application and Ex-Im Bank may ask the applicant
to pay for outside counsel or consultants selected by Ex-Im Bank to research partic ular is sues. Include with th e appli cation any addi tional
infor mation that may facilita te Ex-Im Bank's d etermin ation of secur ity.
a.

Aircraft Registration

P

Is the country of registration a party to the Chicago Convention of 1944 on International Civil Aviation?

P

Are there statutes or regulations in the country dealing with the registration of aircraft? If so, provide an English translation of
such statutes or regulations.

P

Is there an aircraft registry? If so, describe how it operates.

P

What specific steps (including any provisions that must be contained in the relevant documents) must be taken to register and
deregister an aircraft?

b.

Aircraft Mortgages

P

Is the country of registr ation a party to the Co nvention of 194 8 on Internatio nal Recognition of Rights in Aircraft (the “Geneva
Convention”)?

P

Describe the statutes or regulations in the country dealing with mortgages of aircraft.

P

Can a valid and perfected first priority mortgage on the aircraft and engin es be created for the ben efit of Ex-Im Bank?

P

What claims may have a “super” priority over a mortgagee or lessor of an aircraft?

P

Following a default, can an aircraft be repossessed without judicial interference?

P

Can a ju dgment b e awarde d in U.S . doll ars and , if so, are any sp ecial ap proval s necess ary?

P

Will a fo reign j udgment or a ju dgment b y an arbi trator be reco gnized in the a irline’s cou ntry?

If you have questions about this attachment, please contact the Transportation Division
(Telephone: 202-565-3550 or Fax: 202-565-3558).

EIB Form 95-10 (attachment A)
Revised 01/07

12

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT B: Environmental Screening Document

OMB 3048-0013
10/31/2015

Must Accompany All Applications For Long-Term Financial Support
The information provided on this form is used to environmentally categorize the application and thereby determine the
information needed (if any) for Ex-Im Bank to evaluate the environmental effects of the transaction, a process that is
crucial to the appropriate and timely review of your application. Please check the boxes that apply.
Are the products or services covered in your application destined for an identified project?
No, explain ___________________________________________________________________
Yes, a) identify the project______________________________________________________ __
b) provide a brief description, including output, capacity, size, etc.____________________ ___
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
c) indicate whether new project, rehabilitation or expansion _____________________________
Project Location
Is the project located in or near an environmentally sensitive site or area? (Check all applicable):
Tropical Forest
Nationally Designated Wetlands or Seashore / Protected Wildlands / Nationally Designated Refuges
National Parks
Coral Reefs or Mangrove Swamps
Habitat of Endangered Species
Location affecting indigenous or tribal populations
Location having Historical / Archaeological Significance
Large Scale Resettlement? (Potential Number of People Affected: ____________________)
Properties on the World Heritage List

Project Sector Or Industry
Check classification(s) describing the project for which the exports are destined:
Large infrastrucure:
Airport
Ports/harbors
Pipelines
Highways
Other large infrastructure

Iron & Steel Plant
Smelter
Pulp & Paper Plant
Petroleum Refinery or Petrochemical Plant
Chemical / Pharmaceutical
Natural Gas Liquefaction Plants
Industrial plants – large scale

Agro-industries – large scale
Forestry
Mining & Mineral Processing Plant
Oil & gas field development

Transportation (Aircraft, Locomotives, Boats)
Telecommunications or Satellites
Air traffic control or navigational aids
Railway signaling

Hydropower Plant / Water Reservoir
Thermal power plant
over 140 MWe
under 140 MWe
Nuclear power plant
Geothermal Power

Pre-project services, feasibility/environmental study
Consulting services

Waste management

Other, specify:_____________________________

Hospitals and medical equipment

Name of Applicant ______________________________________ Date__________________
For inquiries and information please contact the Engineering & Environment Division at (202)565-3570.
Revised 1/07

13

OMB 3048-0013
10/31/2015

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT C: Tied Aid Capital Projects Fund
1.

Check if you are requesting appropriate Ex-Im Bank support to preclude or counter foreign tied aid offers.

2. Check if one or more foreign governments are offering, or planning to offer, unusually long repayment periods, unusually low
interest rates, and/or mixed grant-credit financing for the specific contract for which Ex-Im Bank support is sought. Attach
available documentary evidence of a foreign tied aid credit offer. If such evidence is not available, specify your reasons for
suspecting foreign tied aid.

3. Check if you authorize Ex-Im Bank to ask the OECD Secretariat to issue a confidential “no aid” comm. on line request to OECD
member governments. Acceptance of this request would preclude future foreign and U.S. aid financing for the project.
4. Check if you believe that loss of this contract will jeopardize follow-on sales opportunities for similar sales in the same market.
Provide the type and estimated value of potential follow-on sales.
5.

Provide the following information, if known, for each foreign government’s tied aid offers.
Foreign Offer #1

Foreign Offer #2

Donor government
Foreign exporters supported
Total offer amount
Currency of offer
Credit portion amount
Credit portion interest rate
Credit portion grace period
Credit portion repayment period
Grant portion, if any

If you have questions about this attachment, please contact the Business Development Division
(Telephone: 202-565-3946 or Fax: 202-565-3931).

EIB Form 95-10 (attachment C)
Revised 1/07

14

OMB 3048-0013
10/31/2015

ATTACHMENT D: Anti-lobbying Declaration/Disclosure
The provisions of this Attachment D apply to the following, as applicable: direct loans, medium-term
insurance policies and final commitments for medium or long-term guarantees.
1. Anti-Lobbying Law.

Under a U.S. law (31 U.S.C. 1352), recipients of U.S. government loans (which includes direct loans
from Ex-Im Bank), grants, contracts, and cooperative agreements, are prohibited from spending
Federally appropriated funds to influence certain U.S. government employees, including Ex-Im Bank
employees, in connection with the awarding of any such Federal award.
Recipients of U.S. government loans, grants, contracts and cooperative agreements may spend nonFederally appropriated funds for such lobbying purposes; however, they are required to declare and
disclose such lobbying expenditures related to a specific transaction.
The law also requires recipients of Ex-Im Bank guarantees and insurance to declare and disclose any
lobbying activities in connection with the particular guarantee or insurance policy. Declaration and
Disclosure Forms are to be filed by applicants and recipients, including certain exporters and suppliers,
as defined below.
2. Compliance Procedures. 2a. Who Must File.

All applicants for direct loans, medium-term insurance policies and final commitments for medium or
long-term guarantees must file the appropriate Declaration, in the form annexed to this Attachment D,
regardless of whether any funds have been spent for lobbying purposes.
For applicants for direct loans, if any funds have been spent for lobbying purposes in connection with
this direct loan, a Disclosure Form must also be filed as directed in the annexed Declaration. The
Disclosure Form is OMB Standard Form LLL, “Disclosure Form to Report Lobbying,”
(http://www.exim.gov/pub/ins/pdf/lll.pdf).
For applicants for medium-term insurance policies and for final commitments for medium-term and
long-term guarantees, if any funds have been spent for lobbying purposes in connection with the
insurance policy or guarantee that is the subject of the transaction, a Disclosure Form must also be
filed as directed in the annexed Declaration. The Disclosure Form is OMB Standard Form LLL,
“Disclosure Form to Report Lobbying,” (http://www.exim.gov/pub/ins/pdf/lll.pdf).
The Declaration and/or Disclosure Forms must be received by Ex-Im Bank from the applicant
before Ex-Im Bank will consider the application for a final commitment.
All recipients under Ex-Im Bank programs, who are not the applicant for a final commitment, must file
the appropriate Declaration and, if they have spent funds for lobbying purposes in connection with the
Ex-Im Bank transaction, a Disclosure Form. Recipients include borrowers who receive Ex-Im Bank
direct loans, exporters who receive Ex-Im Bank insurance and lenders who receive Ex-Im Bank
insurance or guarantees.
The Declaration and/or Disclosure Forms must be received by Ex-Im Bank from the recipients
before Ex-Im Bank will enter into a loan, or issue an insurance policy or guarantee.
All suppliers who have entered into a contract in excess of $100,000 with the recipient of an Ex-Im
Bank direct loan or grant must file a Declaration and, if funds have been spent for lobbying purposes, a
Disclosure Form.
Such suppliers must file the Declaration and/or Disclosure Forms upon being awarded the supply
contract.

15

OMB 3048-0013
10/31/2015

2b. Exemptions.

The law has been interpreted so that it does not apply to foreign governments, their instrumentalities or
their wholly-owned companies. Therefore, these entities are exempt from filing both the Declaration
and Disclosure Forms.
The law’s disclosure requirements do not apply to loan, insurance or guarantee transactions where the
U.S. Government-financed portion is $150,000 or less.
2c. How To File.

Complete the appropriate Declaration Form on the following page. If you are required to file a
Disclosure Form, it will be provided by Ex-Im Bank upon request. Any person who fails to file the
required forms shall be subject to a civil penalty of not less than $10,000 and not more than $100,000
for each such failure.

Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying Declaration
3. Certification for Contracts, Grants, Loans and Cooperative Agreements.

The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of an agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with
the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated 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 Federal
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard FormLLL, “Disclosure Form to Report Lobbying”, in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents
for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification 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
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each
such failure.
Applicant/Recipient Company ______________________________________________
Signature _______________________________________________________________
Name Title ______________________________________________________________

16

OMB 3048-0013
10/31/2015

Long-Term Loan or Guarantee Application
ATTACHMENT D: Anti-lobbying Declaration
4. Statement for Loan Guarantees and Loan Insurance.
The undersigned certifies, to the best of his or her knowledge and belief, that:
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 a 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”, 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.
Applicant/Recipient Company ___________________________________________
Signature ____________________________________________________________
Name Title ___________________________________________________________

EIB Form 95-10 (attachment D) Revised 1/07

17

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT E: Used Equipment Questionnaire

See Attachment E: Used Equipment Questionnaire

EIB Form 95-10 (attachment D)
Revised 1/07

18

OMB 3048-0013
10/31/2015

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT F: Project and Structured Finance

I.

OMB 3048-0013
10/31/2015

Project Finance.
The term “project finance” refers to the financing of projects that are dependent on the project cash flows for repayment as defined by the
contractual relationships within each project. These projects do not rely on the typical export credit agency security package which has
recourse to a foreign government, financial institution or established corporation to meet a reasonable assurance of repayment criterion. By
their very nature, projects rely on a large number of integrated contractual arrangements for successful completion.

1.

Ex-Im Bank Project Finance.

P Maximum Support Possible. Where

P Flexible

Equity Arrangements. There P Rapid Case Processing. With the help of

are no predetermined equity requirements.
Ex-Im Bank will review and determine the
appropriate equity structure on a caseby-case basis. The equity sponsor’s ownnership position cannot be transferred
without Ex-Im Bank’s consent.
P Ex-Im Bank Exposure Fee
Commensurate with Risk. Exposure fees
will vary depending on the risk assessment
of the project and the type of coverage
requested during construction and post P
c) Maximum repayment term allowed under
completion. The exposure fee can be paid
the OECD guidelines.
up-front or with each disbursement and can
P No Size Limitation. There are no minibe financed.
mum or maximum size limitations.
P Flexible Coverage. Any combination of P (QYLURQPHQWDO&RQVLGHUDWLRQV Ex-Im
Bank’s environmental procedures will
either direct loans or guarantees for
apply.
commercial bank loans with political risk
only or comprehensive coverage are
available for a given project.
appropriate, Ex-Im Bank will offer the
maximum support allowed within the
rules of the OECD Arrangement, to
include:
a) Financing of interest accrued during
construction related to the Ex-Im Bank
financing.
b) Allowance of up to % foreign content
in the U.S. package.

outside financial consultants, Ex-Im Bank will
give a preliminary indication of support, called
a Preliminary Project Letter (PPL), within 45
days from the date evaluation begins by the
outside consultant. Should the project be
sufficiently developed, the sponsor may
proceed directly to a final commitment from
the PPL, as determined by the Project Finance
Division.
Financial Consultants. Ex-Im Bank has
advisers on specific project finance cases.
Please contact the Structured Finance Group.

2. Application Process.

P Submission.

The project finance application

must include: 1) the standard Ex-Im Bank LT
Application, and 2) an electronic copy of the
materials listed in this attachment. These
materials should be marked “Project Finance
Application” and submitted to Ex-Im Bank.
P Preliminary

Review. Ex-Im Bank will
review the submitted material within five to
ten business days of the date that the
application is received by the Structured
Finance Division. This review will
determine if the application includes the
information required to proceed with an
evaluation.
P Incomplete

Applications. If the application presented is determined to be incomplete by the Structured Finance Division, the
applicant will be contacted with an
explanation of the application’s deficiencies.
If the application is not determined to be
suit-able for limited recourse project
financing but could still be considered for
another form of Ex-Im Bank financing, it
will be forwarded to the appropriate division
and the applicant will be notified.

EIB Form 95-10 (attachment F)
Revised 1/07

P Choice

of Financial Consultant. A

P

financial consultant will be selected by ExIm Bank to evaluate the application.
Determination of the specific financial
consultant will depend on several factors
including geographic and sector expertise,
and ability to meet project deadlines.
P Evaluation

Fee. Before the financial
consultant begins review, the applicant
will be required to pay an evaluation fee.
P Other

Fees. For most projects, Ex-Im
Bank will require, either in conjunction
P
with other lenders or for its own use, the
advice of independent outside legal
counsel, independent engineers, and
insurance advisers. In addition, there may
be other fees associated with conducting
proper due diligence. Payment for these
and any other fees will be the
responsibility of the project sponsors or
the applicant.

19

Preliminary Project Letter. Assuming the
evaluation process is satisfactory, the Structured
Finance Division will issue a PPL. The PPL
indicates that Ex-Im Bank is prepared to move
forward on a financing offer and the
corresponding general terms and conditions.
These terms and conditions will be based
upon the information available at the time of
application. The evaluation and issuance of
the PPL will be completed within 45 days of
commencement of the evaluation.
Evaluation Post-PPL. After issuance of the
PPL, Ex-Im Bank will work with the applicant
to secure a final commitment. On a case-bycase basis, Ex-Im Bank may continue to
utilize the financial consultant.

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT F: Project and Structured Finance

OMB 3048-0013
10/31/2015

3. Project Criteria and Application Information Requirements.
a. General Project.
Definition
P Ideally the project should have long-term contracts from creditworthy entities for the
purchase of the project’s output and the
purchase of the project’s major project inputs
such as fuel, raw materials, and operations
and maintenance. Such con-tracts should
extend beyond the term of the requested ExIm Bank financing. Where such contracts do
not exist, additional equity and/or other credit
support is expected.

P The project should contain an appropriate

P Product unit pricing and costs should reflect

allocation of risk to the parties best suited to
manage those risks. Sensitivity analysis should
result in a sufficient debt service coverage ratio
to ensure uninterrupted debt servicing for the
term of the debt.

market-based pricing.

P Devaluation risk needs to be substantially

mitigated through revenues denominated in
hard currencies, revenue adjustment formulas
based on changing currency relationships, or
other structural mechanisms.

P Total project cost should be comparable to

projects of similar type and size for a particular
market.

Information required
1. Summary of all aspects of the project, as
contained in an independently prepared
feasibility study and/or a detailed information memorandum, prepared by a qualified
party. The study or memorandum should
include the project description, location, legal
5.
status, ownership, and the background and
status of key elements of the project structure,
such as agreements, licenses, local partner
participation, and financing.
2. Draft agreements for key elements of the
project, including supply and offtake
agreements.
3. A breakdown of anticipated project costs
through commissioning, including interest
during construction and working capital
requirements, by major cost category and
country of origin.
4. A summary of the anticipated project
financing plan and security package,
including: the proposed source, amount,
currency and terms of the debt and equity
investments; the sources of finance in the

event of project cost overruns; and description of 6.
escrow accounts. Information on the terms,
security requirements, and status of financing
commitments of other lenders to the project, if
applicable, should be provided.
Projected annual financial statements
covering the period from project develop7.
ment through final maturity of the
proposed Ex-Im Bank financing, to
include balance sheet, profit and loss,
source and application of funds
statements, and debt service ratios.
Projections should include a sensitivity
analysis for not only the expected
scenario but pessimistic and optimistic
cases as well. This information should also be
8.
electronically provided with the project’s
financial model. The structure of the financial
model should be in a format that is user friendly.
Ex-Im Bank must be able to review and adjust
9.
the assumptions in the model.

Assumptions for the financial projections,
including but not limited to the basis for
sales volume and prices; operating and
administrative costs; depreciation,
a mortization and tax rates; and local
government policy on price regulation.
Market information, to include: ten
years of historical price and volume
data; present and projected capacity of
industry; product demand forecast with
assumptions; description of competition
and projected market share of the project
as compared to the shares of the competition; identity and location of customers;
and marketing and distribution strategy.
A description of the principal risks and
benefits of the project to the sponsors,
lenders, and host government.
A description of the types of
insurance coverage to be purchased for
both the pre- and post-completion
phases of the project.

b. Participants.
Definition

P Project sponsors, offtake purchasers,

contractors, operators, and suppliers must
be able to demonstrate the technical
managerial and financial capabilities to
perform their respective obligations within
the project.

EIB Form 95-10 (attachment F)
Revised 1/07

Information Required
1. Sponsors must provide a brief history
description of their operations, a
description of their relevant experience in
similar projects, and three years of audited
financial statements, in English.
2. If the sponsors are part of a joint venture or
consortium, information on all participants
should be provided. A shareholders’
agreement should also be provided.

20

3.

Offtake purchasers and suppliers should
provide a history and description of
operations, at least three years of audited
financial statements, in English, and a
description of how the project fits in their
long-term strategic plan.

4.

Contractors and operators must provide
resumes of experience with similar projects
and recent historical financial information.

OMB 3048-0013
10/31/2015

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT F: Project and Structured Finance
c. Technical.
P Project technology must be proven and

reliable, and licensing arrangements must
be contractually secured for a period
extending beyond the term of the Ex-Im
Bank financing.

Information Required
1. Technical description and a process flow
diagram for each project facility.
2. Detailed estimate of operating costs.

P A technical feasibility study or sufficiently

3. Arrangement for supply of raw materials
and utilities.
detailed engineering information needs to be
provided to demonstrate technical feasibility 4. Draft turnkey construction contract and
of the project.
description of sources of possible cost
increases and delays during construction,
including detailed description of liquidated
damage provisions and performance bond
requirements.

5. Project implementation schedule, showing
target dates for achieving essential project
milestones.
6. A site-specific environmental assessment,
highlighting concerns, requirements and
solutions. The information to be provided
should demonstrate compliance with Ex-Im
Bank’s environmental guidelines.

d. Host Country Legal/Regulatory Framework and Government Role.
Definition

P Host government commitment to

proceeding with the project needs to
be demonstrated.

Information Required

1. A description of the host government’s role in
the project, and progress made toward obtaining
essential government commitments, including
P Legal and regulatory analysis needs to
authorizations from appropriate government
demonstrate that the country conditions
entities to proceed with the project.
and the project structure are sufficient to
support long-term debt exposure for the
project through enforceable contractual 2. A definition of the control, if any, that the
government will have in the management and
relationships.
operation of the project, and status of any
assurances that the government will not
P Ex-Im Bank’s relationship with the host
interfere in the project’s operation. If the
government will be addressed on a casegovernment is also a project sponsor, these
by-case basis.
issues will be of particular importance.

3. Evidence of the government’s current and
historical commitment and policies for
availability and convertibility of foreign
currency.
4. Status and strategy for obtaining
government undertakings to support any
government parties involved in the project,
to the extent that such undertakings are
needed to provide adequate credit support
for such entities.

II. Structured Finance.
“Structured” transactions will have an established corporation as a borrower but may rely upon sources of collateral or security in
addition to the corporation’s balance sheet. The information required for structured finance applications is the same as that requested in
“Attachment G” plus any additional data describing the proposed structure and security package.

If you have questions about this attachment, please contact the Structured Finance Division
(Telephone: 202-565-3690 or Fax: 202-565-3695).

EIB Form 95-10 (attachment F)
Revised 1/07

21

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT G: Credit Information
This attachment applies to all Long-Term Loan or Guarantee Applications, except for Large Aircraft and Project
Finance Transactions. Provide the General Information and Supplemental Financial Information requested below
(as applicable) on the borrower and, if any, guarantor. If any items are not available, provide an explanation.
Following Ex-Im Bank’s initial review of the application, an Ex-Im Bank Credit Officer may request additional
credit information.
In the event that the borrower lacks sufficient credit strength in terms of asset size, operating history or cash flows to
provide a reasonable assurance of repayment, an Ex-Im Bank Credit Officer will contact you to discuss whether
“Structured Finance” credit enhancements are appropriate. Such enhancements may include one or more of the
following:
- Special purpose accounts, including offshore payment accounts, escrow or reserve accounts, or
other accounts that would be subject to Ex-Im Bank’s control.
- Covenants and default provisions such as financial ratio or debt service coverage requirements that
would, if violated, prevent payment of dividends to the company owners.
- Insurance requirements that might be more strict than those typically applicable under corporate
insurance policies.
- Letters of credit or other sources of funds that would be pledged by the sponsor to Ex-Im Bank
through a bank or other third party.
GENERAL INFORMATION
1.
Company description and ownership. Provide a concise description of company origin, legal status,
facilities, business activities (and any major changes during the last three years), and primary market(s). Describe
the principal customer base (e.g., manufacturers, wholesalers) and provide the percentage of domestic versus export
sales and the amount of sales to each major export market. Provide the name and address of each owner of at least
10% of company shares and his/her ownership percent.
2.
Related party information. Provide the names and description of subsidiaries, affiliates and commonly
owned companies. Indicate which, if any, of these related parties account for more than 25% of the borrower’s sales
or purchases during the last fiscal year.
3.

References.
a. Bank references. Provide a creditor bank reference prepared within six months of the application date. A
bank reference is not required for sovereign or political risk transactions. Report should include bank
name, address, length of relationship, amount, currency, terms of secured and unsecured credit and
repayment experience.
b. Credit Report: Provide a credit report (such as D and B) prepared within six months of the application
date. Not required for sovereign or financial institution transactions.

4.
Financial Statements. Provide independently audited balance sheets, income statements and cash flow
statements, in English, for the last three fiscal years. Include the auditor’s notes to the financial statements. If the
most recent fiscal year ended more than nine months prior to the application date, provide interim statements. When
interim statements are provided, also provide interim statements for the same period of the previous year (for
comparative purposes). If there are substantial related party transactions as described in #2, the financial statements
must adequately disclose the consolidated financial condition of the borrower/guarantor and the named related
parties. Financial statements are not required for sovereign or political risk transactions.
5.
Financial projections. Provide projected annual income statement, balance sheet and cash flow forecasts
for the period of the Ex-Im Bank financing, accompanied by supporting assumptions. Projections are not required if
the borrower or guarantor is a financial institution, or for sovereign or political risk transactions.

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ATTACHMENT G: Credit Information
6.
Market indications. Provide debt ratings assigned by Standard and Poor’s, Moody’s, Fitch-IBCA and
Duff & Phelps, as well as other international and local rating agencies. Include the debt rating reports issued by the
rating agency, and if applicable, the prospectus for debt or equity offered during the two years prior to the
application date.
7.
Credit Agreement Information. Provide a summary of the covenants, events of default, security interest
and inter-creditor arrangements for existing creditors of the borrower or other entity considered to be the primary
source of repayment.
SUPPLEMENTAL FINANCIAL INFORMATION
This information is required for comprehensive-cover transactions where the primary source of repayment is not a
financial institution or a sovereign entity. Provide the information requested below on the borrower or guarantor
that is designated as the primary source of repayment in accordance with the following guidance:
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if the requested information is provided in the notes to the financial statements, refer to the notes and
indicate the note number.
if the requested information is provided in a credit write-up that is enclosed, refer to the write-up and
indicate the page number.
unless otherwise indicated, provide information for each fiscal year for which financial statements are
submitted.
Items regarding changes in amounts or percentages refer to changes measured in U.S. dollars.
a “change” means any change, either an increase or a decrease.

Operating Performance
1.
Describe the expected operational and financial impact of the goods and/or services being purchased.
2.
If any customer accounted for more than 25% of sales revenue in the last fiscal year, provide the
customer’s name, industry, percentage of revenue, length of relationship, sales terms, and whether or not
the customer is a related or commonly owned entity.
3.
If sales revenue changed by more than 15%, provide reasons.
4.
Provide the level of production (in units) for principal product lines for each fiscal year and, if the
production level changed by more than 15%, provide reasons.
5.
For each component of cost of goods sold for the last fiscal year, provide the component type, amount,
origin (domestic or foreign), and range of terms offered by suppliers.
6.
If cost of goods sold as a percentage of sales revenue changed by more than 5%, provide reasons.
7.
If any non-operating expense (other than interest or income taxes) represented more than 20% of operating
profit, describe the expense.
8.
If an operating loss or a net loss was incurred, provide reasons.
Balance Sheet
9.
If total investments were more than 15% of total assets at the end of the last fiscal year, provide for each
investment the type, amount, currency, security issuer, and/or company owned.
10.
If there has been a change of more than 20% in receivables days-on-hand, provide the reasons and the
range of terms granted for trade receivables.
11.
If aggregate related company receivables, commonly owned company receivables, and non-trade related
receivables exceeded 15% of total assets, provide the amount and purpose of each category of receivables.
12.
If inventory was more than 20% of total assets at the end of the last fiscal year and/or inventory days-on­
hand increased more than 20%, provide reasons.
13.
If payables days-on-hand increased more than 20%, provide reasons and the terms granted by each supplier
that represented more than 20% of payables.
14.
If capital expenditures anticipated during the next 2 fiscal years exceed 15% of net fixed assets at the end of
the last fiscal year, provide the amount, purpose, and financing plans for the capital expenditures.

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ATTACHMENT G: Credit Information
15.
16.
17.
18.

Provide the source, amount, currency, terms, and security/guarantees for credit lines available from
financial institutions and credits owed to financial institutions.
Provide the aggregate amount of principal maturities due to all creditors in each of the next five fiscal
years.
Provide the source, amount, and dates of equity cash infusions in each of the last three fiscal years and
anticipated during the next fiscal year.
If any asset, liability, or equity account represented more than 15% of total assets and has not been
previously described, provide the amount and a description of the account.

Off Balance Sheet Items
19.
If the aggregate amount of contingent/off balance sheet items was more than 10% of total assets at the end
of the last fiscal year, provide a description of the items.
Interim Statements
20.
Explain any material changes in the interim financial statements relative to the statements for the last fiscal
year.
Subsequent Events
21.
Provide details of events subsequent to the end of the last fiscal year that could have a material effect on the
creditworthiness of the company, and plans to deal with any material adverse changes.

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