Form EIB 10-06 EIB 10-06 Application for Approved Finance Provider

 
OMB No. 3048-0032
Expires Pending

APPLICATION FOR APPROVED FINANCE PROVIDER

This application is to be completed by a financial institution in order to become an Approved Finance Provider (AFP).
An AFP may make loans under Ex-Im Bank insurance policies and, if approved, may enter into one or more Master
Guarantee Agreements (MGA) with Ex-Im Bank. An AFP may participate in the Medium-Term Insurance, Bank Letter
of Credit, and Financial Institution Buyer Credit programs as an insured lender. AFPs approved for an MGA may apply
for multiple loan or lease transactions to be guaranteed by Ex-Im Bank. 

Send this completed application to Ex-Im Bank, 811 Vermont Ave NW, Washington, D.C. 20571. Ex-Im Bank also
accepts electronic scans and faxed applications. Ex-Im Bank does not require originals of the application materials to
be mailed. Applications sent electronically or by fax must include the signed application and all required attachments.
(Fax number: 202.565.3675, e-mail: [email protected])

Note: A separate application must be completed for each subsidiary or affiliate that is a separate legal entity. All
information should be in English. AFPs must renew this application every three years to remain active.  

Applicant Name:

Phone Number:

Contact Person:

Fax Number:

Position Title:

Email:

Address:

City:

State:

Zip Code:

Country:

Email:

DUNS Number:
Renewal Application?

YES

NO

If yes, please list MGA Numbers:

YES
NO
Does the Applicant have a market rating?
If yes, provide the name of the rating agency, rating, and the date of the rating.

Rating Agency Name:

Rating:

Rating Date:

Is the Applicant regulated by a State/Provincial or Federal regulatory agency?
If yes, provide the name of the regulatory agency.

YES

NO

Regulatory Agency Name:

An Approved Finance Provider may provide financing under any of the following Ex-Im Bank programs. Please check
all programs being requested.
Insured Lender (Medium-Term, Bank Letter of Credit, Financial Institution Buyer Credit)
Master Guarantee Agreement – Medium-Term Loan Credits
Master Guarantee Agreement – Long-Term Loan Credits
Master Guarantee Agreement – Agency - Medium-Term Loan Credits
Master Guarantee Agreement – Agency – Long-Term Loan Credits
Master Guarantee Agreement – Medium-Term Finance Lease Credits
  EIB10-06
01/16

1. REQUIRED SUPPLEMENTAL INFORMATION

OMB No. 3048-0032
Expires 05/31/2014

a. Description of Applicant's organization, including: type of lending institution (commercial bank,

finance company, etc.), type of organization (corporation, partnership, etc.), and business activities.
b. Audited annual financial statements for the two most recent fiscal years (parent consolidated
statements if Applicant does not prepare separate financial statements).
c. Full names and city and country of residence of all of Applicant's (i) owners or stockholders with an
interest in excess of 10% and (ii) members of the Board of Directors.
d. Description of Applicant's trade finance experience and a description of the trade finance experience
of each member of senior management and each person who will be responsible for the Ex-Im Bank
relationship, including each person who will sign the MGA (if one is being requested) or other
documents to be submitted to Ex-Im Bank.
e. Description of Applicant's target market(s) and transaction origination plans, including whether

Applicant will employ third-parties to originate transactions and the process Applicant has used or
will use to select and compensate such parties.
f. Description of Applicant's transaction due diligence and "know-your-customer" processes. Please
note Applicant is expected to conduct due diligence in accordance with good industry practices. ExIm Bank encourages each Applicant to review and consider Ex-Im Bank's "Transaction Due
Diligence Best Practices" published on Ex-Im Bank's internet website.
g. Certificate of Good Standing or other similar document issued by Applicant's regulating entity or
chartering authority.
h. For Applicants for Finance Lease MGA only: A brief description of the Applicant's international
leasing experience, including: (i) years engaged in leasing both domestically and internationally; (ii)
number of leases during the current and past two years, broken down by domestic and international
leases; (iii) size of leasing portfolio at the end of the most recent fiscal year, with percentage
breakdowns by financing vs. operating leases and top five countries; and (iv) name and percentage
of any lessees that represent more than 5% of the leasing portfolio at the end of the most recent
fiscal year.

2. ADDITIONAL INFORMATION REQURED FOR UNREGULATED FINANCIAL INSTITUTIONS AND ALL
INSTITUTIONS DOMICILED IN AN OECD CATEGORY II COUNTRY
a. Description of how Applicant plans to fund transactions. If Applicant does not plan to fund the

transactions from internal sources, specify how transactions will be funded and by whom (Ex-Im
Bank may require evidence of agreements demonstrating the availability of outside funding).
b. State whether Applicant intends to retain or sell Ex-Im Bank guaranteed or insured transactions. If
Applicant intends to sell the transactions, identify the purchaser (Ex-Im Bank may require evidence
of purchase agreements).
c. Describe Applicant's loan servicing and loan monitoring capabilities and experience. If an outside
entity will service the transactions, identify this entity and its experience.
d. Credit report from a third party source dated within six-months of the date of this application, and a
bank reference.

  EIB10-06
01/16

CERTIFICATIONS AND NOTICES
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 any
transaction with any Ex-Im Bank support, including checking: (i) the System for Award Management
(https://www.sam.gov/portal/public/SAM/) (“SAM”) to determine if any parties with which Applicant
has or will have a purchase, sale, leasing or financing agreement related to such transaction are
excluded from U.S. Government transactions; and (ii) the Sanctions List Search tool maintained by
the Office of Foreign Assets Control (“OFAC”) (https://sdnsearch.ofac.treas.gov) (“Sanctions List
Search”).
Applicant will not knowingly enter into any purchase, sale, leasing or financing agreements in
connection with any Ex-Im Bank support with any individual or entity that is listed on the SAM or the
Sanctions List Search (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 Form4

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 undersigned authorized officer, on Applicant’s behalf, further certifies that the representations
made and the facts stated in this Application and its attachments are true to the best of our
knowledge and belief, and we have not misrepresented or omitted any material facts. We
understand that EXIM Bank will rely on the certifications and representations made in this
Application, including its attachments, and we agree we are liable for any damages suffered by
EXIM Bank’s reliance. We also understand that these certifications are subject to penalties for fraud
and for providing false documentation, including, but not limited to, those penalties provided f or in
Article 18 United States Code, Section 1001. We agree that presentation of disbursement or claim
documentation to EXIM Bank for approval or payment, as the case may be, under the EXIM Bank
Credit/Guarantee/Insurance, is a confirmation and re-certification by us of the information and
certifications made herein. We agree to provide additional information with respect to any of the
matters covered in this Application upon EXIM Bank’s reasonable written request.
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.

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Paperwork Reduction Act Statement: We estimate that it will take you about 3 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 # 3048-0032 Washington, D.C. 20503.

(Signature)

(Print Name and Title)

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(Date)