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

OMB 3048-0013
PENDING 2019

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 may also be used for certain EXIM 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 EXIM long-term loans and guarantees can be found at EXIM’s web site http://
exim.gov/tools-for-exporters//applications-forms
Send this completed application to EXIM, 811 Vermont Avenue, NW, Washington, DC 20571. EXIM will also accept e-mailed
PDF applications. Please note that applications must be PDF scans of original applications and all required application attachments.
(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. (https://www.exim.gov/tools-for-exporters/applications-forms)

B Conversion of a Preliminary Commitment or a Letter of Interest
☐ No
☐ Yes.
The EXIM 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was withdrawn for other reasons.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 EXIM 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:
*Business Address:
*City:
*Corporate Ownership:
* Does the Applicant have any affiliates2?
*Total Number of Employees:
Contact Person:
Position Title:
1

Duns #:
Taxpayer ID#:
Country:

*State:
Yes

*Zip + 4:
* Primary Industry NAICS1:
No

*Annual Sales Volume:
Email:
Phone:

Fax:

A company’s Primary Industry NAICS code 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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*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)
Primary contact point for EXIM inquiries on this transaction:
☐ borrower
☐ exporter
☐ lender
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:
*Business 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:
*Business 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 code 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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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 #: __________________________________
Business 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 #: _________________________________
Business 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 #: __________________________________
Business 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 #: __________________________________
Business address: _________________________________________ E-mail: __________________________________
City: ______________________ State/Province: ______________ Postal code: ______________________________
Country: _________________________________________________________________________________________
Lender. The lender is the company that extends the EXIM 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 #: __________________________________
Business 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 #: __________________________________
Business 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
EXIM’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://exim.gov/what-we-do/loanguarantee/foreign_currencyguarantee

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

☐ Co-Financing with
Foreign Export Credit
Agency Attachment H
required

☐ Used Equipment
Attachment E required
http://exim.gov/policies/
used-equipment

☐ Nuclear

http://exim.gov/policies/ex-imbank-and-the-environment
/international-environmental-andsocial-guidelines

☐ Ancillary Service Fees

document)
☐this
Environmental Exports
Program
http://exim.gov/about/
special-initiatives/environment

☐ Capitalization of Interest
During Construction

http://exim.gov/sites/default/
files/forms/ebd-m-13.pdf

☐ Tied Aid Program
Attachment C required

☐ Finance Lease Structure
http://exim.gov/what-we-do/
finance-lease-guarantee

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

☐ Other

☐ Other

☐ Other

4. TRANSACTION DESCRIPTION
a) Describe Goods and Services. Include make, model, manufacturer/supplier, NAICS of goods and services, number of units,
values, and estimated U.S. and foreign content.
__________________________________________________________________________________________________

__________________________________________________________________________________________________

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
EXIM 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, EXIM 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
B

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.

Excluded Goods and
Services

The aggregate price of all goods and services that are not
eligible for or are excluded from EXIM support (e.g.
goods not shipped from the U.S. and excluded ancillary
services). Local costs should not be included in this line.

US$
Ai _____________
Aii _____________

 ________________

C

Total Local Costs

The aggregate price of all goods originated/manufactured
in the Purchaser's country and all services provided by

 ________________

residents purchaser’s country. EXIM may be able to
finance these amounts up to 30% of D below.

D
E

Net Contract Price

A minus B minus C

F
G

Eligible Foreign
content

The aggregate cost of any goods (or components thereof)
produced or manufactured outside the U.S, or services
provided by third country personnel, foreign freight costs
and foreign insurance included in the net contract price
(line D), (e.g. foreign items exported from the US)

 ________________

 ________________

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

 ________________

A. Exposure Fee. Check one box.

☐ EXIM to finance the fee, which will be paid as the credit is drawn down.
☐ EXIM to finance the fee, which will be paid up front.
☐ EXIM will not finance the fee, and it will be paid as the credit is drawn down.
☐ EXIM 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 EXIM’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 EXIM SUPPORT.
The basic rationale for EXIM 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
 competition.

Most
 Important?

Are
 any
 non-­‐-­‐-­‐U.S.
 companies
 competing
 for
 this
 sale?
No
 ☐
Yes
 ☐
If yes, please identity non-U.S. competitor:

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 https://www.exim.gov/sites/default/files//forms/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 EXIM standard form fee letter from the
borrower (at https://www.exim.gov/sites/default/files/forms/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 https://www.exim.gov/sites/default/files/forms/mtmgaannexes.pdf).
This letter irrevocably commits the borrower or guaranteed lender to pay the fee.
D. Anti-Lobbying Disclosure Form
Please refer to the Anti-Lobbying Declaration/Disclosure forms (see Attachment D) and include a signed copy of the
appropriate form(s) with your application.

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LONG-TERM LOAN OR GUARANTEE APPLICATION ATTACHMENTS
Attachment A (Form EIB 95-10a): Large Aircraft Transactions
Attachment B (Form EIB 95-10b): Environmental Screening Document
Attachment C (Form EIB 95-10c): Tied Aid Capital Project Fund
Attachment D (Form EIB 95-10d): Anti-lobbying Declaration/Disclosure
Attachment E (Form EIB 11-03): Used Equipment Questionnaire
Attachment F (Form EIB 95-10f): Project and Structured Finance
Attachment G (Form EIB 95-10g): Credit Information
Attachment H (Form EIB 11-04): Co-financing with Foreign Export Credit Agency

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CERTIFICATIONS AND SIGNATURE
Please refer to the “Standard Certifications and Covenants for EXIM Applications” set forth in Form EIB 18-CN, posted
on the EXIM website at https://www.exim.gov/tools-for-exporters/applications-forms/complete-list (the “Standard
Certifications”). THE STANDARD CERTIFICATIONS ARE INCORPORATED INTO THIS APPLICATION AS IF FULLY
AND DIRECTLY SET FORTH HEREIN. When signing this application in the space provided below, the undersigned
authorized officer signing on the applicant's behalf certifies and represents that he or she is fully authorized to sign on the
applicant's behalf, and that HE OR SHE HAS READ the Standard Certifications referenced above AND IS CERTIFYING
AND COVENANTING, as appropriate, to all of the certifications, acknowledgments and covenants set forth in the
Standard Certifications.
Applicant further certifies that 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 set forth in this application or in the Standard Certifications, becomes untrue, or is discovered to have been
untrue when made, Applicant will promptly inform EXIM of all such changes or discoveries. Applicant further understands
that in accepting or approving this application, EXIM is relying upon Applicant's statements set forth in the application
and in the Standard Certifications, and all statements and certifications to EXIM are subject to the penalties for false or
misleading statements to the U.S. Government (18 USC § 1001, et. seq.).
I,

, do hereby certify that I am the duly appointed and qualified

of

(Name of Applicant)

on behalf of

(Title)

and that as such I am authorized to execute this application

(Name of Applicant)

.

In witness whereof, I have hereunto signed my name this

day of

. 20

.

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 EXIM 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 EXIM 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. EXIM 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). EXIM 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 1.75 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 EXIM and the Office of Management and Budget, Paperwork Reduction Project, OMB# 3048-0013 Washington, D.C. 20503

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