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

OMB #3048-0015
Expires 4/30/2013

Export-Import Bank of the United States
Application for Special Buyer Credit Limit (SBLC) under Multi-Buyer Export Credit Insurance Policies

App. No. ______________________
(Ex-Im Bank Use Only)
Insured Name: ____________________________________
Policy No.: _________________ State: ________________
Contact: ___________________ Tel No: _______________
E-mail: __________________________________________

Broker (If none, state “None”): ___________________
Policy No.: _______________ State: ______________
Contact: _________________ Tel No: _____________
E-mail: ______________________________________

Buyer Name and Address
Country: _____________________________________
Legal Name: __________________________________
Tradestyle/Acronym: ___________________________
Street Address: ________________________________
City: ________________________________________
State or Province: ______________________________
DUNS Number: _______________________________
Zip/Postal Code: _______________________________
Phone: _______________________________________
Fax: _________________________________________
Website: _____________________________________

Primary Contact Prefix: _________________________
First Name: ___________________________________
Last Name: ___________________________________
Title: ________________________________________
e-Mail: ______________________________________
Fax: _________________________________________
Phone: _______________________________________

Guarantor, if any, Name and Address
Country: _____________________________________
Legal Name: __________________________________
Tradestyle/Acronym: ___________________________
Street Address: ________________________________
City: ________________________________________
State or Province: ______________________________
DUNS Number: _______________________________
Zip/Postal Code: _______________________________
Phone: _______________________________________
Fax: _________________________________________
Website: _____________________________________

Primary Contact Prefix: _________________________
First Name: ___________________________________
Last Name: ___________________________________
Title: ________________________________________
e-Mail: ______________________________________
Fax: _________________________________________
Phone: _______________________________________

GENERAL QUESTIONS
Reason for Application on this Buyer:
☐ Policy carries no Discretionary Credit Limit (DCL)
☐ Country Limitation Schedule restricts your DCL in this market
☐ Renewal/Increase/Amendment of existing SBCL–existing final shipment date
☐ Amount requested exceeds DCL
☐ Other, if selected please provide comments in the comment section.

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Do you have any ownership interest (direct or indirect) or familial ties with the buyer (or guarantor)?
Yes ☐

No ☐ (If Yes, provide comments in the comment section.)

Will the products be shipped directly to the buyer in the buyer’s country?
Yes ☐

No ☐ (If No, provide comments in the comment section.)

Is the buyer purchasing your product/service for resale to another country (ies)?

Yes ☐

No ☐ (If Yes, provide comments in the comment section.)

Are the products/services to be exported currently endorsed on your policy?
Yes ☐

No ☐ (If No, please submit a policy amendment to add the new product/service.)

Are you exporting capital goods?

Yes ☐

No ☐ If Yes, please certify to the following:

Section 2 (e) Ex-Im Bank’s Charter prohibits the Bank from supporting transactions that will result in the production
of an exportable good that is subject to trade measures or sanctions.
I have reviewed the list of products and countries/sectors subject to trade measures, including Anti-Dumping and
Countervailing Duty sanctions available at http://www.usitc.gov/trade_remedy/
If there are trade measures, please provide comments in the comment section.
Limit/Terms (Requested Buyer Credit Limit and Payment Terms)
Buyer Credit Limit Requested: $ _________________________________________________________________
What is the amount that you are prepared to ship now? _______________________________________________
What amount of down payment, if any, is offered or required? _________________________________________
What effective date do you require for the SBCL? (mm/dd/yyyy) ______________________________________
Select Transaction Type*
☐ Cash Against Documents
☐ Sight Draft Documents Against Payment
☐ Sight Draft Documents Against Acceptance

Open Account
☐
Promissory Note ☐

*If the transaction type is payment by a letter of credit, please complete the application for
Issuing Bank Credit Limit (IBCL).
Select Maximum Tenor
☐ Sight Payment
☐ 1-30 Days
☐ 31-60 Days
☐ 61-90 Days

91-120 Days
121-180 Days
181-270 Days
271-360 Days

(Describe any multiple term requests in the comment section)

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BUYER CREDIT EXPERIENCE
Any prior sales to the buyer?
Yes ☐

No ☐

Year of your first sale to the buyer: __________________________________________

Any prior sales to the buyer on credit terms (exclude Cash-In-Advance or Letter of Credit sales)?

Yes ☐ No ☐

Year of your first sale to the buyer on credit terms (exclude Cash-In-Advance or Letter of Credit sales): ________
Total sales made to the buyer on credit terms over the last three years: $ (0 if the buyer is new to you): _________

Payment Terms extended to Buyer over the last 12 months
Select Transaction Type
☐ Cash Against Documents
☐ Sight Draft Documents Against Payment
☐ Sight Draft Documents Against Acceptance
☐ Unconfirmed Letter of Credit

Open Account
☐
Promissory Note ☐
Confirmed Letter of Credit

Select Maximum Tenor
☐ Sight Payment
☐ 1-30 Days
☐ 31-60 Days
☐ 61-90 Days

91-120 Days
121-180 Days
181-270 Days
271-360 Days

☐

☐
☐
☐
☐

Highest Amount Outstanding over the last 12 months for which you have been paid: $ ______________________
Describe the buyer’s history over the last 12 months:
☐ Prompt
☐ 1-30 days slow
☐ 31-60 days slow

61-90 days slow ☐
90+ days slow ☐
no experience ☐

Amount now owed to you by the buyer: $ (0 if none) _________________________________________________
Total amount now more than 60 days past due: $ (0 if none) ___________________________________________
Reason for the buyer being past due:

☐
☐
☐
☐
☐

Cash-Flow/Commercial Problems
Foreign Exchange Problems
Insolvency
Dispute
Slow Pay Typical

☐
☐
☐
☐

Natural Disaster
Buyer Re-organizing
Rescheduling
Other – please provide information in comment section

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Do you hold Security on amount past due?

☐
☐
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☐
☐

Standby Letter of Credit
Receivables
Inventory
Real Property
Cash

☐
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Personal Guarantee
Corporate Guarantee(s)
Other – please provide information in comment section
None

COMMENTS
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

CREDIT INFORMATION REQUIREMENTS

Please review the Ex-Im Bank’s Short-Term Credit Standards (STCS) for complete details on the credit information
requirements for a buyer credit limit request. Credit Information required is based on the requested amount. If the buyer has a
market rating you may submit the rating in place of the credit and financial information. Please review the Country Limitation
Schedule (CLS) to see if Ex-Im Bank is open for coverage in the country of your buyer, the guarantor (if any), or the buyer's
end user. Both the STCS & CLS can be found at Ex-Im Bank’s web site, www.exim.gov

(A) Up to $100,000: Your credit history with the buyer for the last three years, or a current trade reference whose
credit limit and payment terms are at least half of those you request, or a current credit agency report.
(B) $100,001 - $300,000: Current credit agency report and either your credit history with the buyer or a trade
reference as qualified above.
(C) $300,001 - $1,000,000: "B" above, plus attach the buyer's audited or signed unaudited financial statements with
notes for the last two fiscal years.
(D) More than $1,000,000: "B" above, plus attach the buyer's audited financial statements with notes and auditor's
opinion for the last three fiscal years.
Signature: ___________________________________________________________________________
Name: ______________________________________________________________________________
Title: _______________________________________________________________________________
Date: _______________________________________________________________________________

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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 System for Award Management (https://www.sam.gov/portal/public/SAM/)
(“SAM”) to determine if parties are excluded from U.S. Government transactions, and the Specially Designated
Nationals (“SDN”) List of the Department of the Treasury, Office of Foreign Assets Control (“OFAC”)
(http://www.ustreas.gov/offices/enforcement/ofac/sdn/). Applicant will not knowingly enter into any sales, leasing
or financing agreements in connection with this transaction with any individual or entity that is listed on the SAM
or the SDN List (or is otherwise prohibited from conducting business with U.S. public and private entities pursuant
to OFAC Regulations).
C. If any funds have been paid or will be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member
of Congress in connection with this commitment providing for the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,”
(http://www.exim.gov/pub/ins/pdf/lll.pdf) in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering into this transaction imposed by section 1352,
title 31, U.S. Code. Any person who fails to file the required statement shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure.
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D. Neither Applicant nor any agent or representative acting on Applicant’s behalf, has or will engage in any activity
in connection with this transaction that is a violation of 1) the Foreign Corrupt Practices Act of 1977, 15 U.S.C. §
78dd-1, et seq.; 2) the Arms Export Control Act, 22 U.S.C. § 2751 et seq., 3) the International Emergency
Economic Powers Act, 50 U.S.C. § 1701 et seq., 4) the Export Administration Act of 1979, 50 U.S.C. § 2401 et
seq., and, 5) the regulations issued by the OFAC. Applicant also certifies that neither Applicant nor any agent or
representative acting on Applicant’s behalf, has been found by a court of the United States to be in violation of any
of the foregoing statutes or regulations within the preceding 12 months, and to the best of its knowledge, the
performance by the parties to this transaction of their respective obligations does not violate any of the foregoing or
any other applicable law.
E. Neither the Applicant nor any agent or representative acting on Applicant’s behalf in connection with this
transaction is currently under charge or has been, within the past 5 years, convicted in any court of any country, or
subject to national administrative measures of any country, for bribery of public officials.

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

Notices
The applicant is hereby notified that information requested by this application is done so under authority of the
Export-Import Bank Act of 1945, as amended (12 USC 635 et. seq.); provision of this information is mandatory and
failure to provide the requested information may result in Ex-Im Bank being unable to determine eligibility for
support. If any of the information provided in this application changes in any material way or if any of the
certifications made herein become untrue, the applicant must promptly inform Ex-Im Bank of such changes. The
information provided will be reviewed to determine the participants’ ability to perform and pay under the
transaction referenced in this application. Ex-Im Bank may not require the information and applicants are not
required to provide information requested in this application unless a currently valid OMB control number is
displayed on this form (see upper right of each page). Ex-Im Bank reserves the right to decline to process or to
discontinue processing of an application.
Paperwork Reduction Act Statement: We estimate that it will take you about 1 hour 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 #
3048-0015 Washington, D.C. 20503.

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