Form EIB 92-34 EIB 92-34 Application for Short-Term Letter of Credit Export Credi

Print Form

OMB No. 3048-0009
PENDING

APPLICATION
FOR SHORT-TERM LETTER OF CREDIT
EXPORT CREDIT INSURANCE POLICY
App. Number (Ex-Im Bank Use Only)

This application is to be completed by a financial institution (or a broker acting on its behalf) in order to obtain a short-term letter
of credit insurance policy. An online version of this application is available on Ex-Im Bank’s web site. EXIM Bank encourages
customers to apply online, as it will facilitate our review and allow customers a faster response time. Additional information on
how to apply for EXIM Bank insurance can be found at EXIM’s web site http://www.exim.gov.
Send this completed application to EXIM Bank, 811 Vermont Ave NW, Washington, D.C. 20571. EXIM Bank will also accept emailed pdf and faxed applications. EXIM Bank will not require the originals of these applications to be mailed. The application
must be PDF scans of original applications and all required attachments. (Fax number 202.565.3675, e-mail
[email protected])
APPLICANT
Applicant Name:

Phone #:

Contact Person:

Fax #:

Position Title:

E-mail:

Street Address:

Duns #:

City:

State/Province:

NAICS code:

Nine-digit zip code:

Does the applicant have a market rating?

Yes

No

Website:
Country:

If yes, indicate the name of the rating agency, rating, type of rating, outlook, and the date of the rating.
Please provide the following information from the applicant’s most recent audited financial statements.
Are the financial statements combined or consolidated?

Statement period (fiscal or interim):
Financial Statement Dates:

Do the Statement Dates above apply to both the Balance Sheet and Income Statement?
Did auditor provide a qualifying opinion?

Yes

No

Auditor:

Opinion:

Net Income:

Net Loans:

Total Assets

Equity:

Woman Owned?

Yes

No

Decline to Answer

Minority Owned?

Yes

No

Decline to Answer

Veteran Owned?

Yes

No

Decline to Answer

Does the Applicant have any affiliates?

Yes

No

Decline to Answer

Is there corporate ownership?

Yes

No

Decline to Answer

Name of the ultimate parent company:
Annual Revenues:
# of Employees:

Broker: If Applicable
Name of Broker:

Phone #:

Ex-Im Bank Broker #:

Fax #:

Contact Person:

E-mail:

EIB92-34
Revised 04/2021

Yes

No

OMB No. 3048-0009

PENDING
Affiliate(s) (if applicable)
Please provide the following information for any subsidiaries, branches, or affiliates that the applicant would like us to consider
adding as Additional Named Insureds under the policy.

Legal Name:

Phone #:

Contact Person:

Fax #:

Position Title:

E-mail:

Street Address:

Nine-digit zip code:

City:

Country:

State/Province:

1. General Questions
Insurance
A. Indicate the EXIM Bank programs the applicant has used.
State
National
B. What type of charter does the applicant hold?
Yes
No
C. Publicly Traded?
D. Indicate the name of the applicant’s regulatory authority.
E. Does the applicant have any foreign government ownership?
If yes, please indicate the country and the percentage owned:

Working Capital

Loan Guarantee

F. Letter of Credit Experience
• In what year did the applicant’s letter of credit business begin?
• What was the total amount of letter of credit transactions in the last 12 months?
• What was the total number of letter of credit transactions in the last 12 months?
• Please provide the following information on the individuals responsible for administering the letter of credit policy:
Name

Title

Years of Trade Finance Experience

Years of Letter of Credit Experience

2. Letter of Credit Portfolio
What is the expected maximum value of letters of credit outstanding at any time over the next 12 months?
Please provide the following details regarding projected transactions to be insured over the next 12 months.
Country

Number of Issuing Banks

Total Letters of Credit

Total Letters of Credit #

3. Attachments
Please provide any information (e.g., the applicant’s most recent annual report) that would be helpful in evaluating this
application.
EIB92-34
Revised 04/2021

OMB No. 3048-0009
PENDING

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
(Title)

of

(Name of Applicant)

on behalf of

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

.

Signature:

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 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 EXIM and
the Office of Management and Budget, Paperwork Reduction Project, OMB# 3048-0009 Washington, D.C. 20503.

EIB92-34
Revised 04/2021