Form EIB 18-04 EIB 18-04 Itemized Statement of Payments—Long-term Guarantees and

ITEMIZED STATEMENT OF PAYMENTS--US COSTS FOR EXIM LONG-TERM GUARANTEES AND DIRECT LOANS							OMB No.: XXXX-XXXX
ITEMIZED STATEMENT OF PAYMENTS - US COSTS
Long-Term Guarantees and Direct Loans
EXIM Bank Transaction No:
US Cost Request Number:
Exporter Name:
Exporter Address:
Supply Contract No(s):
Date of Exporter's Certificate(s):		<MM/DD/YYYY>
NAICS:
Acquisition List No(s).	Invoice No.	Invoice Amount	Invoice Amount Paid	Acquisition List Description of Item	Bill of Lading No(s).	AES/ITN No(s).	Remarks/Comments
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
	TOTAL INVOICE AMOUNT	0.00	0.00	TOTAL INVOICE AMOUNT PAID	INDICATE CURRENCY
			0.00	LESS Excluded Goods and Services
			0.00	LESS Local Costs
			0.00	LESS Other	<Comments for Less Other to be entered here>
			0.00	NET AMOUNT
			0.0000000	EXCHANGE RATE
			<MM/DD/YYYY>	DATE OF CONVERSION
			0.00%	DISBURSEMENT %
	TOTAL GROSS AMOUNT	$0.00	$0.00	TOTAL PAYMENTS IN US DOLLARS
			$0.00	LESS Other	<Comments for Less Other to be entered here>
			$0.00	TOTAL FINANCED AMOUNT
Complete Reachback Determination Calculation only if applicable as per Instruction #7.
			0.00%	Reachback Determination Percentage
			$0.00	TOTAL FINANCED AMOUNT
INSTRUCTIONS AND NOTES: LINK to exim.gov
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EIB 18-04 5/2018