Form EIB 11-05 EIB 11-05 Exporter’s Certificate for Loan Guarantee & MT Insurance

EXPORTER’S CERTIFICATE
FOR USE WITH CREDIT/GUARANTEE/MT INSURANCE
PROGRAMS

(Please type or print legibly)

Name and U.S. Street Address of Exporter:

RE:

OMB 3048 - 0043
Expires Pending

EXIM Credit/Guarantee/Insurance Number:
Purchaser:

Supply Contract/Purchase Order No.(s)1:

(The purchaser or buyer identified in the Supply Contract/Purchase Order identified above is referred to
hereafter in this Exporter’s Certificate as the “Purchaser”)
Check one:
☐Initial Exporter’s Certificate
☐Amended Exporter’s Certificate The following has changed:

We understand that the Export-Import Bank of the United States (“EXIM”) provides credit support to promote U.S.
export sales, and that, subject to the terms of the EXIM Credit/Guarantee/Insurance applicable to the transaction,
EXIM will determine the scope of its support for your sale to the Purchaser based on the information provided
below.
To aid in this determination, we, the Exporter, hereby certify:

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Note: Medium-term (non-limited recourse project finance) transactions: if any Local Costs for which EXIM support is

sought are not included in the Exporter’s supply contract(s)/purchase order(s), any such other contracts containing
eligible Local Costs must also be included in this list and will be covered by the certifications made by the Exporter in this
Exporter’s Certificate. For more information: http://www.exim.gov/policies/local-cost.
EIB 11-05
Revised 11/2021

1

EXPORTER’S CERTIFICATE

OMB 3048 - 0043
Expires Pending

FOR USE WITH CREDIT/GUARANTEE/MT INSURANCE
PROGRAMS

PART A: CONTENT

1. Content. This information is based on our reasonable best efforts to assess the value of the goods (“Goods”)

and services (“Services”) to be provided under the above-referenced supply contract(s) or signed purchase order(s)
with the Purchaser (the “Supply Contract(s)/Purchase Order(s)”). Content changes may need to be reported via an
amended Exporter’s Certificate (see Part C: Certifications, Changes and EXIM Reliance below). Check one:
The Goods and Services contain only U.S. Content: the U.S. Content Percentage is 100% (i.e., no Foreign Content,
Local Costs, or Excluded Goods and Services (defined below)). Please do not complete the table if this box is checked.
The Goods and Services contain less than 100% U.S. Content. Please complete the table if this box is checked.

Definition

USD

A.

Supply Contract/
Purchase Order(s)

The aggregate price of all Goods and Services in the Supply Contract/
Purchase Order(s).

B.

Excluded
Goods and Services

The aggregate price of all Goods and Services that are not eligible for (or
excluded from) EXIM support (e.g., goods not shipped from the U.S.)

C.

Contract Price

A minus B

D.

Local Costs

The aggregate price of all Goods originated/manufactured in the Purchaser's
country and all Services provided by residents of the Purchaser's Country.

E.

Net Contract Price

C minus D

F.

Foreign Content

The aggregate cost to the Exporter of any Goods (or components thereof)
that were produced or manufactured outside the U.S., Services provided
by personnel without I-9 Forms, and foreign freight costs and foreign
insurance included in the Net Contract Price for Goods exported from the
U.S. (Such amount shall not include any Local Costs.)

G.

U.S. Content

E minus F

H.

U.S. Content
Percentage

G divided by E, expressed as a percentage.

%

I.

Disbursement
Percentage

Initial Exporter’s Certificate: input the lower of (i) 85% and (ii) the
percentage in H. Amended Exporter’s Certificate: input the percentage
obtained from the Disbursement Percentage Calculator page (if any).

%

EIB 11-05
Revised 11/2021

2

EXPORTER’S CERTIFICATE
FOR USE WITH CREDIT/GUARANTEE/MT INSURANCE
PROGRAMS

OMB 3048 - 0043
Expires Pending

PART B: CASH PAYMENT
In connection with the Supply Contract(s)/Purchaser Order(s) referenced above:

1. For any and all provision of Goods and/or Services to date, we have a) received payment in an amount equal to at least
fifteen percent (15%) of the portion of the Net Contract Price related to such provision of Goods and/or Services, or b) wehave
financed such amount pursuant to documents executed by us and the Purchaser, providing for such financing at market rates
of interest; and,
2.

For any and all provision of Goods and/or Services, we will receive payment in an amount equal to at least fifteen
percent (15%) of the portion of the Net Contract Price related to such future shipments or deliveries or future transportation
of Goods or provision of Services: a) at or about the time of such provision of Goods and/or Services, or, b) pursuant to
documents executed or to be executed by us and the Purchaser, providing for such financing at market rates of interest.

(For transactions involving 100% U.S. Goods and Services, “Net Contract Price” means the aggregate price of such Goods and
Services. For transactions involving less than 100% U.S. Goods and Services, “Net Contract Price” means the amount
calculated in row “E” of the table on page 2 of this Exporter’s Certificate.)
We have submitted (or will submit) evidence of payment of our invoices issued in connection with the Supply
Contract(s)/Purchase Order(s) listed above.
PART C: CERTIFICATIONS, CHANGES AND EXIM RELIANCE
1. Changes to Content. With respect to Part A: Content, above we will promptly complete and submit an Amended
Exporter’s Certificate if there has been a “material change” in the U.S. Content Percentage (together with a copy of the
completed “Disbursement Percentage Calculator” found at http://www.exim.gov/tools-for-exporters/credit-administrationand-operations/disbursement-calculator) prior to any further presentation of invoices for payment. A “material change” in the
U.S. Content Percentage occurs if (i) the U.S. Content Percentage has decreased by more than 5% (as compared to the U.S.
Content Percentage reported in the initial Exporter’s Certificate) and (ii) aggregate foreign content is over 20% (i.e., the new
U.S. Content Percentage is less than 80%).
With respect to Part B: Cash Payment, we will promptly complete and submit an Amended Exporter’s Certificate if there has
been any change regarding, or if we have obtained new information or documentation in connection with the Cash Payment.
With respect to Part C: Certifications, Changes and EXIM Reliance, if any of the certifications made therein become untrue, we
will promptly submit an amended Exporter’s Certificate, noting the changes and with any required attachments, prior to any
further presentation of invoices forpayment.
2.
EXIM Reliance. The undersigned authorized representative, on our behalf, further certifies that the representations
made and the facts stated in this Exporter’s Certificate are true to the best of our knowledge and belief, and we have not
misrepresented or omitted any material facts.
We understand that EXIM will rely on the certifications and
representations made in this Exporter’s Certificate; we agree we are liable for any damage suffered by EXIM’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 for in Article 18 United States Code, Section 1001. We agree that
presentation of invoices to a guaranteed/insured lender or EXIM for payment, under the EXIM
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
Exporter’s Certificate upon EXIM’s reasonable written request.

EIB 11-05
Revised 11/2021

3

EXPORTER’S CERTIFICATE

OMB 3048 - 0043
Expires Pending

FOR USE WITH CREDIT/GUARANTEE/MT INSURANCE
PROGRAMS

3.

Certifications and Signature

Please refer to the Certifications and Covenants for Direct Loan and Medium Term/Long Term Exporter’s Certificates (Part
D: Additional Certifications) posted on EXIM’s website as document EIB 15-05. THE CERTIFICATIONS AND COVENANTS
FOR EXPORTER’S CERTIFICATES ARE INCORPORATED INTO THIS EXPORTER’S CERTIFICATE AS IF FULLY SET FORTH
HEREIN. When signing this Exporter’s Certificate in thespace provided below, the undersigned authorized representative
signing on our behalf certifies and represents that the undersigned is fully authorized to sign on our behalf, and that THE
UNDERSIGNED HAS READ the Certifications and Covenants for Direct Loan and Medium Term/Long Term Exporter’s
Certificates (Part D: Additional Certifications) referenced above AND IS CERTIFYING AND COVENANTING, as appropriate,
to all of the certifications, acknowledgements and covenants set forth in that document.

I,

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

of

and that as such I am authorized to execute this Exporter’s Certificate on behalf of
.
In witness whereof, I have hereunto signed my name this

Mont
day of Month

Yea
, Year

.

Name of Exporter:

(Authorized Representative)

By:
Name:
Title:
Tel. #:
Email:

Links and Additional Information
For information regarding the Exporter’s Certificate (and other helpful facts), go to http://www.exim.gov/. Should you have
any further questions regarding the Exporter’s Certificate, please call EXIM’s Customer Contact Center: 1 800 565 EXIM/202
565 EXIM.
Paperwork Reduction Act Statement: We estimate that it will take you about 30 minutes 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 #3048-0043 Washington, D.C. 20503.

EIB 11-05
Revised 11/2021

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