Form EIB 18-05 EIB 18-05 Itemized Statement of Payments Long-term Guarantee and D

ITEMIZED STATEMENT OF PAYMENTS - LOCAL COSTS FOR US EXIM LONG-TERM GUARANTEES AND DIRECT LOANS						OMB No.: XXXX-XXXX
ITEMIZED STATEMENT OF PAYMENTS - LOCAL COSTS
Long-Term Guarantees and Direct Loans
EXIM Bank Transaction No:		Transaction No: 123
Local Cost Request Number:		Request Number: 456
Local Cost Provider Name:		Exp Name BBB
Local Cost Provider Address:		Exp Addr: BBB Address
Supply Contract No(s):		Contract No(s): 789
NAICS:		222240
Acquisition List No.	Invoice No.	Invoice Amount	Invoice Amount Paid	Acquisition List Description of Item	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 Other	<Comments for Less Other to be entered here>
			0.00	NET AMOUNT
			0.0000000	EXCHANGE RATE
			<MM/DD/YYYY>	DATE OF CONVERSION
	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
INSTRUCTIONS AND NOTES: LINK to exim.gov
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EIB 18-05 5/2018