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.: 3048-0057
ITEMIZED STATEMENT OF PAYMENTS - LOCAL COSTS
Long-Term Guarantees and Direct Loans
EXIM Bank Transaction No:
Local Cost Request Number:
Local Cost Provider Name:
Local Cost Provider Address:		<Address 1>		<City>	<Postal Code>
		<Address 2>		<Country>
Supply Contract No(s):
NAICS:
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
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EIB 18-05 10/2021