Eib 03-02 Application For Medium-term Insurance, Direct Loan Or Gu

OMB 3048-0014
PENDING 2022

Export-Import
Bank of the
United States

APPLICATION FOR
MEDIUM-TERM
INSURANCE, DIRECT
LOAN OR GUARANTEE

This application is to be used for insurance and guarantee transactions, including Domestic Financing, with financed
amounts of $25 million or less (excluding financed exposure fee/premium) and repayment terms between twelve months
and seven years. An online version of this application is available on EXIM’s website. EXIM encourages customers to
apply on-line, as it will facilitate our review and allow customers a faster response time. If you are requesting a mediumterm direct loan, please email a completed application to [email protected]. Please note that
applications must be a signed and dated PDF and include all required application attachments.
Please note that if your financing request is between $20 and $25 million or a direct loan for any amount,
excluding exposure fee, the transaction will be subject to U.S. flag shipping requirements. For more information,
visit EXIM’s website: https://www.exim.gov/policies/us-flag-shipping-requirements.

FINANCING TYPE REQUESTED
☐Loan Guarantee
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
MGA No. (if known): ____________________
☐Finance Lease Guarantee
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
☐Direct Loan
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
☐Insurance
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
Coverage Type ☐Comprehensive Risk
☐ Political Risk
Conversion of a Preliminary Commitment or a Letter of Interest
☐No
☐ Yes The EXIM reference number is:
Resubmission ☐ Check if this is a resubmission of an application that was previously deemed incomplete or
was withdrawn for other reasons. The EXIM reference number is: _____________
Renewal
☐ MTR (Medium-Term Repetitive Insurance Policy)
Product

PARTICIPANTS:
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide the name of the ultimate
parent company, if there is a corporate owner. For number of employees and sales volume, aggregate for the company
and all its affiliates, including corporate owners and subsidiaries.
Applicant: The applicant may be any exporter, financial institution, supplier, the primary borrower, buyer or
controlling sponsor associated with the transaction. ☐ Check if the applicant has been assisted by a city or state
export agency and provide the name of the agency: __________________________________________________
*Applicant Name: _______________________________________________________________________________
Tradestyle: ____________________________________________________________________________________
*Business Address: _____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

UEI No.1 __________________ Taxpayer ID No. ________________

A Unique Entity Identifier (UEI) No. is a 12-character unique number assigned to all entities (public and private companies, individuals, institutions or
organizations) who must register in SAM.gov to do business with the federal government. If your entity is registered in SAM.gov, your UEI has already
been assigned and is viewable in SAM.gov. If you do not have a UEI No., then you must register your entity. Visit https://sam.gov/content/home to see
if your entity has a UEI No. or to register your entity. A UEI No. is required for the Applicant at time of application and is also required for the Borrower
and Lender(s). [NOTE: As the UEI No. process becomes fully clarified, EXIM’s instructions will be updated accordingly and more information will be
added to assist an Applicant and any other affected transactional parties with this process, but it was not ready prior to submission for OMB review.]
1

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For an Applicant located in the United States, items marked with an asterisk (*) are required fields.
No ☐
Decline to Answer ☐
*Woman-owned business:
Yes ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Disability-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Hispanic or Latino ☐

Asian ☐
White ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

Exporter: The “exporter” is the company which is contracting with the Buyer for the sale of the U.S. goods and/or
services. ☐ Check if the exporter is the applicant. Otherwise, complete the information below for each exporter
including any ancillary service providers. For more information about ancillary services visit:
https://www.exim.gov/solutions/loan-guarantee/ancillary-services
*Exporter Name: _______________________________________________________________________________
Tradestyle: ____________________________________________________________________________________
*Business Address: _____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

Taxpayer ID No. _________________

*Corporate Ownership: _________________________________________________________________________
*Does the Exporter have any affiliates2?

Yes

No

*Total Number of Employees: ______________________

*Primary Industry NAICS3: ______________________
* Annual Sales Volume: ________________________

For an Exporter located in the United States, items marked with an asterisk (*) are required fields.
*Woman-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Disability-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Hispanic or Latino ☐

Asian ☐
White ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

How many years has the Exporter been in commercial operations? _______________
Does the Exporter have experience with transactions of similar size, scope and complexity? Explain below:

2 Affiliations exist when one individual or entity controls or has the power to control another or when a third party or parties control or have the
power to control both. Factors such as common ownership, common management, previous relationships with or ties to another entity,
and contractual relationships may cause affiliation. The complete definition of ‘affiliation’ is found at 13 C.F.R. § 121.103.
3 A company’s Primary Industry NAICS code is the NAICS that accounts for the largest share of sales for the most recently completed fiscal
year. The full definition of “primary industry” is set forth at 13 C.F.R. § 121.107.

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Supplier. The "supplier" is the U.S. company which manufactures the goods and/or performs the services to be exported.
☐ Check if the Supplier is also the Exporter. Otherwise, complete the information below for each exporter including
any ancillary service providers. ☐ Check if the Supplier is not determined. If neither applies, attach the same
information for the primary supplier as requested above for the Exporter.
*Supplier Name: _______________________________________________________________________________
Tradestyle: ____________________________________________________________________________________
*Business Address: _____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

Taxpayer ID No. _________________

*Corporate Ownership: _________________________________________________________________________
*Does the Exporter have any affiliates2?

Yes

No

*Total Number of Employees: ______________________

*Primary Industry NAICS3: ______________________
* Annual Sales Volume: ________________________

How many years has the Supplier been in commercial operations? _______________
Does the Supplier have experience with transactions of similar size, scope and complexity? Explain below:

For a Supplier located in the United States, items marked with an asterisk (*) are required fields.
No ☐
Decline to Answer ☐
*Woman-owned business:
Yes ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Disability-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Hispanic or Latino ☐

Asian ☐
White ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

Borrower or Lessee: The borrower is the entity that agrees to repay the loan. The lessee is the entity that agrees to
lease the goods and services from the lessor and pay rent under a finance lease. ☐ Check if the borrower is the
applicant. If not, complete the information below.
*Borrower/Lessee Name: ________________________________________________________________________
*Business Address: _____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

UEI No.1 __________________ Taxpayer ID No. ________________

For a borrower located in the United States, items marked with an asterisk (*) are required fields.
No ☐
Decline to Answer ☐
*Woman-owned business:
Yes ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Disability-owned business:
Yes ☐
No ☐
Decline to Answer ☐

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*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Hispanic or Latino ☐

Asian ☐
White ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

Guarantor: The guarantor is the person or entity that agrees to repay the credit if the borrower or lessee does not.
Refer to the Medium-Term Credit Standards (at http://www.exim.gov/tools/credit-standards.cfm) to determine in what
situations personal or corporate guarantors are required for medium-term transactions.
Complete the information below for each guarantor if a guarantor is offered or required.
Check to indicate: ☐ There is no guarantor
☐ Guarantor is an individual ☐ Guarantor is a financial institution
☐ Guarantor is a corporation. Complete the information below for each guarantor if a guarantor is offered or required.
*Guarantor Name: ______________________________________________________________________________
*Business Address: _____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Buyer: The buyer is the entity that contracts with the exporter for the purchase of the U.S. goods and services.
Check if the buyer is also the ☐ borrower/lessee or lessor or ☐ guarantor. Otherwise complete the information
below.
*Buyer Name: _________________________________________________________________________________
*Business Address: _____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________
Phone: ________________________________________

Position Title: ________________________________
Email: ______________________________________

Primary Source of Repayment (PSOR). The PSOR is the entity whose financial statements form the basis of
EXIM’s evaluation of reasonable assurance of repayment. For this transaction, indicate whether the PSOR is:
☐ buyer or ☐ guarantor or ☐ business combination (e.g., the consolidated or combined financial statement of the buyer
and one or more corporate guarantors or controlling sponsor(s).) If business combination, indicate which entities
comprise the combination:

Is the PSOR a financial institution? Yes ☐ No ☐
The risk category of the PSOR:

Sovereign ☐

Public Non-sovereign ☐

Private ☐

Does the PSOR have a bond rating?
Yes ☐ No ☐
If yes, indicate the name(s) of the rating agency, rating, and the date of rating:

End-user. The end-user is the foreign entity that uses the U.S. goods and services. Check if the end-user is also
the ☐ borrower or ☐guarantor or ☐ buyer or ☐PSOR. Otherwise, complete the information below.
*End-user Name: _______________________________________________________________________________
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*Business Address: _____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Lender/Lessor. The lender is the company that extends the EXIM guaranteed loan to the borrower. The Lessor is
the company that extends the EXIM guaranteed finance lease to the Lessee. If the application is for a guaranteed loan,
check if the lender is also the ☐ applicant or otherwise, complete the information below. If a direct loan is being
requested, complete for Lessor, if applicable.
*Lender/Lessor Name:
____________________________________________________________________________
*Business Address:
______________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________ UEI No.1 _____________ MGA No.: ___________________________________
Agent. An agent is a business entity or individual, usually located in the country of the borrower or buyer, who
has assisted in the sourcing, packaging, and/or preparation of a request for support from EXIM, and who will
receive compensation in some form for their services. Is an agent involved in the transaction? ☐ Yes ☐No
If yes, complete the information below.
*Agent’s Name: _____________________________________________________________________________
*Business Address: ____________________________________________________________________________
*City: _______________________ *State: _____________ *Zip/Postal Code: _________ *Country: ____________
Contact Person: _________________________________ Position Title: ________________________________
Phone: ________________________________________ Email: ______________________________________
Broker. ☐ Check if there is no broker
Broker Name:______________________________________________________________________________
Contact Person: _________________________________ Position Title: ________________________________
Phone: ________________________________________ Email: ______________________________________
Duns No. ___________________
SPECIAL FEATURES REQUESTED
Check the box(es) for the coverage(s) that apply to the transaction. View the fact sheets describing the coverage
on EXIM’s website as noted below. Complete and attach the required forms.
☐ Used Equipment: Required Attachment (Form EIB 11-03): Used Equipment Questionnaire. For more information:
https://www.exim.gov/policies/used-equipment
☐ Structured Finance: Required Attachment G (Form EIB 95-10g): Credit Information. For more information:
https://www.exim.gov/solutions/project-and-structured-finance/structured-finance-for-small-projects
☐ Co-financing with a Foreign Export Credit Agency: Required Attachment (Form EIB 11-04): Co-financing with
Foreign Export Credit Agency. For more information: https://www.exim.gov/policies/co-financing
☐ Domestic Finance: Required Attachment I (Form EIB 22-05) [weblink TBD] and Required Attachment F (Form EIB
95-10f): Foreign and Domestic Project Finance. For more information: [web link TBD]
☐ Foreign Dealer Support: Required Attachment C (Form EIB 22-04) [weblink TBD]
☐ Pre-Export Payment Questionnaire: Required Attachment J (Form EIB 22-02) [weblink TBD]
☐ Ancillary Service Fees: For more information: https://www.exim.gov/what-we-do/loan-guarantee/ancillary-services
☐ China and Transformational Exports Program: For more information: https://www.exim.gov/about/specialinitiatives/ctep
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☐ Environmental Exports Program: For more information: https://www.exim.gov/about/special-initiatives/environment
☐ Finance Lease Structure: For more information: https://www.exim.gov/what-we-do/loanguarantee/transportation/finance-lease-structure
☐ Foreign Currency Guarantee: For more information: https://www.exim.gov/what-we-do/loan-guarantee/foreigncurrency-guarantee
☐ Local Cost Support: For more information: https://www.exim.gov/policies/local-cost
☐ Military/Security/Police: For more information: https://www.exim.gov/policies/military and
https://www.exim.gov/policies/security-forces-sales
☐ Other: __________________________________________________________________________________
TRANSACTION DESCRIPTION

Describe Goods and Services, which are proposed for the scope of supply. Include make, model, manufacturer/supplier,
NAICS of goods and services, number of units, values, and estimated U.S. and foreign content.

Describe the purpose of the transaction. Address the following in the description: Will the goods be used to
create or expand production capacity for an exportable product?

Are the goods and services destined for an identifiable project? If so, provide information on the total estimated
project cost in US dollars. Also provide information as to other proposed sources of financing for the project,
including working capital.

Indicate whether an application for support of this export contract or a related project has been filed with the Agency
for International Development, Maritime Administration, U.S. International Development Finance Corporation, Trade
Development Agency or a multilateral financing agency. If so, include a brief description of the additional
support being sought and identify the name and contact at each.

CHINA AND TRANSFORMATIONAL EXPORTS PROGRAM (CTEP)
Check one or both applicable boxes, as appropriate, below if (a) the items to be exported from the U.S. face export subsidies
from competing goods and/or services financed by the People’s Republic of China (PRC) or by other countries (as designated
by the U.S. Secretary of the Treasury)4; and/or (b) the export items qualify as one or more of the Transformational Export
Areas designated by Congress, as necessary to advance the comparative leadership of the U.S. which include:
•
•
•
•
•
•

Artificial Intelligence
Biotechnology
Biomedical sciences
Quantum computing
Renewable energy, energy efficiency, &
energy storage
Semiconductor and semiconductor machinery
manufacturing

•
•
•
•
•

Emerging financial technologies
Water treatment and sanitation
High-performance computing
Associated services necessary for use of any
of the foregoing exports
Wireless communications equipment

4 As of this writing, no other country besides the PRC has been designated a covered country.
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☐ Face export subsidies for competing goods and/or services financed by the PRC or other covered
countries
☐ Transformational Export Area

OMB 3048-0014
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If either is checked, provide an explanation via attachment.
REQUESTED FINANCING AMOUNTS AND STRUCTURE
EXIM financing support is based on the value of the eligible goods and services in the exporter’s supply contract(s) or
purchase order(s). The total level of support will be the lesser of: 85% of the value of all eligible goods and services;
or 100% of the U.S. content included in all eligible goods and services in the exporter’s supply contracts or purchase
order(s). In addition, EXIM may also finance certain local costs, ancillary services as approved, and the exposure
fee/premium. Complete the chart below for Uses and Sources of Funds.
Uses of Funds
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Total Uses of Funds

($mm)
$______________________
$______________________
$______________________
$______________________
$______________________
$______________________

Sources of Funds
_____EXIM Bank_______
_____________________
_____________________
_____________________

($mm)
$____________________$____________________$____________________$____________________-

_____________________
Total Senior Debt

$____________________

$______________________
$______________________

Equity

$____________________

$______________________
$______________________

Total Sources of Funds

$____________________

Exposure Fee (Guarantee)/Premium (Insurance). Check one box.
☐ EXIM to finance the fee, which will be paid as the credit is drawn down.
☐ EXIM to finance the fee, which will be paid up front.
☐ EXIM will not finance the fee, and it will be paid as the credit is drawn down.
☐ EXIM will not finance the fee, and it will be paid up front.
Transaction Structure
Principal Repayment Term. _____ (years). Unless otherwise requested, equal installments of principal will
be repaid semi-annually beginning six months after the starting point. In the case of a finance lease, unless
otherwise requested, rent will be calculated based on equal installments of principal, paid semi-annually beginning
six months after the starting point.
Starting Point. The starting point is generally the event that marks the fulfillment of the exporter’s contractual
responsibility, except for project finance, when it occurs at the time the project meets all completion tests. (Check
one box.)
☐ Shipment (single shipment)
☐ Services Completion.
☐ Completion of Installation. Specify date:
☐ Final Shipment (multiple shipments)
☐ Mean Shipment (multiple shipments)
☐ Project Completion. Specify date:
☐ Other
Shipment Period. Shipments will be completed and/or services will be performed from: ______________
(month/year) to ____________ (month/year) excluding any acceptance, retention, or warranty period.
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Promissory Notes/Lease Supplements. For transactions with multiple shipments. Indicate:
☐ There will be one promissory note per shipment
☐ Disbursements will be consolidated into one promissory note
☐ There will be one lease supplement per shipment (Finance lease only)
☐ Lease deliveries will be consolidated under one lease supplement (Finance lease only)
Interest rate. The interest rate to be charged on the guaranteed loan is: _____________________________
REASON FOR REQUESTING EXIM SUPPORT
The basic rationale for EXIM support is that the export of U.S. goods and services needs financing but there are
one or more obstacles to obtaining such financing. Please check all the boxes below that apply to this transaction,
to the best of your knowledge. Please also check the appropriate box to indicate which factor is most important.
Most Important? ☐

Export-credit competition.
Are any non-­‐U.S. companies competing for this sale?

Yes ☐
No ☐
Don’t Know ☐
If yes, please identity non-U.S. competitor: _______________________________________________
If yes, is the non-U.S. competitor receiving support from any export credit agency for this sale?

No ☐
Yes ☐
Don’t Know ☐
If yes, please list the export credit agency: _______________________________________________
Structural constraints.
Most Important? ☐
Is commercial financing for this sale limited by bank requirements (such as maturity limits or capacity limits on
the borrower, industry, or country)?

Yes ☐

No ☐

Don’t Know ☐

If yes, are the relevant limits related to risk or liquidity or both?
Yes ☐

Risk constraints.

No ☐

Other ☐ ___________________________________________________________________
Most Important? ☐

Is commercial financing for this sale limited because providers of commercial financings are unwilling or
unable to accept the commercial and/or political risks of the borrower or the country?
Yes ☐

No ☐

Don’t Know ☐

If yes, what risks are creating the limitation?
Yes ☐

No ☐

Other ☐ ___________________________________________________________________

China and Transformational Exports Program (CTEP).

Most Important? ☐

Are any Chinese companies competing for this sale?
Yes ☐
No ☐
Don’t Know ☐
If yes, please identity the Chinese competitor: _______________________________________________
If yes, is the Chinese competitor receiving support from any government financing agency for this sale?
Yes ☐
No ☐
Don’t Know ☐
If yes, please list the agency:
Most Important? ☐

Other.

Is commercial financing for this sale limited because of other considerations?
Yes ☐

No ☐

Don’t Know ☐

If yes, please describe:
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CREDIT INFORMATION Complete Attachment A (Form EIB 22-06) Credit Information [weblink to be added]
OTHER INFORMATION AND CERTIFICATIONS
General Information. Be prepared to provide the following upon request:
☐ Credit Agency report(s) on the borrowers and exporter(s).
☐ Annex A to the Master Guarantee Agreement (Guarantees only) at:
https://www.exim.gov/sites/default/files//forms/mtmgaannexes.pdf
☐ Lender’s mandate letter (required when applicant is a financial institution).
☐ Environmental Screening (Attachment B (Form EIB 95-10b): Environmental Screening Document).
Supply Contracts Between the Exporter and Buyer.

☐ Sales contract(s), pro forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction
between the exporter and buyer are attached.
☐ The exporter(s) are not the manufacturers of the goods nor the producers of the services to be exported; the Sales
contract(s), pro forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction between the
supplier(s) and exporter(s) are attached; AND the Sales contract(s), pro forma invoice(s), or purchase order(s) and
finance lease(s) evidencing the transaction between the supplier(s) and buyer are attached.
Commitment Fee Agreement.
A commitment fee accrues starting 60 days after the authorization of a final commitment and is payable semiannually in arrears on a schedule determined at the time of authorization. The commitment fee is either:
1/8 of 1% per annum on the undisbursed and uncancelled balance of a guaranteed loan or
1/2 of 1% per annum for a direct loan.
Choose one of the options below regarding the payment of the commitment or facility fee:
☐ The applicant is the borrower or project sponsor, and by signing the application, is irrevocably committing to pay
the commitment fee.
☐ The applicant is the guaranteed lender, and is (check one):

☐ signing the application which irrevocably commits it to pay the fee, or

☐ signing the application and enclosing with it an EXIM standard form fee letter signed by the borrower (at
https://www.exim.gov/sites/default/files//forms/mtmgaannexes.pdf). This letter irrevocably commits the borrower to
pay the fee.

☐ The applicant is the exporter, and is signing the application and enclosing with it an Ex-Im Bank standard form fee
letter from the ☐borrower or ☐guaranteed lender (at
https://www.exim.gov/sites/default/files//forms/mtmgaannexes.pdf). This letter irrevocably commits the borrower or
guaranteed lender to pay the fee.

Anti-Lobbying Disclosure Form
Please refer to the Anti-Lobbying Declaration/Disclosure forms (see Attachment D (Form EIB 95-10d): Anti-lobbying
Declaration/Disclosure) and include a signed copy of the appropriate form(s) with your application

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MEDIUM-TERM APPLICATION ATTACHMENTS
Attachment A (Form EIB 22-06) Credit Information Requirements
Attachment B (Form EIB 95-10b): Environmental Screening Document
Attachment C (Form EIB 22-03) Supplemental Information Requirements for Foreign Dealer Support
Attachment D (Form EIB 95-10d): Anti-lobbying Declaration/Disclosure
Attachment E (Form EIB 11-03): Used Equipment Questionnaire
Attachment F (Form EIB 95-10f): Foreign and Domestic Project Finance
Attachment G (Form EIB 95-10g): Credit Information
Attachment H (Form EIB 11-04): Co-financing with Foreign Export Credit Agency
Attachment I (Form EIB 22-05): Domestic Financing
Attachment J (Form EIB 22-02): Pre-Export Payments Questionnaire
Attachment K (Form EIB 22-04): Form of Fee Letter
Attachment K is to be submitted in the following circumstances:
• the application is for a guarantee or a credit guarantee facility
• the applicant is the guaranteed lender or the exporter, and
• the applicant is signing the application, but the borrower is committing to pay the commitment or facility fee

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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 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, including the reason for requesting
EXIM support. 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

of

(Name of Applicant)

on behalf of

(Title)

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

.

Name of Applicant:

(Authorized Officer)

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

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 any application.
Paperwork Reduction Act Statement: We estimate that it will take you about 2 hours 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# 3048-0014 Washington, D.C. 20503
EIB 03-02 (Rev. 5/2022)

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