Form EIB 92-27 EIB 92-27 Report of Overdue Accounts

PRINT FORM
OMB 3048-0027
PENDING 2024

REPORT OF OVERDUE ACCOUNTS UNDER SHORT-TERM POLICIES*
REPORT FOR PERIOD:

POLICY NUMBER
(Prefix)

(Month)

(Number)
Date Received
EXIM use only

POLICYHOLDER
CONTACT:

OVERDUE REASON

FAX:

TEL:
EMAIL:
BROKERAGE:
Item

Buyer Name

(Year)

Cash Flow / Commercial Problems*
Foreign Exchange Problems (local payment made)
Insolvency*
Dispute* (Product; terms; documents; etc.)
Slow Pay Typical
Natural Disaster
Buyer Re-Organizing
Other*

*Please attach detailed explanation of the overdue item and prospect for recovery
COUNTRY

Actual Payment
Terms

EOL Shipment
Confirmation #

Shipment
Date

EOL Shipment
Report Date

Due Date

SHIPMENT
AMOUNT

OVERDUE
AMOUNT

REASON

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PAGE TOTALS
complete only on last page----- >

REPORT TOTALS

We hereby certify that this report is a true and complete statement as required by the policy, that we have read the additional notes and instructions
on the second page side and that we understand this form to the pertinent conditions of the policy.
Name of Preparer:

Phone:

Signature:

Date Prepared:

EIB 92-27
Revised 6/24

Page No.
(Month)

(Day)

(Year)

of

pages

OMB 3048-0027
PENDING 2024

* USE SEPARATE REPORT-FORMS WHEN REPORTING OVERDUE ACCOUNTS UNDER DIFFERENT
POLICIES OR DIFFERENT POLICY NUMBERS.

NOTE 1: CHECK YOUR POLICY TO DETERMINE WHEN YOU SHOULD BEGIN TO REPORT AN ACCOUNT AS
OVERDUE
NOTE 2: FOLLOW THE COLLECTIONS AND CLAIMS FILING PROCEDURES IN ACCORDANCE WITH THE
TERMS AND CONDITIONS OF YOUR INSURANCE POLICY.
(a) You should make every effort to collect from the buyer and guarantor (if any) . If you have not received a reply
from the buyer as to the reasons for the non-payment, contact the agent or sales representative (if any)
requesting assistance. Include copies of any such correspondence with your Proof of Loss if you file a claim.
(b) If the buyer has refused to accept the insured products under the terms authorized under your policy (not
applicable under letter of credit transactions):
(i) Do not release the insured products to the buyer on payment terms other than those approved under your
insurance policy for that buyer;
(ii) Before you sell the insured products to a party other than the buyer, or incur collections costs related to
such a sale, notify EXIM of the non-acceptance and seek EXIM's written approval to take any actions.
(c) Check your policy for any requirements related to making demand for payment on the buyer and guarantor (if
any). Rescheduling of maturity dates must not be granted by you unless specifically authorized by EXIM.

Send this completed form to EXIM at 811 Vermont Ave NW, Washington, D.C. 20571. EXIM will also accept e-mailed
pdf and faxed forms. EXIM will not require the originals of these forms to be mailed. The form must be PDF scans of
original form and all required attachments. (Fax # 202.565.3380, e-mail: [email protected])

The applicant is hereby notified that information requested by this form 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 Ex-Im Bank being unable to
determine eligibility for support. Ex-Im Bank 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).
Ex-Im Bank and its officers and employees are subject to the Trade Secrets Act (18 U.S.C. Sec. 1905) which requires Ex-Im Bank to protect confidential
Business and commercial information from disclosure, and 12 CFR 404.7 which provides that Ex-Im Bank will not disclose information provided in
confidence without the submitter’s consent and except as required by law. Ex-Im Bank will endeavor to restrict the disclosure of all information provided in
this form to the fullest extent permissible under federal information disclosure laws including the Freedom of Information Act (5 U.S.C. 552), the Privacy Act
of 1974 (5 U.S.C. 552a), or under any other law or court order.
Paperwork Reduction Act Statement: We estimate that it will take you about 1/4 hour 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 Ex-Im Bank and the Office of Management and Budget, Paperwork Reduction Project OMB# 3048-0027; Washington, D.C. 20503.

EIB 92-27
Revised 6/24