Form EIB 18-01 EIB 18-01 EIB 18-01, Multi-Buyer Policy Select Risk (MBSR) Exclusi

OMB No. 3048-0053
PENDING 2025

MULTI-BUYER SELECT RISK POLICY (MBSR)
EXCLUSIONS WORKSHEET
Instructions:
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Select and list the sales you wish to exclude. Add additional pages, if needed.
"Non-Standard" Exclusions must be EXIM authorized, and are available only for multi-buyer policies with deductibles.
The Multi-Buyer Select Risk EXIM Policy Portfolio should represent at least 50% of the exporter’s Total Eligible
Export Credit Sales in U.S. dollars, excluding standard exclusions. Eligible Export Credit Sales are sales that comply
with EXIM programs and policies.
Please refer to the 2nd page of this form for guidance on calculating the Multi-Buyer Select Risk EXIM Policy Portfolio.
All endorsed exclusions are locked-in for the policy period.
Premiums must be paid on all "Reportable Transactions" as required by the insurance policy, except for the
endorsed exclusions.
Sign the worksheet certification on the 2nd page of this form.
Attach the MBSR Exclusions Worksheet to the Short Term Multi-Buyer Insurance application in EXIM Online (EOL).

STANDARD EXCLUSIONS
Unconfirmed Irrevocable Letters of
Credit Sales to Subsidiaries and Affiliates
Any Invoice of $10,000 or less

Payments at Sight (SDDP or CAD)
Sales to Canada
None requested

NON-STANDARD EXCLUSIONS
Instructions: Please complete the information for each desired exclusion category. Any combination of
categories is permitted.
A. Sales to Top Corporates (companies with revenues > $100,000,000):
Buyer Name

City/Country

Total Annual Credit Sales

Payment Terms

B. Sales to Prime Customers (companies that paid you promptly, < 60 days slow, for three consecutive years):
Buyer Name

City/Country

Total Annual Credit Sales

Payment Terms

C. Sales to the following country (ies) are to be excluded:
Country

EIB 18-01 10/2024

Total Annual Credit Sales

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OMB No. 3048-0053
PENDING 2025

CALCULATING THE MULTI-BUYER SELECT
RISK (MBSR) EXIM POLICY PORTFOLIO
Total Eligible Export Credit Sales
Subtract Any Standard Exclusions
Adjusted Total Eligible Export Credit Sales (a)
Subtract Any Non-Standard Exclusions (b)
TOTAL MBSR EXIM POLICY PORTFOLIO (c)
[ a minus b ]
[ c divided by a]
MBSR EXIM POLICY PORTFOLIO %

$
$
$ 0.00
$
$ 0.00
0.00%

COMMENTS

CERTIFICATIONS
The representations made and the facts stated in this worksheet for the endorsement of sales exclusions are true, to the best of
my knowledge and belief, and I have not misrepresented or omitted any material facts relevant to said representations. It is
agreed that this worksheet shall form a part of the Policy, if issued, and the truth of the representations and facts, and
performance of every undertaking in this worksheet shall be a condition precedent to any coverage under such Policy. I further
understand that this certification is subject to the penalties for fraud against The U.S. Government (18 USC 1001).

(Applicant)

(Print Name and Title)

(Broker)

(Signature)

(Date)

Paperwork Reduction Act Statement: We estimate that it will take you about 15 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# 3048-0053; Washington, D.C.
20503.

EIB 18-01 10/2024

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