EIB 07-01A, Sectio Electronic Claim Filing System, Short-Term Insurance

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Claim Control No.:CAP0001091 (Draft)

Short-term Multi-buyer Policy Claim
Section C - Claim Information

( * An asterisk denotes that a field is a required entry)
What is the earliest date shipped?

* Month

Day

, Year

What are the original terms of sale?

*

What is the first default date?

* Month

Day

, Year

What is your claim filing deadline?

* Month

Day

, Year

What are the products?
*
What is the foreign content percentage?

*

What is the reason for the claim?

* Bankruptcy

Has this transaction been rescheduled?

*

Yes

No

Did Ex-Im Bank approve the
rescheduling?
Type of foreign buyer.

*

Yes

No

Type of buyer's business.

* Wholesale

Is this non-acceptance coverage?

N/A

* Proprietorship

Yes

No

https://tpccapps.exim.gov/apps/ecfs/ecfsprod.nsf/0/274078054352AB3B852572A4004D4...

3/20/2007