Form EIB 92-28 EIB 92-28 Report of Overdue Accounts Under Medium-Term Credit Insu

EXPORT-IMPORT BANK OF THE UNITED STATES
REPORT OF OVERDUE ACCOUNTS
UNDER MEDIUM-TERM CREDIT INSURANCE POLICIES

Date Prepared_________________________

Submit this form for all amounts which are in default,
in accordance with the terms of your policy.

POLICY #____________________________

DESCRIPTION OF
INSTRUCTIONS
1.

BUYER NAME AND ADDRESS:
(No Abbreviations)

You should check the terms and conditions of
your policy with regard to what overdue
amounts must be reported.

DEFAULT
Maturity Date(s) :
No. of Days Overdue:
Installment Number(s):
__________________ of _______________

2.

You should continue to report overdues either
until the amount overdue is paid or until you
have filed a claim. Please read your policy to
determine the claim filing deadline.

SHIPMENT DATE:

Payable: M Q S A (Circle One)

3.

ln general, it is your responsibility to take all
reasonable measures to collect the debt,
including making demand for payment upon
both the buyer and any guarantor(s).

PRODUCT(S) SHIPPED:

Total Principal Amount in Default

4.

Any extension or rescheduling of the due date of
an obligation must be approved, in advance and
in writing, by the insurer.

NAME(S) OF GUARANTOR(S):

Total Interest Amount in Default
as of Last Maturity Date:

REASON FOR NON-PAYMENT AND WHAT ACTION TAKEN TO COLLECT

WHO TO CONTACT:
Name of Insured______________________________________________

Name of Assignee_____________________________________________

Please send or ask your insurance agent or broker to submit this completed form to
EXPORT-IMPORT BANK OF THE U.S.
TRADE FINANCE & INSURANCE DIVISION
811 VERMONT AVENUE, NW,
WASHINGTON, DC 20571
TEL (202) 565-3400 FAX (202) 565-3684

EIB-92-28

(10/07)

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 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 USC 552), the Privacy Act of 1974 (5 USC 552a), or under any other law or court order.
Public Burden Statement: Reporting for this collection of information is estimated to average
1/4 hour per response, including reviewing instructions, searching data sources, gathering
information, completing, and reviewing the application. Send comments regarding the burden
estimate, including suggestions for reducing it, to Office of Management and Budget, Paperwork
Reduction Project OMB# 3048, Washington, D.C. 20503.