Form EIB 92-30 OMB 3048 EIB 92-30 OMB 3048 Report of Premiums Payable for Financial Institutins

EXPORT-IMPORT BANK--REPORT
(please type or print all information)

POLICY NUM BER:(

OF PREMIUMS PAYABLE FOR FINANCIAL INSTITUTIONS ONLY.
IF NO PREM IUMS PAYABLE, CHECK HERE:

)-

(prefix)

Report for period:____________________________through__________________________
(number)

(month)

(day)

(year)

Date Received

INSURED:____________________________________________________

(month)

(day)

(year)

USING SAME CODE?

if sam e for all

Coverage Type
Obligor Type
Transaction Type
Term Code
Premium Rate

check box

transactions

BROKER:_____________________________________________________

(Contact:

Tel:

Fax:

E-Mail:

)

________
________
________
________
$ .

and enter
appropriate
code or rate
here instead
of below

I
T
E
M

(a) NAME OF FOREIGN OBLIGOR/STREET/CITY/COUNTRY
------------------------------------------------------(b) Exporter Name/Street/City/State/Zip Code
(c) Products Exported

Coverage
Code

Obligor
Code

Transaction
Code

Term
Code

POLICY
ENDORSEMENT
NUMBER OF
OBLIGOR

AMOUNT

Premium
Rate
Per
$100

PREMIUM
DUE

(See Step 6 on back)

1.

(a)
__________
L/C Ref#)<

(b)
(c)
2.

(a)
__________
L/C Ref#)<

(b)
(c)
3.

(a)
__________
L/C Ref#)<

(b)
(c)
4.

(a)
__________
L/C Ref#)<

(b)
(c)
PAGE TOTALS
complete only on last page ))))))<

REPORT TOTALS

W e hereby certify that this report is a com plete and accurate declaration of all transactions required to be r eported under the term s of the policy and that prem ium s have been correctly com puted and rem itted. W e understand that
E x-Im Bank' s acceptance of this r eport or the prem ium due is not an acknow ledgm ent of coverage and does not constitute a w aiver of any policy condition or lim itation. W e understand that, for purposes of policy com pliance, this
report is not received by E x-Im Bank until both this report and the prem ium due hereunder are received.

Signature:_______________________________________________

Date Prepared:__________________________, ______
(month)

(day)

OMB 3048-0020
Expi r es 12/ 31/ 2009
SEE REVERSE SIDE FOR ADDITIONAL NOTES AND
INSTRUCTIONS ON COMPLETING THIS REPORT
COVERAGE TYPES (see Note C. on back)
CODE
Comprehensive Risk Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . A
Political Only Risk Only Insurance . . . . . . . . . . . . . . . . . . . . . . . . . B
OBLIGOR TYPES
CODE
Financial Institution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Private Sector Obligor or Guarantor . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Government Sector (Non-Sovereign) Obligor or Guarantor . . . . . . . . . . 2
Government Sector (Sovereign) Obligor or Guarantor . . . . . . . . . . . . . 1
(A "sovereign" is a national government or government entity that the insurer has
determined carries the full faith and credit of the national government. Most
government sector companies and/or agencies do not carry the full faith and
credit of their government and are therefore considered "non-sovereign" and
should be reported as such unless the insurer has determined otherwise.)
TRANSACTION TYPE
Letters of Credit (non-bulk agricultural products) . . . . . . . . . . . .
Letters of Credit (bulk agricultural products) . . . . . . . . . . . . . . .
Refinanced Sight Letters of Credit (bulk agricultural products) . . .
Refinanced Sight Letters of Credit (non-bulk agricultural products)
Bank-Guaranteed (if applicable, use in lieu of any other code) . . . .
Drafts/Notes/Documents . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Open Account . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pre-Shipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Initial Pre-Presentation Agreement . . . . . . . . . . . . . . . . . . . . . .
Consignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pre-Presentation Agreement Extension . . . . . . . . . . . . . . . . . . .
Due Date Rescheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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CODE
. A
. B
. B
. C
. D
. E
. F
. G
. G
. H
.. I
.. I

TERM (corresponding to Transaction Type being reported)
CODE
Sight Payments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CAD or SDDP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1- 30 Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
31- 60 Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
61- 90 Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
91- 120 Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
121- 180 Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
181- 270 Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
271- 360 Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1 1/2 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
2 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
2 1/2 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 1/2 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
4 1/2 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
5 Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Over 5 Years . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Page No.____ of ____ Pages

(Year)

EIB-92-30 2/07

USE SEPARATE REPORT-FORMS WHEN REPORTING PREMIUMS PAYABLE
UNDER DIFFERENT POLICIES OR DIFFERENT POLICY NUMBERS
MAKE CHECKS PAYABLE TO: EXPORT-IMPORT BANK OF THE UNITED STATES OR EX-IM BANK
MAIL THIS REPORT WITH YOUR PAYMENT TO: EXPORT-IM PORT BANK OF THE UNITED STATES
DEPT. 22
WASHINGTON, DC 20055
INSTRUCTIONS FOR REPORTING PREMIUMS PAYABLE
Complete the page heading on the front of this report-form, then follow the steps shown below to report each transaction.
(If NO premiums are payable, check the appropriate box on the front of this report-form.)
STEP 1.

a)

If your loan is directly with the foreign buyer, enter the OBLIGOR NAME, STREET, CITY, COUNTRY of the buyer. If your loan is
to a foreign financial institution (including all letter of credit transactions) enter the OBLIGOR NAME, STREET, CITY, COUNTRY of
the financial institution. (Please avoid using acronyms if possible.)
Enter the L/C Ref. # (Letter of Credit Reference Number) if you are reporting a letter of credit transaction. If your policy carries the prefix
"ELC" and your are reporting a letter of credit transaction or a refinancing of a sight letter or credit, please refer to the Premium Payment
Procedure endorsement attached to your policy.

b); c) Enter the EXPORTER NAME, STREET, CITY, STATE, ZIP CODE and a brief description of the PRODUCTS that are being exported
by the exporter to the OBLIGOR (please avoid using acronyms if possible). If the OBLIGOR is a financial institution, enter the
PRODUCTS being exported by the EXPORTER under the loan agreement or the letter of credit. If you are reporting a shipment of
agricultural commodities, please be specific when entering commodity. If your policy carries the prefix "ELC", the exporter name, city,
state and products information need to be reported only for insured transactions, not for pre-presentation agreements.
STEP 2.

Enter the applicable COVERAGE TYPE CODE from the list given on the front of this report-form. (see Note A and Note C below.)

STEP 3.

Enter the applicable OBLIGOR TYPE CODE from the list given on the front of this report-form. (see NOTE A below.)

STEP 4.

Enter the applicable TRANSACTION TYPE CODE from the list given on the front of this report-form. (see NOTE A and NOTE B below.)

STEP 5.

Enter the applicable TERM CODE from the list given on the front of this report-form. The TERM CODE should correspond only to the particular
TRANSACTION TYPE you are reporting. For example, if you are reporting an initial pre-presentation agreement, indicate the length of the prepresentation agreement only. (see NOTE A and NOTE B below.)

STEP 6.

If your policy carries the prefix "ELC" or "EBD", enter the policy endorsement number of the Special Buyer Credit Limit (SBCL) or issuing Bank
Credit Limit (IBCL) that pertains to the transaction. The endorsement number can be found at the bottom of the SBCL or IBCL endorsement page,
next to the field labelled "Endorsement No.". If the transaction was a supplier credit transaction done under your discretionary credit limit (DCL),
then you may leave this box blank. All other policyholders may leave this box blank.

STEP 7.

Enter the AMOUNT of the transaction which is applicable to the OBLIGOR (Step 1.a) and the EXPORTER Step 1.b,c). (Use contract price, less
downpayment for medium term transactions.)

STEP 8.

Enter your PREMIUM RATE. (if your policy has more than one premium rate, or if your premium rate is taken from an SBCL or IBCL
endorsement be sure to use the correct premium rate.) (see NOTE A below.)

STEP 9.

Enter the PREMIUM DUE by applying the AMOUNT you have declared under Step #8 to the applicable PREMIUM RATE. (if you are using
the same premium rate for all transactions reported on this form and have checked the box marked "USING SAME CODE", you need only show
total premium due at the end of your report.)

STEP 10.

Enter PAGE TOTALS and REPORT TOTALS for AMOUNT and for PREMIUM DUE.

STEP 11.

Read the paragraph at the bottom of the report-form, then enter your SIGNATURE and DATE PREPARED.
ADDITIONAL NOTES

NOTE A.

If you expect to use the same code (or rate) for each transaction recorded on this page, check the box on the front of this report-form marked
"USING SAME CODE" then enter the appropriate code (or rate) in the space provided. You need not enter the code (or rate) for each transaction
thereafter.

NOTE B.

Be certain that your policy allows you to use the TRANSACTION TYPE or TERM being reported.

NOTE C.

Under most policies, "Comprehensive" means commercial and political risks coverage. Under the Bank Letter Policy "comprehensive" means
"Risks 1, 2, 3, 4 and 5". Under the Financial Institution Buyer Credit Policy "comprehensive" means "Risks 1, 2. 3 and 4".
Under most policies, "Political Only" means that coverage is restricted to political risks. Under the Bank Letter of Credit Policy "political only"
means that coverage is restricted to "Risks 1, 2, 3 and 5". Under the Bank Letter of Credit Policy "political only" means that coverage is restricted
to "Risks 1, 2, and 3".
SPECIAL POLICIES--REPORTING ADDITIONAL INFORMATION
(If your policy has been endorsed to require you to report information not included on the front of this report-form,
you may use the space provided below to report that information. Numbers to the left refer to line-item numbers on the front of this form.)

ITEM

1. ______________________________________________________________________________________________________
2. _______________________________________________________________________________________________________
3. _______________________________________________________________________________________________________
4. _______________________________________________________________________________________________________

Privacy and Paperwork Reduction Act Statements: We estimate that it will take you about fifteen 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 Ex-Im Bank and the Office of Management and Budget, Paperwork Reduction Project 1535-0111, Washington, DC 20503.

E IB-92-30 2/07

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