Form EIB 92-32 EIB 92-32 Notification by Insured of Amounts Payable Under Single-

OMB 3048-xxxx
Expires: xx/xx/xxxx
Export – Import Bank of the United States
Notification by Insured of Amounts Payable under
Single Buyer Export Credit Insurance Policy
(Standard Assignment)
Effective Date of Notification:________________________
A. General Information
Policy No._______________________
Insured: _________________________________________________________________________
Buyer: __________________________________________________________________________
Assignee: ________________________________________________________________________
B. Notification
The Insured hereby notifies the Export-Import Bank of the United States (Ex-Im Bank) that, in accordance with the
information contained herein, it has assigned its interest to claim payment(s) which may become due under the
Policy.
This Assignment relates to:
___ 1. All transactions covered by the Policy:
___ 2. The following specific transaction(s): (Use additional sheets if necessary).
Country

Buyer

Contract Price of
Sale or Gross
Invoice Value of
Shipment

Invoice Date or
Number

___ 3. Other. If Number 3 is checked, the Insured and the Assignee agree that:
(a) there may be multiple assignments made to various assignees under this policy and Ex-Im Bank does
not determine which assignee, if any, may have an interest in any particular claim payment; and
(b) in the event Ex-Im Bank approves the Insured’s claim for payment, a check will be issued payable to
the order of the Insured, unless the Insured provides the name of an assignee on the “Notice of Claim

EIB-92-32 (11/12)

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and Proof of Loss”, in which case a check will be forwarded to the assignee, made payable jointly to
the order of the Insured and the assignee named on the Notice of Claim and Proof of Loss.
C. Conditions of Notification
1. The Assignee agrees that:
(a) this notification is not an assignment of the Policy, does not give the Assignee any right to file a claim
or sue under the referenced Policy, does not create any duty or obligation to the Assignee except as set
forth in subparagraph 2 below;
(b) the Insured’s execution of a release and assignment in favor of Ex-Im Bank shall bind the Assignee;
and
(c) this notification and the assignment related hereto shall not constitute waiver of any terms or
conditions of the Policy.
2. The Insured agrees that its execution of this notification authorizes Ex-Im Bank:
(a) to release to the Assignee all information and records relating to the Insured’s Policy and claims; and
(b) to make all claim payments relating to this assignment by check forwarded to the Assignee, made
payable jointly to the order of the Insured and the Assignee.
This Notification is subject to the Conditions of Notification set forth above, and execution by the Assignee and
the Insured shall constitute their acceptance of these conditions.
_________________________________________________
Name of Assignee

_________________________________________________
Name of Insured (as specified in the Declarations)

_________________________________________________
Address
_________________________________________________

_________________________________________________
Address
_________________________________________________

Phone____________Fax__________E-mail______________

Phone____________Fax__________E -mail______________

_________________________________________________
Signature of Officer

_________________________________________________
Signature of Officer

_________________________________________________
Name (Print or Type)

_________________________________________________
Name (Print or Type)

_________________________________________________
Title
Date Signed

_________________________________________________
Title
Date Signed

EIB-92-32 (11/12)

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The above notification is hereby acknowledged for the EXPORT-IMPORT BANK OF THE UNITED STATES by:
_________________________________________________
Signature of Officer

__________________________________________________
Effective Date of Notification

_________________________________________________
Name (Print or Type

__________________________________________________
Title

PLEASE SUBMIT TWO ORIGINAL COPIES.
EXECUTED ORIGINALS WILL BE PROVIDED TO THE ASSIGNEE, INSURED AND BROKER
Send form to: Export - Import Trade Finance Division,
811 Vermont Avenue, NW, Washington, DC 20571
For information call (202)565-3400 or 1-800-565-EXIM Fax (202) 565-3694 or Internet http:\\www.exim.gov
The insured is hereby notified that the information requested on 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 process this form.

Paperwork Reduction Act Statement: We estimate that it will take you about 15 minutes per response that
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-xxxx Washington, D.C. 20503.

EIB-92-32 (11/12)

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