Form EIB 95-09 EIB 95-09 Letter of Interest Application

OMB #3048-0005
PENDING-2014

Export-Import Bank of the United States (Ex-Im Bank)

Letter of Interest Application

Please type. Processing of applications may be delayed if the requested information is not provided.
1.

Applicant. The applicant may be any responsible individual, financial institution or non-financial enterprise.
☐ Check if applicant has been assisted by a city or state export agency and provide the name of the agency:
Applicant name: ________________________________ Duns #: __________________________________________
Contact person: _________________________________ Phone #: _________________________________________
Position title: __________________________________ Fax #: ___________________________________________
Street Address: _________________________________________________ City: _____________________________
State/Province: ________________ Postal Code: _____________________ Country: _________________________
Taxpayer ID #: ___________________________________________________________________________________

2.

Exporter. The "exporter" is the company which contracts with the buyer for the sale of the U.S. goods and services.
☐ Check if the exporter is also the applicant. If not, complete the information below.
Exporter name: _________________________________ Duns #: __________________________________________
Street address: _________________________________ Phone #: _________________________________________
City: ________________________ State: ___________________________ Postal Code: ______________________
Taxpayer ID #: ___________________________________________________________________________________

3. Supplier. The "supplier" is the U.S. company which manufactures the goods and/or performs the services to be exported.
☐ Check if the supplier is also the exporter. ☐ Check if the supplier is not determined. If neither applies, attach the same
information for the primary supplier as requested above for the exporter. Information on additional suppliers is not required
for an LI.
4.

Borrower. The "borrower" is the company which agrees to repay the Ex-Im Bank direct or guaranteed loan. Complete the
information below. Check the box for "public sector" if the borrower is at least 50% directly or indirectly owned by a
government. Check the box for "private sector" if the borrower is less than 50% owned by a government.
Contact person: _________________________________ Fax #: ___________________________________________
Borrower name: ________________________________ Duns #: __________________________________________
Street Address: __________________________ City: _______________ ☐ public sector ☐ private sector
Taxpayer ID #: _________________________________ Postal Code: ___________________________________

5. Buyer and End-user. The "buyer" is the company which contracts with the exporter for the purchase of the U.S. goods and
services. The "end-user" is the foreign company which utilizes the U.S. goods and services in its business. Check if the
borrower, buyer, and end-user are not the same entity. If box is checked, attach the same information for the buyer and the
end-user as requested above for the borrower.

6. Export Items The "export items" are the goods and services to be exported from the U.S.
6a. Large Aircraft. ☐ Check if the export items include aircraft which, in a passenger configuration, contain more
than 70 seats. If box is checked, complete Attachment A.
6b. Military. ☐ Check if the buyer is associated in any way with the military, if any export items are to be used by the
military, or if any export items are defense articles or have a military application.
6c. Limited Recourse Project Finance. ☐ Check if you want a Letter of Interest issued by the Project Finance
Division. If box is checked, complete Attachment D.
6d. Description of Export Items. Briefly describe the principal goods and services, including the type, quantity, model
number and capacity (if applicable), and SIC Code. For an aircraft transaction, include a description of the engines.

EIB Form 95-9
Revised 03/14

Page 1 of 7

OMB #3048-0005
PENDING-2014

Export-Import Bank of the United States (Ex-Im Bank)

Letter of Interest Application

7.

6e. Utilization of Export Items. Briefly describe the principal business activity of the end-user. If the export items are to be used
in a project, also provide the name, location, purpose, and scope of the project.
______________________________________________________________________________________________________
Financing Type Requested. Check applicable box(es). You may request both a direct loan and a guarantee. If both financing options are
acceptable to Ex-Im Bank, they will be indicated in the LI as options. Refer to Attachment A if the transaction involves the export of new
large aircraft.
☐ Direct Loans

8.

☐ Comprehensive Guarantee

☐Political Risk Guarantee

Contract Price. The "contract price" is the amount to be shown in the supplier's invoice related to goods to be exported from the U.S. and
services to be performed by U.S. companies. If there is more than one supplier, the contract price is the sum of the suppliers' invoice
amounts. The "eligible foreign content" is the portion of the contract price representing components to be purchased by the supplier outside
the U.S. and incorporated in the U.S. into the items to be exported. Costs to be incurred in the end-user's country are not considered eligible
foreign content. Note that the eligible foreign content, if any, is part of the contract price.
8a. Contract Price: $ _________________ (including eligible foreign content)
8b. Eligible Foreign Content: $ _____________________________________

9.

Foreign Competition. ☐ Check if, to the best of your knowledge, there is at least one entity offering non-U.S. goods and/or services
indirect competition for this specific export sale.

10. Other U.S. Government Agencies. ☐ Check if an application for support of this export contract or related project has been filed with
the Agency for International Development, Maritime Administration, Overseas Private Investment Corporation or Trade Development
Agency.
11. Environmental Effects. If 85% of the contract price exceeds $10,000,000, complete Attachment B. Attachment B is not required for
aircraft transactions.
12. Environmental Effects. If you want Ex-Im Bank to preclude or counter a tied aid offer, complete Attachment C.
13. Certifications. The undersigned certifies that the facts stated and the representations made in this application and any attachments to this
application are true, to the best of the applicant's knowledge and belief after due diligence, and that the applicant has not omitted any
material facts.
The undersigned further certifies that it is not currently, nor has it been within the preceding three years: 1) debarred, suspended or
declared ineligible from participating in any Federal program; 2) formally proposed for debarment, with a final determination still
pending; 3) voluntarily excluded from participation in a Federal transaction; or 4) indicted, convicted or had a civil judgment rendered
against it for any of the offenses listed in the Regulations Governing Debarment and Suspension (Governmentwide Nonprocurement
Debarment and Suspension Regulations: Common Rule), 53 fed. Reg. 19204 (1988). The undersigned is not listed on any of the publicly
available debarment lists of the following international financial institutions: World Bank Group, African Development Bank, Asian
Development Bank, European Bank for Reconstruction and Development and the Inter-American Development Bank.
In addition, the undersigned certifies that neither the undersigned nor anyone acting on its behalf, such as agents, has engaged, or will
engage, in any activity in connection with this transaction that is a violation of the Foreign Corrupt Practices Act of 1977, 15 U.S.C. 78dd1, et seq. (which provides for civil and criminal penalties against companies and individuals who directly or indirectly make or facilitate
corrupt payments to foreign officials to obtain or keep business).
Further, neither the undersigned nor anyone acting on its behalf in connection with this transaction is currently under charge or have
been, within the past 5 years, convicted in any court or been subject to national administrative measures of any country for bribery of
foreign public officials.
Applicant (company) name: ___________________________________________________________________________________
Name and title of authorized officer: ____________________________________________________________________________
Signature of authorized officer: _________________________________________________ Date: _________________________
Payment, payable to the Export-Import Bank of the U.S., must accompany application; please indicate: ☐ V isa ☐ Mastercard ☐ Check
Account #: _________________________________________________________________ Expiration Date: ________________
Signature: _________________________________________________________________________________________________
Ex-Im Bank would be pleased to assist you in applying for financial support. If you have any questions, please contact the Business Development Division
(Telephone: 202-565-3946 or Fax: 202-565-3931). For information concerning financing of large aircraft and ancillary equipment, please contact the
Aircraft Finance Division (Telephone: 202-565-3550 or Fax: 202-565-3558). Taxpayer Identifying Numbers: Ex-Im Bank intends to use the taxpayer
identifying numbers furnished on this application for purposes of collecting and reporting on any claims arising out of such persons' or business entities'
relationships with the U.S. government.

EIB Form 95-9
Revised 03/14

Page 2 of 7

OMB #3048-0005
PENDING-2014

Export-Import Bank of the United States (Ex-Im Bank)

Letter of Interest Application
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 U.S.C. 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 issue the Letter of Interest. 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).
Public Burden Statement: Public burden reporting for this collection of information is estimated to average 20 minutes per
response, including time required for searching existing data sources, gathering the necessary data, providing the information
required, and reviewing the final collection. Send comments on the accuracy of this estimate of the burden and
recommendations for reducing it to: Office of Management and Budget, Paperwork Reduction Project (#3048-0005),
Washington, D.C. 20503.
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.

EIB Form 95-9
Revised 03/14

Page 3 of 7

OMB #3048-0005
PENDING-2014

Export-Import Bank of the United States (Ex-Im Bank)

Letter of Interest Application

ATTACHMENT A: Large Aircraft Transactions
1.

Spare Parts Financing. Indicate in No. 6d. of the Letter of Interest Application if any spare parts or spare engines are
included in the export sale. Provide the requested information on these items.

2.

Transaction Information. Include with your application a background summary on the airline, the reason for the
purchase, proposed routes, and delivery dates. This information replaces the information requested in No. 6e. of the
Letter of Interest Application.

3.

Contract Price. If credit memoranda information is available, deduct all airframe and engine credit memoranda, if
any, from the aircraft price when calculating the contract price to be entered in No. 8a. of the Letter of Interest
Application.

If you have questions about this attachment, please contact the Aircraft Finance Division at 202-565-3550.

EIB Form 95-9
Revised 03/14

Page 4 of 7

OMB #3048-0005
PENDING-2014

Export-Import Bank of the United States (Ex-Im Bank)

Letter of Interest Application

ATTACHMENT B: Ex-Im Bank Environmental Screening Document
Limited Recourse Project Financing and Long-Term Programs Only

Ex-Im Bank will screen project finance and long-term transactions into three categories, as defined in Ex-Im Bank's
Environmental Procedures. The information you provide will help Ex-Im Bank to determine the proper category for your
application. This information is crucial to the appropriate and timely review of your application. Check the boxes that apply
to your application.

1.

Project Identification. ~
☐ Check if the goods and/or services described in your application are destined for an identified project.
If checked, identify the project: ___________________________________________________________________
If not checked, explain: _________________________________________________________________________

2.

Project Location. Is the project located in or sufficiently near to have perceptible environmental effects in any of the
following areas? Check all that apply.

☐
☐
☐
☐
☐

Tropical Forest
Nationally designated wetlands or protected wild lands
National parks
Nationally designated refuges
Coral reefs or mangrove swamps

3.

Project Sector or Industry. Which classification describes the project for which the exports are destined? Check all
that apply.

☐
☐
☐
☐
☐
☐
☐
☐
☐

Airport construction
Chemical plant
Forestry
Geothermal Power
Hydropower plant
Iron & steel plant
Large infrastructure project
Large-scale water reservoir
Mining & mineral processing plant

☐ Nationally designated seashore areas
☐ Habitat of endangered species
☐ Large scale resettlement
(How many persons?)
☐ Properties on the World Heritage List

☐ Nuclear power plant
☐ Consulting services
☐ Oil & gas field development
☐ Hospitals and medical equipment
☐ Petrochemical plant or refinery
☐ Pre-project services (feasibility
☐ Pharmaceutical project
& environmental studies)
☐ Pulp & paper plant
☐ Railway signaling
☐ Smelter
☐ Telecommunications or satellites
☐ Thermal power plant locomotives, boats)
☐ Waste management
☐ Other (describe)
☐ Air traffic control systems or navigational aids

Name of Applicant: ___________________________________________________ Date: ______________________
If you have questions about this attachment, please contact the Engineering and Environment Division at 202-565-3570.

EIB Form 95-9
Revised 03/14

Page 5 of 7

OMB #3048-0005
PENDING-2014

Export-Import Bank of the United States (Ex-Im Bank)

Letter of Interest Application

ATTACHMENT C: Tied Aid Capital Projects Fund

1.

☐ Check if you are requesting appropriate Ex-Im Bank support to preclude or counter foreign tied aid offers.

2.

☐ Check if one or more foreign governments are offering, or planning to offer, unusually long repayment periods,
unusually low interest rates, and/or mixed grant-credit financing for the specific contract for which Ex-Im Bank
support is sought. Attach available documentary evidence of a foreign tied aid credit offer. If such evidence is not
available, specify your reasons for suspecting foreign tied aid.

3.

☐ Check if you authorize Ex-Im Bank to ask the OECD Secretariat to issue a confidential "no aid" common line
request to OECD member governments. Acceptance of this request would preclude future foreign and U.S. aid
financing for the project.

4.

☐ Check if you believe that loss of this contract will jeopardize follow-on sales opportunities for similar sales in the
same market. Provide the type and estimated value of potential follow-on sales.

5.

Provide the following information, if known, for each foreign government's tied aid offer.

Donor government

Foreign Offer #1
______________________________

Foreign Offer #2
_______________________________

Foreign exporters supported

______________________________

_______________________________

Total offer amount

______________________________

_______________________________

Currency of offer

______________________________

_______________________________

Credit portion amount

______________________________

_______________________________

Credit portion interest rate

______________________________

_______________________________

Credit portion grace period

______________________________

_______________________________

Credit portion repayment period

______________________________

_______________________________

Grant portion, if any

______________________________

_______________________________

If you have questions about this attachment, please contact the Credit Applications and Processing Unit at 202-565-3800.

EIB Form 95-9
Revised 03/14

Page 6 of 7

OMB #3048-0005
PENDING-2014

Export-Import Bank of the United States (Ex-Im Bank)

Letter of Interest Application

ATTACHMENT D: Project Finance Transactions, Executive Summary
Ex-Im Bank's analysis of potential limited recourse project finance transactions differs from routine export trade finance
transactions. Therefore, we require additional information from applicants for a Project Finance Letter of Interest. Please
provide the information outlined below to the best of your ability. It is highly recommended that you provide as much
information as possible at this stage of the application process.
1.

Project Name: ________________________________________________________________________________

2.

Type of Project: _______________________________________________________________________________

3.

Project Location: ______________________________________________________________________________

4.

Project Description: ____________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

5.

Project Participants:
a.

Sponsors: _____________________________________________________________________________
_____________________________________________________________________________________

b.

EPC Contractor: ____________________________________________________________________
_____________________________________________________________________________________

c.

Project Input Supplier(s): _____________________________________________________________
_____________________________________________________________________________________

d.

Off-taker(s): _______________________________________________________________________
_____________________________________________________________________________________

6.

Estimated Debt to Equity Ratio:
____________________________________________________________________________________________

7.

Other Potential Financing Sources:
____________________________________________________________________________________________

8.

Is this an international tender?
☐ Yes

9.

☐ No

Bid due date: ________________________________________________________________

Estimated Project Timeline: (e.g. financial close, construction start date, etc.)
____________________________________________________________________________________________

10. Project Status: (e.g. signed EPC contract, status of offtake contract, etc.)
____________________________________________________________________________________________
11. Other Relevant Factors:
____________________________________________________________________________________________
If you have questions about this attachment, please contact Business Development Division at 202-565-3946.

EIB Form 95-9
Revised 03/14

Page 7 of 7