Form EIB 15-04 EIB 15-04 Exporter’s Certificate For Co-Financed Loan, Guarantee &

FORM OF EXPORTER’S CERTIFICATE
(Co-financing Transactions)

(Please type or print legibly)

Name and U.S. Street Address of Exporter:

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

RE:

EXIM Bank Credit/Guarantee/Insurance Number: _______________________________________
Follower ECA Name and Follower ECA Country: ____________________ , ___________________
Purchaser:

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Supply Contract/Purchase Order No.(s)1

______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

(The purchaser or buyer identified in the Supply Contract/Purchase Order identified above is referred to hereafter
in this Exporter’s Certificate as the “Purchaser”)
(Follower ECA Name identified above is referred to hereafter in this Exporter’s Certificate as the “Follower ECA”)
(Follower ECA Country identified above is referred to hereafter in this Exporter’s Certificate as the “Follower ECA Country”)

Check one:

Initial Exporter’s Certificate
Amended Exporter’s Certificate. The following has changed:

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

We understand that the Export-Import Bank of the United States (“EXIM Bank”) provides credit support to promote U.S. export sales, and
that, subject to the terms of the EXIM Bank Credit/Guarantee/Insurance applicable to the transaction, EXIM Bank will determine the scope
of its support for your sale to the Purchaser based on the information provided below.

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Note: Medium-term (non-limited recourse project finance) transactions: if any Local Costs for which Ex-Im Bank support is sought are
not included in the Exporter’s supply contract(s)/purchase order(s), any such other contracts containing eligible Local Costs must also be
must be included in this list and will be covered by the certifications made by the Exporter in this Exporter’s Certificate. For more
information: http://www.exim.gov/policies/local-cost.

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FORM OF EXPORTER’S CERTIFICATE
(Co-financing Transactions)

To aid in this determination, we, the Exporter, hereby certify:

PART A: CONTENT

1.
Content. This information is based on our reasonable best efforts to assess the value of the
goods (“Goods”) and services (“Services”) to be provided under the above-referenced supply contract(s)
or signed purchase order(s) with the Purchaser (the “Supply Contract(s)/Purchase Order(s)”). Content
changes may need to be reported via an amended Exporter’s Certificate (see Part C below). Check one:

The Goods and Services contain only U.S. Content: the U.S. Content
Percentage is 100% (i.e., no Foreign Content, Local Costs, or Excluded
Goods and Services (defined below)). Please do not complete the chart if
this box is checked.

The Goods and Services contain less than 100% U.S. Content. Please complete the
chart if this box is checked.

EIB 15-04
01/2016

Definition

USD

The aggregate price of all Goods and Services in the Supply Contract/ Purchase Order(s).

A.

Supply Contract/
Purchase Order(s)

B.

C.

Follower ECACovered
Goods and
Services and
Excluded
Goods and
Contract Price
Services

D.

Local Costs

The aggregate price of all Goods originated/manufactured in the Purchaser’s
country and all Services provided by residents of the Purchaser’s country.

E.

Net Contract Price

C minus D

F.

Foreign Content

G.

U.S. Content

The aggregate cost to the Exporter of any Goods (or components thereof) that were
produced or manufactured outside the U.S., Services provided by third countryresident personnel, and foreign freight costs and foreign insurance included in the
Net Contract Price for Goods exported from the U.S. (Such amount shall not include
any Local Costs.)
E minus F

H.

U.S. Content
Percentage

G divided by E, expressed as a percentage.

%

I.

Disbursement
Percentage

Initial Exporter’s Certificate: input the lower of (i) 85% and (ii) the percentage in H.
Amended Exporter’s Certificate: input the percentage obtained from the
Disbursement Percentage Calculator page (if any).

%

The aggregate price of all Goods and Services that are eligible for EXIM Bank support
as Follower ECA-Covered Goods and Services
The aggregate price of all Goods and Services that are not eligible for (or excluded
from) EXIM Bank support (e.g., goods not shipped from the U.S.)

A minus B

Follower
ECA-covered:

Excluded:

Total:

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FORM OF EXPORTER’S CERTIFICATE
(Co-financing Transactions)

PART B: DOWN PAYMENT
In connection with the Supply Contract(s)/Purchaser Order(s) referenced above:

1. For any and all provision of Goods and/or Services to date, we have a) received payment in an amount equal to
at least fifteen percent (15%) of (i) the portion of the Net Contract Price related to such provision of Goods and/or
Services and (ii) the value of the Follower ECA-covered Goods and Services, or b) we have financed such amount
pursuant to documents executed by us and the Purchaser, providing for such financing at market rates of interest;
and,

2. For any and all provision of Goods and/or Services , we will receive payment in an amount equal to at least

fifteen percent (15%) of (i) the portion of the Net Contract Price related to such future provision of Goods and/or
Services and (ii) the value of such future provision of Follower ECA-covered Goods and Services: a) at or about the
time of such provision of Goods and/or Services, or, b) pursuant to documents executed or to be executed by us and
the Purchaser, providing for such financing at market rates of interest.
(For transactions involving 100% U.S. Goods and Services, “Net Contract Price” means the aggregate price of such
Goods and Services. For transactions involving less than 100% U.S. Goods and Services, “Net Contract Price” means
the amount calculated in row “E” of the chart on page 2 of this Exporter’s Certificate.)

We have submitted (or will submit) evidence of payment of our invoices issued in connection with the Supply
Contract(s)/Purchase Order(s) listed above.

PART C: CERTIFICATIONS, CHANGES AND EXIM BANK RELIANCE
1. Changes to Content. With respect to Part A, “Content”, above we will promptly complete and submit an
Amended Exporter’s Certificate if there has been a “material change” in the U.S. Content Percentage (together
with a copy of the completed “Disbursement Percentage Calculator” found at http://www.exim.gov/toolsfor-exporters/credit-administration-and-operations/disbursement-calculator) prior to any further presentation of
invoices for payment. A “material change” in the U.S. Content Percentage occurs if (i) the U.S. Content
Percentage has decreased by more than 5% (as compared to the U.S. Content Percentage reported in the
initial Exporter’s Certificate) and (ii) aggregate foreign content is over 20% (i.e., the new U.S. Content
Percentage is less than 80%).
With respect to Part B, we will promptly complete and submit an Amended Exporter’s Certificate if there has
been any change regarding, or if we have obtained new information or documentation in connection with, the
Down Payment.
With respect to Part C, if any of the certifications made therein become untrue, we will promptly submit an
amended Exporter’s Certificate, noting the changes and with any required attachments, prior to any further
presentation of invoices for payment.

2. Changes in Follower ECA-Covered Goods and Services. To the best of our knowledge and belief, we certify that
$______ in Goods and Services to be provided under the Supply Contract/Purchase Orders(s) (as set forth in Part
A.1.B of this Certificate) are from the Follower ECA Country or otherwise eligible for Follower ECA support
(“Follower ECA-covered Goods and Services”). We will promptly complete and submit an amended Exporter’s
Certificate if there has been a “material change” in the amount of the Follower ECA-covered Goods and Services
prior to any further presentation of invoices for payment. A “material change” in the amount of Follower ECAcovered Goods and Services is defined as a more than 5% change in value of the Follower ECA-covered Goods and
Services as represented in Part A.1.B.

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FORM OF EXPORTER’S CERTIFICATE
(Co-financing Transactions)
3. EXIM Bank Reliance. The undersigned authorized officer, on our behalf, further certifies that the
representations made and the facts stated in this Exporter’s Certificate are true to the best of our knowledge and
belief, and we have not misrepresented or omitted any material facts. We understand that EXIM Bank will rely
on the certifications and representations made in this Exporter’s Certificate; we agree we are liable for any
damages suffered by EXIM Bank’s reliance. We also understand that these certifications are subject to
penalties for fraud and for providing false documentation, including, but not limited to, those penalties provided
f o r in Article 18 United States Code, Section 1001. We agree that presentation of invoices to a
guaranteed/insured lender or EXIM Bank for payment, under the EXIM Bank Credit/Guarantee/Insurance, is a
confirmation and re-certification by us of the information and certifications made herein. We agree to provide
additional information with respect to any of the matters covered in this Exporter’s Certificate upon EXIM
Bank’s reasonable written request.

4.

Certifications and Signature

Please refer to the Certifications and Covenants for Exporter’s Certificates (Part D) posted on EXIM Bank’s website as
document EIB – 15-05. THE CERTIFICATIONS AND COVENANTS FOR EXPORTER’S CERTIFICATES ARE
INCORPORATED INTO THIS EXPORTER’S CERTIFICATE AS IF FULLY SET FORTH HEREIN. When signing this Exporter’s
Certificate in the space provided below, the undersigned authorized officer signing on our behalf certifies and
represents that he or she is fully authorized to sign on our behalf, and that HE OR SHE HAS READ the Certifications
and Covenants for Exporter’s Certificates (Part D) referenced above (which shall be understood to also cover the
Follower ECA-covered Goods and Services), AND IS CERTIFYING AND COVENANTING, as appropriate, to all of the
certifications, acknowledgements and covenants set forth in that document.
I, _________________________, do hereby certify that I am the duly appointed and qualified ______________ of
_______________________ and that as such I am authorized to execute this Exporter’s Certificate on behalf of
_______________________.
In witness whereof, I have hereunto signed my name this _________ day of ___________, 20_________.
Name of Exporter:

By:____________________________________________
(Authorized Officer)

Name: _______________________________________

Title: ________________________________________

Tel. #: _______________________________________
Email: _______________________________________

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01/2016

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FORM OF EXPORTER’S CERTIFICATE
(Co-financing Transactions)

INSTRUCTIONS TO EXPORTERS:
Links and Additional Information
For information regarding the Exporter’s Certificate (and other helpful facts), go to http://www.exim.gov.
Should you have any further questions about the Exporter’s Certificate, please call EXIM Bank’s Customer
Contact Center at 1 800 565 EXIM/202 565 EXIM. For insurance transactions, please contact your insurance
broker or appropriate EXIM Bank regional office.

Paperwork Reduction Act Statement: We estimate that it will take you about 30 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 EXIM Bank and the Office of Management and Budget,
Paperwork Reduction Project, OMB #3048-00XX Washington, D.C. 20503.

EIB 15-04
01/2016

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