eib 92-27 Report of Overdue Accounts Under Short Term Policies

Print Form
OMB 3048-0027
02/28/2018

EXPORT-IMPORT BANK-REPORT OF OVERDUE ACCOUNTS UNDER SHORT TERM POLICIES
(please type or print all information)

POLICY NUMBER :(

(Prefix)

)-

Report for period: _______________________

(Number)

Contact:_________________________________
Tel:________________ Fax: ________________
E-mail:_______________

BROKER:________________________________

Buyer Name

COUNTRY

Actual Payment
Terms

(Year)

OVERDUE REASON
Cash Flow / Commercial Problems*
Foreign Exchange Problems (local payment made)
Insolvency*
Dispute* (Product; terms; documents; etc.)
Slow Pay Typical
Natural Disaster
Buyer Re-Organizing
Other*

Date Received
EXIM use only

POLICYHOLDER:___________________________________

Item

_________

(Month)

*Please attach detailed explanation of the overdue item and prospect for recovery

EOL Shipment
Confirmation #

Shipment
Date

EOL Shipment
Report Date

Due Date

SHIPMENT
AMOUNT

OVERDUE
AMOUNT

REASON

1
2
3
4
5
6
7
8
PAGE TOTALS
complete only on last page ---->

REPORT TOTALS

We hereby certify that this report is a true and complete statement as required by the policy, that we have read the additional notes and instructions on the reverse side and that we understand this form to the pertinent conditions of the
policy.

Name of Preparer: ________________________________________

Phone: (

Signature: _______________________________________________

Date Prepared: __________________________, _____

EIB 92-27
Revised 11/10

) _________-_____________________
(Month)

(Day)

(Year)

Page No.____ of ____ pages

OMB 3048-0027
02/28/2018

WHO TO CONTACT:
Export-Import Bank of the United States
Export Credit Insurance Division
811 Vermont Ave. N.W.
Washington, DC, 20571
TEL: (202 ) 565-3644 or 3681
Email: PMA_ECI Mailbox
USE SEPARATE REPORT-FORMS WHEN REPORTING OVERDUE ACCOUNTS UNDER DIFFERENT POLICIES OR DIFFERENT
POLICY NUMBERS.
NOTE 1. Check your policy to determine when you should begin to report an account as overdue.
NOTE 2.
a)
b)

c)
d)
e)

THE FOLLOWING ARE COLLECTION AND CLAIM FILING PROCEDURES TO BE FOLLOWED BY YOU IN ACCORDANCE
WITH THE TERMS AND CONDITIONS OF THE POLICY (UNLESS ALTERNATE ACTION IS APPROVED IN WRITING BY
THE INSURER):
You should make every effort to collect from the obligor. If you have not yet received a reply from the obligor as to the reasons
for non-payment, you should write to the agent or sales representative, requesting assistance. (Copies of such
correspondence must accompany the Proof of Loss Form if a claim is filed.)
If the obligor has not accepted the goods (under a non-letter of credit transaction):
You should not release the merchandise to the buyer on payment terms other than those originally agreed upon.
You should consider the possibility of reselling the merchandise on the local market or of arranging for the immediate return of
the merchandise to the United States, and consult with the insurer before taking any such action.
Generally, you should make written demand for payment on the obligor and guarantor prior to claim submission.
Rescheduling of maturity dates must not be granted by you unless specifically authorized by the insurer in writing or as
specified in the policy for short-term sales.
In order to file a claim, you must submit a properly completed Proof of Loss Form. All pertinent questions on that form must be
answered and documentation requested therein must be submitted.
REFER TO YOUR POLICY FOR INSTRUCTIONS ON WHEN A CLAIM SHOULD BE FILED.

The applicant is hereby notified that information requested by 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
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 U.S.C. 552), the Privacy Act
of 1974 (5 U.S.C. 552a), or under any other law or court order.
Paperwork Reduction Act Statement: We estimate that it will take you about 1/4 hour 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 OMB# 3048-0027; Washington, D.C. 20503.

EIB 92-27
Revised 11/10