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pdfOMB No. 3048-0023
08/31/2022
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APPLICATION
FOR SHORT-TERM MULTI-BUYER
EXPORT-IMPORT BANK
of the UNITED STATES
EXPORT CREDIT INSURANCE POLICY
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate owner. For
number of employees and sales volume, aggregate for the company and all its affiliates1, including corporate owners and subsidiaries.
Tradestyle:
*Exporter Legal Name:
*Total Number of Employees:
*Business Address:
*Annual Sales Volume:
*City:
*State:
Country:
Contact Person:
*Woman-owned business:
Position Title:
Phone #:
*Minority-owned business:
E-mail:
*Zip + 4:
Yes
Decline to Answer
Yes
No
Race (One or more boxes may be selected.):
*Primary Industry NAICS2:
*Does the Exporter have any affiliates2?
Decline to Answer
No
Yes
American Indian or Alaska Native
No
Native Hawaiian or Pacific Islander
Asian
Black or African American
White
Other
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
*Veteran-owned business:
*Disability-owned business:
Yes
Yes
No
No
Decline to Answer
Decline to Answer
1Affiliations exist when one individual or entity controls or has the power to control another or when a third party or parties control or have the power to control
both. Factors such as common ownership, common management, previous relationships with or ties to another entity, and contractual relationships may cause
affiliation. The complete definition of affiliation is found at 13 C.F.R. § 121.103.
2A company’s Primary Industry NAICS codes is the NAICS that accounts for the largest share of sales for the most recently completed fiscal year. The full
definition of “primary industry” is set forth at 13 C.F.R. § 121.107.
*Corporate Ownership:
Brokerage:
EXIM Regional Office
How did you learn about EXIM?
EXIM City/State Partner
Other
Broker
Bank
U.S. Export Assistance Center
(describe):
1. Primary reason for application:
risk mitigation
2. Coverage Type Requested:
Comprehensive (Commercial & Political)
financing
extend more competitive terms
Political Only
4. Do you have a SBA export Working Capital Loan or EXIM Working Capital Loan? SBA
YES
NO
YES
3. Do you have a credit line with a financial institution (exclude overdraft protection and credit cards)
NO
EXIM
YES
NO
5. Average total of annual export credit sales over the last three years for you and your affiliates: $
6. Do you wish to insure export credit sales made by your affiliates?
Yes
No
(If yes, please refer to “additional named insured” eligibility criteria in question # 26. Answers to all remaining questions must include eligible
affiliates you wish to add.)
7. Product and/or services to be exported & NAICS (if known):
8. Are the products:
New
Used
9. (a) For SBA defined Small Businesses Only: Was each of the products to be covered under the policy
manufactured or reconditioned with more than 50% U.S. content (comprised of all direct and indirect costs
including but not limited to, labor, materials, research and administrative costs, but excluding net profit)?
(b) If the answer to 9(a) is “No” because one or more of your products contains less than 50% U.S. content
then coverage is available for the U.S. content only in each product with less than 50% U.S. content.
Please indicate if you are seeking coverage for products with less than 50% U.S. content.
(c) If the answer to 9(a) is “No” you may also obtain coverage on an aggregated basis for all products on an
invoice, provided that a Content Report is submitted at the time of shipment (please see applicable Fact
Sheet for information on aggregation). Please indicate if you are seeking coverage on an aggregated basis.
YES
NO
YES
NO
YES
NO
YES
NO
* PLEASE NOTE THAT YOU MAY ANSWER “YES” TO EITHER OR BOTH (b) AND (c) ABOVE.
For Non-SBA Defined Small Businesses: Was each of the products to be covered under the policy
(d) manufactured or reconditioned with more than 50% U.S. content (labor, materials and direct overhead, but
excluding net profit)?
10. Do you sell Capital Goods to foreign manufacturers or producers?
YES
NO
(if yes, attach explanation)
Note: Your buyers, their guarantors (if any), and end users of the products must be in countries where EXIM is able to provide support, see EXIM's Country Limitation Schedule (CLS) at
http://www.exim.gov. There may not be trade measures or sanctions against the good produced with the
U.S. export under Section 201 of the Trade Act of 1974. For a list of products and countries with Anti-Duping or Countervailing Duty sanctions, see section AD/CVD Orders available at
http://www.usitc.gov/trade_remedy/731_ad_701_cvd/investigations/active/index.htm. Trade sanctions are product and country specific (i.e., all firms within a country are subject to the
order, unless a specific firm is explicitly excluded).
EIB-92-50 (Rev. 7/2021)
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OMB No. 3048-0023
08/31/2022
11. Are the Products to be covered under the policy:
Manufactured or reconditioned in the U.S.?
YES
NO
Environmentally Beneficial?
Shipped from the U.S.?
YES
NO
Sold to Military entities or Security Forces?
YES
NO
Used to support Nuclear Energy?
YES
NO
12. Policy Payment Limit Requested:
13. Buyer Types:
Supporting Renewable Energy?
YES
YES
NO
NO
On the U.S. Munitions List?
YES
NO
(part 121 of title 22 of the Code of Federal Regulations)
$
% Manufacturers
% Wholesalers/Traders
% Retailers
%Service Providers
% Government Agency
14. Projected # of buyers to whom you will offer export credit terms:
15. Enter the percentage of export credit sales by payment and term type projected for the next twelve months:
Payment Type
Terms (# of days) (must total 100%, collectively)
Sight
1-30
31-60
61-90
91-120
121-180
181-270
271-360
Unconfirmed L/C
Open account or Draft
(enter "Cash Against Documents" in the "Sight" column and "Open account/Draft" row)
16. Export Credit Portfolio: Enter amounts for the projected top 10 countries to which you will have export credit sales over the
next 12 months.
Country Export
Credit Sales
Country Export
Credit Sales
17. Identify your three (3) largest buyers:
Name
Country
Export Credit Sales (next 12 months)
18. Year you began:
a) Exporting?
b) Exporting on credit terms (other than cash in advance or confirmed letters of credit)?
Sales
19. For the last three years what were your total export credit:
(include factored or insured receivables and attach any comments)
write-offs
# of accounts written-off
EIB-92-50 (Rev. 7/2021)
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OMB No. 3048-0023
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20. Highest average amount of export receivables outstanding over the last twelve months:
21. Total export receivables outstanding: $
$
$
current
at
(date should be within 30 days of the application)
$
1-60 days past due
$
61-90 days past due
$
91-180 days past due
180 days past due
22. Number of buyers past due more than 60 days for $10,000 or more:
23. For each buyer over 60 days past due for $10,000 or more, attach an explanation including name of buyer, country,
amount past due, due date, and reason for past due.
24. Name(s) of export credit decision maker(s):
Years of Credit Years of Foreign Credit
Experience
Experience
Title(s):
25. Please submit the following as Attachments:
• Your financial statements for the most recently completed fiscal year (with notes if available)
• Descriptive product brochures (if available).
• Other pertinent information you wish to include.
26. Special Coverages Required: If "none" check
N/A
Add Additional Named Insureds (ANI's). Credit decisions of each affiliate listed must be centralized with the Applicant and
each affiliate must invoice export credit sales in their own name (or tradestyle); if either is not applicable, please attach an
explanation. Questions 7-25 should include export sales of prospective ANI's.
Does each affiliate invoice export credit sales in its own name or trade style?
Are the credit decisions of each affiliate centralized with this applicant?
Yes
Yes
No
No
If "No" provide comment:
Are the products of each affiliate the same as the applicant's products listed in question 7 of this application?
If No, please list the products in question #7.
Yes
No
Affiliate Company/Trade style
EIB-92-50 (Rev. 7/2021)
Business Address /City / State / Country
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OMB No. 3048-0023
08/31/2022
Services (Please attach a copy of your sample services contract) Services must be: performed by
U.S. based personnel or those temporarily domiciled overseas, and billed (invoiced) separately from
any product sales.
Small Business Policy To be eligible, your company, together with your affiliates, must have had
average annual export credit sales during the preceding three fiscal years not exceeding $10,000,000,
excluding sales made on terms of confirmed irrevocable letters of credit (CILC) or cash in advance
(CIA).
Warehouse: Please answer the following questions about the warehouse.
Select Warehouse Type:
Warehouse Location:
Owned or controlled by insured
Bonded warehouse
Neither
State (if U.S.)
City:
State/Province
Country
Selected Exclusion: specify transactions you wish to exclude from coverage.
UILC (Unconfirmed Irrevocable Letters of Credit)
Invoices Under $10,000
SDDP/CAD (Sight Draft Documents Against Payment or Cash Against Documents)
Sales of Samples
Sales to Canada
Sales to Subsidiaries and/or Affiliates
Other (please specify):
EIB-92-50 (Rev. 7/2021)
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CERTIFICATIONS AND SIGNATURE
OMB No. 3048-0023
08/31/2022
Please refer to the “Standard Certifications and Covenants for EXIM Applications” set forth in Form EIB 18-CN, posted
on the EXIM website at https://www.exim.gov/tools-for-exporters/applications-forms/complete-list (the “Standard
Certifications”). THE STANDARD CERTIFICATIONS ARE INCORPORATED INTO THIS APPLICATION AS IF FULLY
AND DIRECTLY SET FORTH HEREIN. When signing this application in the space provided below, the undersigned
authorized officer signing on the applicant's behalf certifies and represents that he or she is fully authorized to sign on the
applicant's behalf, and that HE OR SHE HAS READ the Standard Certifications referenced above AND IS CERTIFYING
AND COVENANTING, as appropriate, to all of the certifications, acknowledgments and covenants set forth in the
Standard Certifications.
Applicant further certifies that the representations made and the facts stated in this application and its attachments are
true and Applicant has not misrepresented or omitted any material facts. Applicant further covenants that if any
statement set forth in this application or in the Standard Certifications, becomes untrue, or is discovered to have been
untrue when made, Applicant will promptly inform EXIM of all such changes or discoveries. Applicant further understands
that in accepting or approving this application, EXIM is relying upon Applicant's statements set forth in the application
and in the Standard Certifications, and all statements and certifications to EXIM are subject to the penalties for false or
misleading statements to the U.S. Government (18 USC § 1001, et. seq.).
I,
, do hereby certify that I am the duly appointed and qualified
(Title)
of
and that as such I am authorized to execute this application
(Name of Applicant)
on behalf of
.
(Name of Applicant)
In witness whereof, I have hereunto signed my name this
day of
. 20
.
Signature:
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 USC 635 et. seq.); provision of this information is mandatory and failure to provide the requested information may result in EXIM being
unable to determine eligibility for support. If any of the information provided in this application changes in any material way or if any of the certifications
made herein become untrue, the applicant must promptly inform EXIM of such changes. The information provided will be reviewed to determine the
participants' ability to perform and pay under the transaction referenced in this application. EXIM 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). EXIM reserves the right to decline to process or to discontinue processing of an application.
Paperwork Reduction Act Statement: We estimate that it will take you about 0.5 hour(s) 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 and the Office of Management and Budget, Paperwork Reduction Project, OMB# 3048-0023 Washington, D.C. 20503.
EIB-92-50 (Rev. 7/2021)
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| File Type | application/pdf |
| File Modified | 2021-07-15 |
| File Created | 2020-04-09 |