Form EIB 18-04 EIB 18-04 Itemized Statement of Payments—Long-term Guarantees and

ITEMIZED STATEMENT OF PAYMENTS--US COSTS FOR EXIM LONG-TERM GUARANTEES AND DIRECT LOANS							OMB No.: XXXX-XXXX
ITEMIZED STATEMENT OF PAYMENTS - US COSTS
Long-Term Guarantees and Direct Loans
EXIM Bank Transaction No:
US Cost Request Number:
Exporter Name:
Exporter Address:
Supply Contract No(s):
Date of Exporter's Certificate(s):		<MM/DD/YYYY>
NAICS:
Acquisition List No(s).	Invoice No.	Invoice Amount	Invoice Amount Paid	Acquisition List Description of Item	Bill of Lading No(s).	AES/ITN No(s).	Remarks/Comments
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
		0.00	0.00
	TOTAL INVOICE AMOUNT	0.00	0.00	TOTAL INVOICE AMOUNT PAID	INDICATE CURRENCY
			0.00	LESS Excluded Goods and Services
			0.00	LESS Local Costs
			0.00	LESS Other	<Comments for Less Other to be entered here>
			0.00	NET AMOUNT
			0.0000000	EXCHANGE RATE
			<MM/DD/YYYY>	DATE OF CONVERSION
			0.00%	DISBURSEMENT %
	TOTAL GROSS AMOUNT	$0.00	$0.00	TOTAL PAYMENTS IN US DOLLARS
			$0.00	LESS Other	<Comments for Less Other to be entered here>
			$0.00	TOTAL FINANCED AMOUNT
Complete Reachback Determination Calculation only if applicable as per Instruction #7.
			0.00%	Reachback Determination Percentage
			$0.00	TOTAL FINANCED AMOUNT
INSTRUCTIONS AND NOTES: LINK to exim.gov
For any questions about completing this form, contact Credit Administration at credit.administration@exim.gov.
Paperwork Reduction Act Statement: We estimate that it will take you about 150 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 and the Office of Management and Budget, Paperwork Reduction Project OMB # XXXX-XXXX Washington, D.C. 20503.
EIB 18-04 5/2018