Form EIB 95-10 EIB 95-10 EIB 95-10 Application for Credit Guarantee Facility and

OMB 3048-0013
Expires 08/31/2022

Export-Import
Bank of the
United States

APPLICATION FOR
CREDIT GUARANTEE
FACILITY AND LONGTERM DIRECT LOAN
OR GUARANTEE

This application is for requesting financing of a Credit Guarantee Facility (any dollar amount and tenor) and direct loan
and guarantee transactions with financed amounts over $25 million (excluding financed exposure fee), typically with
tenors over seven years. It may also be used for Large Aircraft, Limited Recourse Project and Structured Financing,
Domestic Financing, and Tied Aid. Additional information on how to apply for an EXIM transaction can be found at
EXIM's website: https://www.exim.gov/resources/applications-forms/applying.
Email this completed application to exim.applications@exim.gov. Please note that applications must be a signed and
dated PDF and include all required application attachments.
COMMITMENT OR FINANCING TYPE REQUESTED
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
Product ☐Comprehensive Guarantee
☐Political Risk Guarantee
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
☐Direct Loan
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
☐ Credit Guarantee Facility
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
☐ New
☐ Renewal
For more information: https://www.exim.gov/solutions/loan-guarantee/credit-guarantee-facility
☐Preliminary Commitment
☐Sovereign
☐ Public Non-sovereign
☐ Private Sector
A justification for a Preliminary Commitment needs to be attached.
Conversion of a Preliminary Commitment or a Letter of Interest
☐No
☐ Yes
The EXIM reference number is: __________________
Resubmission
☐ Check if this is a resubmission of an application that was previously deemed incomplete
or was withdrawn for other reasons. The EXIM reference number is: _____________
PARTICIPANTS:
Items marked with an asterisk (*) are required fields. Under corporate ownership, provide the name of the ultimate parent
company, if there is a corporate owner. For number of employees and sales volume, aggregate for the company and all
its affiliates, including corporate owners and subsidiaries.
Applicant: The applicant may be any exporter, financial institution, supplier, the primary borrower, buyer or controlling
sponsor associated with the transaction. ☐ Check if the applicant has been assisted by a city or state export agency
and provide the name of the agency: __________________________________________________
*Applicant Name: ________________________________________________________________________________
Tradestyle: _____________________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

UEI No.1 __________________ Taxpayer ID No. ________________

1
A Unique Entity Identifier (UEI) No. is a 12-character unique number assigned to all entities (public and private companies, individuals, institutions or
organizations) who must register in SAM.gov to do business with the federal government. If your entity is registered in SAM.gov, your UEI has already been
assigned and is viewable in SAM.gov. If you do not have a UEI No., then you must register your entity. Visit https://sam.gov/content/home to see if your
entity has a UEI No. or to register your entity. A UEI No. is required for the Applicant at time of application and is also required for the Borrower and
Lender(s). [NOTE: As the UEI No. process becomes fully clarified, EXIM’s instructions will be updated accordingly and more information will be added to
assist an Applicant and any other affected transactional parties with this process, but it was not ready prior to submission for OMB review.]

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For an Applicant located in the United States, items marked with an asterisk (*) are required fields.
No ☐
Decline to Answer ☐
*Woman-owned business:
Yes ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Disability-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Asian ☐
White ☐

Hispanic or Latino ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

Exporter: The “exporter” is the company which is contracting with the Buyer for the sale of the U.S. goods and/or
services. ☐ Check if the exporter is the applicant. Otherwise, complete the information below for each exporter
including any ancillary service providers. For more information about ancillary services visit:
https://www.exim.gov/solutions/loan-guarantee/ancillary-services
*Exporter Name: ________________________________________________________________________________
Tradestyle: _____________________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

Taxpayer ID No. _________________

*Corporate Ownership: _________________________________________________________________________
No

*Primary Industry NAICS3: ______________________

*Total Number of Employees: ______________________

* Annual Sales Volume: ________________________

*Does the Exporter have any affiliates2?

Yes

For an Exporter located in the United States, items marked with an asterisk (*) are required fields.
*Woman-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Disability-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Hispanic or Latino ☐

Asian ☐
White ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

How many years has the Exporter been in commercial operations? _______________
Does the Exporter have experience with transactions of similar size, scope and complexity? Explain below:

2 Affiliations 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.
3 A company’s Primary Industry NAICS code 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.
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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. Otherwise, complete the information below for each exporter including
any ancillary service providers. ☐ Check if the Supplier is not determined. If neither applies, attach the same information
for the primary supplier as requested above for the Exporter.
*Supplier Name: _________________________________________________________________________________
Tradestyle: _____________________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

Taxpayer ID No. _________________

*Corporate Ownership: _________________________________________________________________________
No

*Primary Industry NAICS3: ______________________

*Total Number of Employees: ______________________

* Annual Sales Volume: ________________________

*Does the Exporter have any affiliates2?

Yes

How many years has the Supplier been in commercial operations? _______________
Does the Supplier have experience with transactions of similar size, scope and complexity? Explain below:

For a Supplier located in the United States, items marked with an asterisk (*) are required fields.
No ☐
Decline to Answer ☐
*Woman-owned business:
Yes ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Disability-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Hispanic or Latino ☐

Asian ☐
White ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

Borrower or Lessee: The borrower is the entity that agrees to repay the loan. The lessee is the entity that agrees to
lease the goods and services from the lessor and pay rent under a finance lease. ☐ Check if the borrower is the
applicant. If not, complete the information below.
*Borrower/Lessee Name: _________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

UEI No.1 __________________ Taxpayer ID No. ________________

For a borrower located in the United States, items marked with an asterisk (*) are required fields.
No ☐
Decline to Answer ☐
*Woman-owned business:
Yes ☐
*Minority-owned business:
Yes ☐
No ☐
Decline to Answer ☐
*Veteran-owned business:
Yes ☐
No ☐
Decline to Answer ☐
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*Disability-owned business:

Yes ☐

*Race (One or more boxes may be selected.):
American Indian or Alaskan Native ☐
Native Hawaiian or Pacific Islander ☐
*Ethnicity:

Hispanic or Latino ☐

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No ☐

Decline to Answer ☐

Asian ☐
White ☐

Black or African American ☐
Other _______________________________

Not Hispanic or Latino ☐

Guarantor: The guarantor is the person or entity that agrees to repay the credit if the borrower or lessee does not.
Complete the information below for each guarantor if a guarantor is offered or required.
Check to indicate: ☐ There is no guarantor
☐ Guarantor is an individual ☐ Guarantor is a financial institution
☐ Guarantor is a corporation. Complete the information below for each guarantor if a guarantor is offered or required.
*Guarantor Name: _______________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________
Phone: ________________________________________

Position Title: ________________________________
Email: ______________________________________

Buyer: The buyer is the entity that contracts with the exporter for the purchase of the U.S. goods and services.
Check if the buyer is also the ☐ borrower/lessee or lessor or ☐ guarantor. Otherwise complete the information
below.
*Buyer Name: __________________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________
Phone: ________________________________________

Position Title: ________________________________
Email: ______________________________________

Primary Source of Repayment (PSOR). The PSOR is the entity whose financial statements form the basis of
EXIM’s evaluation of reasonable assurance of repayment. For this transaction, indicate whether the PSOR is:
☐ buyer or ☐ guarantor or ☐ business combination (e.g., the consolidated or combined financial statement of the buyer and
one or more corporate guarantors or controlling sponsor(s).) If business combination, indicate which entities comprise the
combination:

Is the PSOR a financial institution? Yes ☐ No ☐
The risk category of the PSOR:

Sovereign ☐

Public Non-sovereign ☐

Private ☐

Does the PSOR have a bond rating? Yes ☐ No ☐
If yes, indicate the name(s) of the rating agency, rating, and the date of rating:

End-user. The end-user is the foreign entity that uses the U.S. goods and services. Check if the end-user is also the
☐ borrower or ☐guarantor or ☐ buyer or ☐PSOR. Otherwise, complete the information below.
*End-user Name: ________________________________________________________________________________
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*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Lender/Lessor. The lender is the company that extends the EXIM guaranteed loan to the borrower. The Lessor is
the company that extends the EXIM guaranteed finance lease to the Lessee. If the application is for a guaranteed loan,
check if the lender is also the ☐ applicant or otherwise, complete the information below. If a direct loan is being requested,
complete for Lessor, if applicable.
*Lender/Lessor Name: ____________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

Duns No. ___________________

UEI No. _____________ MGA No.: ___________________________________
1

Controlling Sponsor. The controlling sponsor is a person providing controlling direct private equity investment
(excluding investments made through publicly held investment funds, publicly held securities, public offerings, or
similar market vehicles) in connection with a financing. Check if the controlling sponsor is also the ☐ applicant.
Otherwise, complete the information below.
*Sponsor Name:_________________________________________________________________________________
*Business Address: ______________________________________________________________________________
*City: _______________________

*State: _____________ *Zip/Postal Code: _________ *Country: ____________

Contact Person: _________________________________

Position Title: ________________________________

Phone: ________________________________________

Email: ______________________________________

SPECIAL FEATURES REQUESTED
Check the box(es) for the coverage(s) that apply to the transaction. View the fact sheets describing the coverage
on EXIM’s website as noted below. Complete and attach the required forms.
☐ Large Aircraft: Required Attachment A (Form EIB 95-10a): Large Aircraft Transactions. For more information:
https://www.exim.gov/policies/aviation-exports
☐ Tied Aid Program: Required Attachment C (Form EIB 95-10c): Tied Aid Capital Project Fund. For more information:
https://www.exim.gov/sites/default/files/newsreleases/tied_aid_procedures_10-29-20.pdf
☐ Used Equipment: Required Attachment E (Form EIB 11-03): Used Equipment Questionnaire. For more information:
https://www.exim.gov/policies/used-equipment
☐ Project Finance: Required Attachment F (Form EIB 95-10f): Foreign and Domestic Project Finance. For more
information: https://www.exim.gov/what-we-do/loan-guarantee/project-and-structured-finance
☐ Structured Finance: Required Attachment G (Form EIB 95-10g): Credit Information
☐ Co-financing with a Foreign Export Credit Agency: Required Attachment H (Form EIB 11-04): Co-financing with
Foreign Export Credit Agency. For more information: https://www.exim.gov/policies/co-financing
☐ Domestic Finance: Required Attachment I (Form EIB 22-05) [weblink TBD] and Required Attachment F (Form EIB
95-10f): Foreign and Domestic Project Finance. For more information: [web link TBD]
☐ Pre-Export Payment Questionnaire: Required Attachment J (Form EIB 22-02) [weblink TBD]
☐ Ancillary Service Fees: For more information: https://www.exim.gov/what-we-do/loan-guarantee/ancillary-services
☐ Capitalization of Interest During Construction: For more information: [weblink TBD\
☐ China and Transformational Exports Program: For more information: https://www.exim.gov/about/specialinitiatives/ctep
☐ Environmental Exports Program: For more information: https://www.exim.gov/about/special-initiatives/environment
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☐ Finance Lease Structure: For more information: https://www.exim.gov/what-we-do/loanguarantee/transportation/finance-lease-structure
☐ Foreign Currency Guarantee: For more information: https://www.exim.gov/what-we-do/loan-guarantee/foreigncurrency-guarantee
☐ Local Cost Support: For more information: https://www.exim.gov/policies/local-cost
☐ Military/Security/Police: For more information: https://www.exim.gov/policies/military and
https://www.exim.gov/policies/security-forces-sales
☐ Nuclear: For more information: https://www.exim.gov/policies/ex-im-bank-and-the-environment/internationalenvironmental-and-social-guidelines#a-3
☐ Other: __________________________________________________________________________________
TRANSACTION DESCRIPTION

Describe Goods and Services, which are proposed for the scope of supply. Include make, model, manufacturer/supplier,
NAICS of goods and services, number of units, values, and estimated U.S. and foreign content.

Describe the purpose of the transaction. Address the following in the description: Will the goods be used to
create or expand production capacity for an exportable product?

Are the goods and services destined for an identifiable project? If so, provide information on the total estimated
project cost in US dollars. Also provide information as to other proposed sources of financing for the project,
including working capital.

Indicate whether an application for support of this export contract or a related project has been filed with the
Agency for International Development, Maritime Administration, U.S. International Development Finance Corporation,
Trade Development Agency or a multilateral financing agency. If so, include a brief description of the additional
support being sought and identify the name and contact at each.

CHINA AND TRANSFORMATIONAL EXPORTS PROGRAM (CTEP)
Check one or both applicable boxes, as appropriate, below if (a) the items to be exported from the U.S. face export subsidies
from competing goods and/or services financed by the People’s Republic of China (PRC) or by other countries (as designated
by the U.S. Secretary of the Treasury)4; and/or (b) the export items qualify as one or more of the Transformational Export
Areas designated by Congress, as necessary to advance the comparative leadership of the U.S. which include:
•
•
•
•
•
•

Artificial Intelligence
Biotechnology
Biomedical sciences
Wireless communications equipment
Quantum computing
Renewable energy, energy efficiency, &
energy storage

•
•
•
•
•

Semiconductor and semiconductor machinery
manufacturing
Emerging financial technologies
Water treatment and sanitation
High-performance computing
Associated services necessary for use of any of
the foregoing exports

4 As of this writing, no other country besides the PRC has been designated a covered country.
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☐ Face export subsidies for competing goods and/or services financed by the PRC or other covered
countries
☐ Transformational Export Area

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If either is checked, provide an explanation via attachment.
REQUESTED FINANCING AMOUNTS AND STRUCTURE
EXIM financing support is based on the value of the eligible goods and services in the exporter’s supply contract(s) or
purchase order(s). The total level of support will be the lesser of: 85% of the value of all eligible goods and services;
or 100% of the U.S. content included in all eligible goods and services in the exporter’s supply contracts or purchase
order(s). In addition, EXIM may also finance certain local costs, ancillary services as approved, and the exposure
fee/premium. Complete the chart below for Uses and Sources of Funds.
Uses of Funds
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
Total Uses of Funds

($mm)
$______________________
$______________________
$______________________
$______________________
$______________________
$______________________

Sources of Funds
_____EXIM Bank_______
_____________________
_____________________
_____________________

($mm)
$____________________$____________________$____________________$____________________-

_____________________
Total Senior Debt

$____________________

$______________________
$______________________

Equity

$____________________

$______________________
$______________________

Total Sources of Funds

$____________________

Exposure Fee. Check one box.
☐ EXIM to finance the fee, which will be paid as the credit is drawn down.
☐ EXIM to finance the fee, which will be paid up front.
☐ EXIM will not finance the fee, and it will be paid as the credit is drawn down.
☐ EXIM will not finance the fee, and it will be paid up front.
Transaction Structure.
Principal Repayment Term. _____ (years). Unless otherwise requested, equal installments of principal will be
repaid semi-annually beginning six months after the starting point.
Starting Point. The starting point is generally the event that marks the fulfillment of the exporter’s contractual
responsibility, except for project finance, when it occurs at the time the project meets all completion tests. (Check
one box.)
☐ Shipment (single shipment)
☐ Services Completion.
☐ Final Shipment (multiple shipments)
☐ Completion of Installation. Specify date:
☐ Mean Shipment (multiple shipments)
☐ Project Completion. Specify date:
☐ Other
Shipment Period. Shipments will be completed and/or services will be performed from: ______________
(month/year) to ____________ (month/year) excluding any acceptance, retention, or warranty period.
Interest rate. The interest rate to be charged on the guaranteed loan is: _____________________________
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REASON FOR REQUESTING EXIM SUPPORT
The basic rationale for EXIM support is that the export of U.S. goods and services needs financing but there are
one or more obstacles to obtaining such financing. Please check all the boxes below that apply to this transaction,
to the best of your knowledge. Please also check the appropriate box to indicate which factor is most important.
Most Important? ☐

Export-credit competition.
Are any non-­‐U.S. companies competing for this sale?

No ☐
Don’t Know ☐
Yes ☐
If yes, please identity non-U.S. competitor: _______________________________________________
If yes, is the non-U.S. competitor receiving support from any export credit agency for this sale?

No ☐
Yes ☐
Don’t Know ☐
If yes, please list the export credit agency: _______________________________________________
Structural constraints.
Most Important? ☐
Is commercial financing for this sale limited by bank requirements (such as maturity limits or capacity limits on
the borrower, industry, or country)?

Yes ☐

No ☐

Don’t Know ☐

If yes, are the relevant limits related to risk or liquidity or both?
Yes ☐

Risk constraints.

No ☐

Other ☐ ___________________________________________________________________
Most Important? ☐

Is commercial financing for this sale limited because providers of commercial financings are unwilling or
unable to accept the commercial and/or political risks of the borrower or the country?
Yes ☐

No ☐

Don’t Know ☐

If yes, what risks are creating the limitation?
Yes ☐

No ☐

Other ☐ ___________________________________________________________________

China and Transformational Exports Program (CTEP).

Most Important? ☐

Are any Chinese companies competing for this sale?
Yes ☐
No ☐
Don’t Know ☐
If yes, please identity the Chinese competitor: _______________________________________________
If yes, is the Chinese competitor receiving support from any government financing agency for this sale?
Yes ☐
No ☐
Don’t Know ☐
If yes, please list the agency:
Most Important? ☐

Other.

Is commercial financing for this sale limited because of other considerations?
Yes ☐

No ☐

Don’t Know ☐

If yes, please describe:
OTHER INFORMATION AND CERTIFICATIONS
General Information. Be prepared to provide the following upon request:
☐ Credit Agency report(s) on the borrowers and exporter(s).
☐ Annex A to the Master Guarantee Agreement (Guarantees only) at:
https://www.exim.gov/sites/default/files//forms/mtmgaannexes.pdf
☐ Lender’s mandate letter (required when applicant is a financial institution).
☐ Environmental Screening (Attachment B (Form EIB 95-10b): Environmental Screening Document).

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Supply Contracts Between the Exporter and Buyer.
☐ Sales contract(s), pro forma invoice(s), or purchase order(s) are attached.
☐ No contract is attached. (Project Finance, CGF, and Preliminary Commitment only)
Commitment/Facility Fee Agreement
A commitment fee accrues starting 60 days after the authorization of a final commitment and is payable semiannually in arrears on a schedule determined at the time of authorization. The commitment fee is either:
1/8 of 1% per annum on the undisbursed and uncancelled balance of a guaranteed loan or
1/2 of 1% per annum for a direct loan.
A facility fee, applicable only to a credit guarantee facility (and in lieu of a commitment fee), is 1/16 of 1% of the
principal amount of the facility, due in full at the time of authorization of a final commitment, and payable in two
equal installments due approximately 90 and 270 days from the date of authorization of the final commitment.
Choose one of the options below regarding the payment of the commitment or facility fee:
☐ The applicant is the borrower or project sponsor, and by signing the application, is irrevocably committing to pay
the commitment fee.
☐ The applicant is the guaranteed lender, and is (check one):

☐ signing the application which irrevocably commits it to pay the fee, or

☐ signing the application and enclosing with it an EXIM standard form fee letter signed by the borrower (at
https://www.exim.gov/sites/default/files//forms/mtmgaannexes.pdf). This letter irrevocably commits the borrower to pay
the fee.

☐ The applicant is the exporter, and is signing the application and enclosing with it an Ex-Im Bank standard form fee
letter from the ☐ borrower or ☐guaranteed lender (at
https://www.exim.gov/sites/default/files//forms/mtmgaannexes.pdf). This letter irrevocably commits the borrower or
guaranteed lender to pay the fee.
Anti-Lobbying Disclosure Form
Please refer to the Anti-Lobbying Declaration/Disclosure forms (see Attachment D (Form EIB 95-10d): Anti-lobbying
Declaration/Disclosure) and include a signed copy of the appropriate form(s) with your application
.

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LONG-TERM LOAN OR GUARANTEE APPLICATION ATTACHMENTS
Attachment A (Form EIB 95-10a): Large Aircraft Transactions
Attachment B (Form EIB 95-10b): Environmental Screening Document
Attachment C (Form EIB 95-10c): Tied Aid Capital Project Fund
Attachment D (Form EIB 95-10d): Anti-lobbying Declaration/Disclosure
Attachment E (Form EIB 11-03): Used Equipment Questionnaire
Attachment F (Form EIB 95-10f): Foreign and Domestic Project Finance
Attachment G (Form EIB 95-10g): Credit Information
Attachment H (Form EIB 11-04): Co-financing with Foreign Export Credit Agency
Attachment I (Form EIB 22-05): Domestic Financing [weblink TBD]
Attachment J (Form EIB 22-02): Pre-Export Payments Questionnaire [weblink TBD]
Attachment K (Form EIB 22-04): Form of Fee Letter [weblink TBD]
Attachment K is to be submitted in the following circumstances:
• the application is for a guarantee or a credit guarantee facility
• the applicant is the guaranteed lender or the exporter, and
• the applicant is signing the application, but the borrower is committing to pay the commitment or facility fee

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CERTIFICATIONS AND SIGNATURE
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 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, including the reason for requesting
EXIM support. 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

of
on behalf of

(Name of Applicant)

and that as such I am authorized to execute this application

(Name of Applicant)

(Title)

.

In witness whereof, I have hereunto signed my name this

day of

. 20

.

Name of Applicant:

(Authorized Officer)

By:
Name:
Title:
Tel. #:
Email:

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 any application.
Paperwork Reduction Act Statement: We estimate that it will take you about 2.5 hours 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# 3048-0013 Washington, D.C. 20503

EIB 95-10 (Rev. 5/2022)

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