Form EIB 92-34 EIB 92-34 Application for Short-Term Letter of Credit Insurance Po

Print Form

OMB No. 3048-0009
PENDING 2024

APPLICATION FOR SHORT-TERM LETTER OF CREDIT
EXPORT CREDIT INSURANCE POLICY

Application Number (For EXIM Use Only):
This application is to be completed by a financial institution (or a broker acting on its behalf) in order to obtain a short-term letter
of credit insurance policy. An online version of this application is available on EXIM web site. EXIM encourages customers to
apply online, as it will facilitate our review and allow customers a faster response time. Additional information on how to apply for
EXIM insurance can be found at EXIM's web site, www.exim.gov
Send this completed application to EXIM at 811 Vermont Ave NW, Washington, D.C. 20571. EXIM will also accept e-mailed pdf
and faxed applications. EXIM will not require the originals of these applications to be mailed. The application must be PDF scans
of original applications and all required attachments. (Fax # 202.565.3380, e-mail exim.applications@exim.gov)
APPLICANT (items marked with an asterisk (*) are required
*Applicant Name:
*Phone#:
Contact Person:
Position Title:

*DUNS #:

Fax#:

*E-mail:

*UEI #:

*NAICS Code:

*Street Address:
*City:

*State:

*Country:

Website:

*Zip Code:

No
Yes
Does the Applicant have a market rating?
If yes, indicate the name of the rating agency, rating, type of rating, outlook, and the date of the rating. Please provide the
following information from the applicant's most recent audited financial statements.

Statement Period (fiscal):

Are the financial statements combined or consolidated?
Financial Statement Dates:

Do the Statement Dates above apply to both the Balance Sheet and Income Statement?
Yes

Did auditor provide a qualifying opinion?

No

No
Opinion:

Auditor:

Net Loans:

Net Income:

Equity:

Total Assets:
Minority Owned?

Yes

No

Decline to Answer

Woman Owned?

Yes

No

Decline to Answer

Veteran Owned?

Yes

No

Decline to Answer

Disability-Owned?

Yes

No

Decline to Answer

EIB92-34
Revised 05/2024

Yes

1

0MB No. 3048-0009
PENDING 2024

Race (One or more boxes may be selected):
Asian

White

Black or African American

American Indian or Alaska Native

Other

Native Hawaiian or Pacific Islander

Ethnicity:
Not Hispanic or Latino

Hispanic or Latino

Does the Applicant have any affiliates?

Yes

No

Is there corporate ownership?

Yes

No

Name of the ultimate parent company:
(Note: aggregate the revenues for the applicant and all affiliates,
including corporate owners and subsidiaries)

Annual Revenues:

(Note: aggregate the number of employees for the applicant and all
affiliates, including corporate owners and subsidiaries)

# of Employees:
BROKER (if applicable)
Name of Brokerage:
AFFILIATES (if applicable)

Please provide the following information for any subsidiaries, branches, or affiliates that the applicant would like us to consider
adding as Additional Named Insureds under the policy.
Legal Name:

Phone#:

Contact Person:

Fax#:

Position Title:

E-mail:

Street Address:
State:

EIB92-34
Revised 05/2024

Country:

Zip Code:

2

0MB No. 3048-0009
PENDING 2024

1. General Questions
A. Indicate the EXIM Bank programs the applicant has used.

Insurance

State

National

B. What type of charter does the applicant hold?
C. Publicly traded?

Working Capital

Loan Guaranty

No

Yes

D. Indicate the name of the applicant's regulatory authority.
E. Does the applicant have any foreign government ownership?

Yes

No

If yes, please indicate the country and the percentage owned:

F. Letter of Credit Experience
• In what year did the applicant's letter of credit business begin?
• What was the total amount of letter of credit transactions in the last 12 months?
• What was the total number of letter of credit transactions in the last 12 months?
• Please provide the following information on the individuals responsible for administering the letter of credit policy:
Name

Title

Years of Trade Finance Experience

Years of Letter of Credit Experience

2. Letter of Credit Portfolio
What is the expected maximum value of letters of credit outstanding at any time over the next 12 months?

Please provide the following details regarding projected transactions to be insured over the next 12
Country

months.

Number of Issuing Banks

Total Estimated Amount of L/Cs

Total Estimated Number of L/Cs

3. Attachments
Please provide any information (e.g., the applicant's most recent annual report) that would be helpful in evaluating this
application.
EIB92-34
Revised 05/2024

3

CERTIFICATIONS AND SIGNATURE

0MB No. 3048-0009
PENDING 2024

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/resources/applications-forms/forms-and-applications (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.).
, do hereby certify that I am the duly appointed and qualified

I,

(Title)

of

(Name of Applicant)

and that as such I am authorized to execute this application

on behalf of
(Name of Applicant)

In witness whereof, I have hereunto signed my name this

day of

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 0MB 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 1 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 0MB 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 P roject, OMB# 3048-0009 Washington, D.C. 20503.

EIB92-34
Revised 05/2024

4