Fillable Co-Financing with Foreign Export Credit Agency (Export-Import Bank of the United States)

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Co-Financing with Foreign Export Credit Agency (Export-Import Bank of the United States)

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OMB 3048-0037
08/31/2021
EIB-11-04
Revised 03/2012
Page 1 of 2
Co-Financing with Foreign Export Credit Agency
I. Parties:
Identify the name of the co-financing Foreign Export Credit Agency, and if known, the contact person(s), their phone and fax numbers, and
e-mail addresses:
Describe any relationships between any of the parties in the transaction except as described in Attachment E, Credit Information:
II. U.S. Supply Contract/Purchase Order Information in Dollars:
U.S. Content included in Supply Contract(s)
Eligible Foreign Content (if any) included in Supply Contract(s)
Local Costs (if any) included in Supply Contract(s)
Ancillary Services (if any)
Total Export-Import Bank Portion
III. Non-U.S. Exporter/Supplier Information in Dollars:
Non-U.S. Exporter(s)/Supplier(s) With Address and Country of Origin Description of their Goods and Services
Non-U.S. Supply Contract(s)/Purchase Order(s) Information
Foreign ECA Content included in Supply Contract(s)
Eligible Foreign Content (if any) included in Supply Contract(s)
Local Costs (if any) included in Supply Contract(s)
Other Services (if any) not included in Supply Contract(s)
Total Foreign ECA Portion
$
$
$
$
$
$
$
$
$
$
$
OMB 3048-0037
08/31/2021
EIB-11-04
Revised 03/2012
Page 2 of 2
IV. Financed Amount Requested in Dollars (excluding Exposure Fee):
This chart is to be completed with respect to those Goods and Services included in the Supply Contract(s) for which financing is requested
from Ex-Im Bank. See Foreign Content Policy for Medium- and Long-Term Exports: http://www.exim.gov/pub/pdf/ebd-m-04a.pdf
( ) ( ) ( )
V. Other Information
Describe any non-ECA financing for the Supply Contract(s):
Certification:
The applicant consents to, and certifies that it has obtained the consent of the other transaction participants (e.g., borrower, guarantor,
lender, exporter, consultants, etc.), to the disclosure by Ex-Im Bank of any information (including documents) relating to this transaction to
the co-financing Foreign Export Credit Agency. If the co-financing Foreign Export Credit Agency shall agree to co-finance (i.e., share in the
risk of) the transaction, this consent to release transactional information shall include such information throughout the life of the transaction.
Paperwork Reduction Act Statement: We estimate that it will take you about 15 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 Ex-Im Bank and the Office of Management and Budget, Paperwork Reduction
Project, OMB # 3048-0037 Washington, D.C. 20503.
Co-Financing with Foreign Export Credit Agency
Ex-Im Bank Foreign ECA Total Financed/Insured
1. Content Sourced in the ECA Country
$ $ $
2. Eligible Foreign Content (if any)
$ $ $
3. Ancillary/Other Services (if any)
$ $ $
4. Less Cash Payment
$ $ $
5. Local Costs (if any)
$ $ $
Total Financed/Insured Amount
Requested (excluding Exposure Fee/
Insurance Premium)
$ $ $
Signed ________________________________________________ Dated __________________
Print Name:
Title:
Firm Name:
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Co-Financing with Foreign Export Credit Agency (Export-Import Bank of the United States)

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Completed 10 August 2020

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