Fillable Export-Import Bank of the United States APPLICATION FOR (Export-Import Bank of the United States)

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Export-Import Bank of the United States APPLICATION FOR (Export-Import Bank of the United States)

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The Export-Import Bank of the United States APPLICATION FOR (Export-Import Bank of the United States) form is 24 pages long and contains:

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  • 73 check-boxes
  • 326 other fields

Country of origin: US
File type: PDF

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This application is to be used for insurance and guarantee transactions with financed amounts of $10 million or less
(excluding financed premium) and repayment terms between eighteen months and seven years. Applications for other
EXIM products can be found on EXIM’s web site under the “Apply” section.
Additional information on how to apply for EXIM medium-term insurance or guarantees can be found at EXIM's web site
http://www.exim.gov/products/how-to-apply.cfm.
An online version of this application is available on EXIM’s web site. EXIM encourages customers to apply on- line, 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 http://www.exim.gov.
Send this completed application to EXIM, 811 Vermont Avenue, NW, Washington, DC 20571. EXIM will also accept e-
mailed PDF and faxed applications. Please note the applications must be PDF scans of original applications and all required
application attachments. (Fax number 202.565.3675, e-mail exim.applications@exim.gov).
APPLICATION FORM
1. GENERAL QUESTIONS
A. Product
Insurance
Finance Lease Guarantee
Loan Guarantee Enter MGA# if known __________________
B. Coverage type
Comprehensive risk
Political risk
C. Conversion of a Preliminary Commitment or a Letter of Interest
No
Yes The EXIM reference number is: _______________
D. Resubmission
E.
Check if this is a resubmission of an application that was previously deemed incomplete or was withdrawn for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: _________________________
Renewal CGF (Credit Guarantee Facility)
MTR (Medium-Term Repetitive Insurance Policy)
F. Primary contact point for EXIM inquiries on this transaction:
Broker (Insurance only)
Lender/Lessor
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM
INSURANCE OR GUARANTEE
*Applicant Legal Name:
Tradestyle:
*Business Address:
*City:
*State: *Zip + 4:
*
Primary Industry NAICS
1
:
*Corporate Ownership:
*Total Number of Employees:
*Annual Sales Volume:
Contact Person:
E-mail:
Fax:
*
No
Decline to Answer
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 affiliates
2
, including corporate owners and subsidiaries.
Duns #:
Country:
*Does the Applicant have any affiliates
2
?
Yes
No
Position Title:
Phone:
Minority-owned business:
Exporter
Woman-owned business:
Veteran-owned business:
*
Yes
No
Decline to Answer
Yes
No
Decline to Answer
Yes
Broker (Insurance Only)
Check if there is no broker
Broker name: _________________________________________________ EXIM Broker#:______________________
Contact person: ________________ Phone # ______________Fax#:___________________E-mail: ____________________
1
A 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.
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.
*
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Print Form
2. SPECIAL COVERAGES
Check the boxes for the coverage(s) that apply to the transaction. View the fact sheets describing the coverage(s) on
EXIM's website as noted below. Complete and attach the requested forms.
Pre-shipment Cover
Attachment II – Pre-shipment
Questionnaire required
Used Equipment
Attachment III - Used Equipment
Information and Questionnaire
required
Co-Financing with Foreign Export
Credit Agency
Attachment H required
https://www.exim.gov/sites/
default/files/forms/eib11-04.pdf
Environmental Exports Program
Foreign Currency
Coverage
(specify
cur
rency)
_______
Supply
c
ontract
den
ominate
d in.
US$
Foreign currency
Leasing Guarantee Other ________________
3. PARTICIPANTS:
Check if the exporter is the applicant. Otherwise, complete the information below for each exporter, including ancillary service
providers.
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
Environmentally Beneficial
Renewable Energy
Exporter: The exporter is the U.S. entity that contracts with the buyer for the sale of the U.S.
goods and services. In the case of a finance
lease, if the lessor is a U.S. entity and takes title to the goods and services for lease to the foreign lessee, the lessor is the exporter.
What is the Applicant’s role in the transaction? Exporter* Buyer/borrower/lessee Lender/lessor?
Ancillary Service Fees
https://www.exim.gov/what-we-
do/loan-guarantee/ancillary-
services
Credit Guarantee Facility
https://www.exim.gov/what-
we-do/loan-guarantee/credit-
guarantee-facility
Military/Security/Police
https://www.exim.gov/
policies/military
Local Cost Support
http://www.exim.gov/policies/
local-cost
*Exporter Legal Name:
Tradestyle:
*Business Address:
*City:
*State: *Zip + 4:
*
Primary Industry NAICS
1
:
*Corporate Ownership:
*Total Number of Employees:
*Annual Sales Volume:
Contact Person:
E-mail:
Position Title:
Phone:
Fax:
*Minority-owned business:
*Woman-owned business:
*Veteran-owned business:
Yes
Yes
Yes
No
No
No
Decline to Answer
Decline to Answer
Decline to Answer
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 affiliates
2
, including corporate owners and subsidiaries.
Duns #:
Country:
*Does the Exporter have any affiliates
2
?
Yes
No
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.
Foreign Dealer Attachment IV
(Required)
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APP
Supplier: The supplier is the U.S. company that 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 supplier, including ancillary
service providers.
The no guarantor
re is The guarantor is an individual The gua fin rantor is a ancial institution The guarantor is a
corporation. Complete the information below for each guarantor.
Guarantor name: ____________________________________________________________________________________
_
Contact person: ___________________________________ Phone#:____________________________________________
Position title: _____________________________________ Fax#:_____________________________________________
_
Business
address:___________________________________E-mail:____________________________________________
City: ____________________State/Province: ___________ Postal code:________________________________________
_
Country:____________________________________________________________________________________________
Export-Import Bank of the United States
LICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
*
Supplier Legal Name:
Tradestyle:
*Business Address:
*City:
*State: *Zip + 4:
Total Number of Employees:*
*Annual Sales Volume:
Contact Person:
E-mail:
Position Title:
Phone:
Fax:
*Minority-owned business:
*Woman-owned business:
*Veteran-owned business:
Yes
No
Yes
Yes
No
No
Decline to Answer
Decline to Answer
Decline to Answer
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, provide answer applicable to entire company including corporate owners, affiliates or subsidiaries.
Duns #:
Country:
*Does the Supplier have any affiliates
2
?
Yes
No
*
Primary Industry NAICS
1
:
*Corporate Ownership:
1
A 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.
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.
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/lessee is the applicant. If not, complete the information below.
Borrower’s/Lessee’s name: _____________________________________________________________________________
Contact person: ___________________________________ Phone#:_____________________________________________
Position title: _____________________________________ Fax#:_______________________________________________
Business address:__________________________________ E-mail:_____________________________________________
City: __________________________State/Province: _________________________________Postal code:______________
Country:_____________________________________________________________________________________________
Guarantor: The guarantor is the person or entity that agrees to repay the credit if the borrower or lessee does not. Refer to
the Medium-Term Credit Standards (at http://www.exim.gov/tools/credit-standards.cfm) to determine in what situations
personal or corporate guarantors are required for medium-term transactions.
Check to indicate whether
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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
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: _______________________________________________________________________________________
_
Contact person: ___________________________________ Phone#:___________________________________________
_
Position title: _____________________________________ Fax#:_____________________________________________
_
Business address:___________________________________ E-mail: ________________________________________
_
City: _________________________State/Province: _________________ Postal code:______________________________
Country: __________________________________________
End-user: The end-user is the foreign entity that uses the U.S. goods and services.
Check if end-user is
The borrower/lessee or Guarantor or Buyer. Otherwise, complete the info
rmation below.
End-user name: ________________________________________________________________________________________
Contact person: __________________________________ Phone#:_____________________________________________
_
Position title: ____________________________________ Fax#:_______________________________________________
_
Business address:____________________________________ E-mail:_________________________________________
_
City: _________________________State/Province: _______________Postal code:__________________________________
Country: ____________________________________________________________________________________________
_
Lender/Lessor: The lender is the company that extends the EXIM guaranteed or insured loan to the Borrower. The Lessor
is the company that extends the EXIM guaranteed finance lease to the Lessee.
Check if the lender/lessor is the applicant. Otherwise, complete the information below.
Lender’s/Lessor’s name:_________________________________________________________________________________
Contact person: ___________________________________ Phone#:_____________________________________________
_
Position title: _____________________________________ Fax#:______________________________________________
_
Business address:____________________________________ E-mail:__________________________________________
_
City: ____________________________State/Province: ____________________Postal code:_________________________
_
Country: _____________________________________________________________________________________________
Agent:
An agent is a business entity or individual, usually located in the country of the borrower or buyer, who has assisted in the
sourcing, packaging, and/or preparation of a request for support from EXIM, and who will receive compensation in some
form for their services.
Is an agent involved in this transaction? Yes No
If yes, add the agent information below:
Agent’s legal name: ______________________________ Province:______________________________________________
Contact person: __________________________________Country:______________________________________________
Position title: ____________________________________E-mail: _______________________________________________
Business address: ___________________________________Phone:_____________________________________________
City: _____________________________Postal code: ___________________________Fax:__________________________
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Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
b) Describe the purpose of the transaction. Include answers to the following: 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 costs in U.S. dollars. Also provide information on other sources of
financing for the project, including working capital.
__________________________________________________________________________________________
c) Indicate whether an application for support of this export contract or a related proj
ect has been filed with the
U.S. Agency for International Development, U.S. Maritime Administration, Overseas Private Investment Corporation, U.S.
Trade Development Agency or a multilateral financing agency. If so, include a brief description of the additional support.
____________________________________________________________________________________________________
Check if the goods and services or their use meet EXIM's requirements for an environmentally beneficial determination.
Check if the goods and services or their use meet EXIM's requirements for a renewable energy
determination.
a)
services, number of units, values and estimated U.S. and foreign content. This section does not need to be completed if the
exporter attaches a Content Report or if the request is for a Credit Guarantee Facility.
_
________________________________________________________________________
_______________
____________
Describe the U.S. goods and service(s). Include make, model, manufacturer/supplier or NAICS of goods and
4. TRANSACTION DESCRIPTION
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, i.e. the entity whose financial statements EXIM uses to calcu
late the ratios for medium-term credit standards
compliance. For this transaction, indicate whether the PSOR is:
the buyer
the corporate guarantor, or
business combination, (e.g. the consolidated
or combined financial statement of the buyer and one or more corporate
guarantors.) If business combination, indicate which entities comprise the combination
____________________________________________________________________________________________________
Is the PSOR a financial institution? Yes No
Sovereign
Select the risk category of the PSOR: Public Non-sovereign Private
Does the PSOR have a bond rating? Yes No
If yes, indicate the name of the rating agency, rating, and the date of the rating. _____________________________________
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5. REQUESTED FINANCING AMOUNTS AND STRUCTURE
EXIM 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. In addition, EXIM may also
finance certain local costs, ancillary services as approved, and the exposure fee/premium. Fill out the chart below to
determine estimated eligible amounts.
Definition US$
A
Supply Contracts or Purchase Orders The aggregate price of all goods and services in all A(i)
[If the lessor is a U.S. entity and the supply contract(s) or purchase order(s),
takes title to the U.S. goods and including local costs, ancillary services, and
services for lease to a foreign lessee, excluded goods and services. Break out ancillary
A(ii)
the finance lease is the supply services in A(ii).
contract]
B
Excluded Goods and Services
The aggregate price of all goods and services that
are not eligible for
or are excluded from EXIM
support (e.g. goods not shipped from the U.S. and
excluded ancillary services). Local costs should
not be included in this line.
C
Total Local Costs The aggregate price of all goods manufactured in
the end-user’s country and all services provided
by residents of the purchaser’s country. EXIM
may be able to finance these amounts up to 30%
of D below.
D
Net Contract Price A minus B minus C
E
Eligible Foreign Content The aggregate cost of any goods produced or
manufactured outside the U.S., or services
provided by third country personnel or foreign
freight cost and foreign insurance included in the
net contract price (line D), (e.g. foreign items
shipped from the U.S.).
F
U.S. Content D minus E
G
Minimum Cash Payment This amount must be the greater of E or 15% of D
H
Local Cost Financing Requested This can be no more than 30% of D
I
Financed Amount Requested
D minus G plus H
(Excluding Exposure Fee)
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
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A. Exposure Fee (Guarantees)/ Premium (Insurance) Check one box.
EXIM to finance the fee/premium, which will be paid as the credit is drawn down.
EXIM to finance the fee/premium, which will be paid up front.
EXIM will not finance the fee/premium, and it will be paid as the credit is drawn down.
EXIM will not finance the fee/premium, and it will be paid up front.
B. Transaction Structure:
i. Principal Repayment Term/Finance Lease: _______(years). Unless otherwise re
quested, equal installments of principal
will be repaid semi-annually beginning six months after the starting point. In the case of a finance lease, unless otherwise
requested, rent will be calculated based on equal installments of principal, paid semi-annually beginning six months after the
starting point.
ii Starting Point: The starting point is generally the event that marks the fulfillment of the exporter’s contractual
responsibility. See EXIM's fact sheets on starting points and reach-back policies at www.exim.gov.
(Check one box.)
Shipment (single shipment)
Final Shipment (multiple shipments)
Mean Shipment (multiple shipments)
Consolidation Date (Foreign Dealer I
Services Completion.
Completion of Installation. Specify date:___________
Project Completion. Specify date:____
_ ___
nsurance Policy only)
iii 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. If shipment is planned
for a
certain nu
mber of d
ays after EXIM authorization, so note: ____________________________________________
iv. Promissory Notes/Lease Supplements: For transactions with multiple shipments indicate:
There will be one promissory note per shipment.
Disbursements will be consolidated into one promissory note.
(Finance lease only) There will be one lease supplement per shipment.
(
Finance lease only) Lease deliveries will be consolidated under one lease supplement.
v. I
nterest rate:
The interest rate to be charged on the guaranteed/insured loan or used to calculate the rent under a finance lease is: _____
6. REASON FOR REQUESTING EXIM SUPPORT
EXIM will finance the export of U.S. goods and services if it can be demonstrated that EXIM support is necessary
for the
transaction to proceed. Check one of the boxes below describing why support is necessary.
The exporter is aware that foreign companies are competing, or are expected to compete, for the sale. Provide company
name, country, and (if known/applicable) the supporting export credit agency.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
The exporter is aware that foreign companies manufacture comparable goods and services that are sold in the buyer’s
market with export credit agency support available. Provide company name, country, and (if known/applicable) the
supporting export credit agency.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
There is limited availability of private financing available from either external or domestic sources.
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
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7. CREDIT INFORMATION
The information requested in Attachment I: Credit information is attached.
8. OTHER INFORMATION, NOTICES AND CERTIFICATIONS
A commitment fee, applicable only to guaranteed and direct loans, accrues starting 60 days after the authorization of a final
commitment and is payable semi-annually in arrears on a schedule determined at the time of authorization. The commitment
fee is 1/8 of 1% per annum on the un-disbursed and un-cancelled balance of a guaranteed loan and ½ 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 and by signing the application is irrevocably committing to pay the commitment or
facility fee.
The applicant is the guaranteed lender or the exporter, 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
stand
ard
form fee letter from the
borrower. This standard form fee letter is attached as Attachment VI. This letter irrevocably
commits the borrower to pay the fee.
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
This question is not applicable because this application is a request for insurance coverage.
A. General Information Provide the following
Credit Agency report(s) on the exporter(s). If exporter has a credit rating of BBB or better, this is not required.
Annex A to the Master Guarantee Agreement (Guarantees only) at www.exim.gov/sites/default/files/forms/mtmgaannexes.pdf
Annex A to the Medium-Term Master Guarantee Agreement – Finance Lease (Finance Lease Guarantees only)
Lender’s mandate letter (require when applicant is a financial institution)
B. Supply Contracts Between the Exporter and Buyer
Sales contract(s), pro forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction between the exporter
and buyer are attached.
The exporter(s) are not the manufacturers of the goods nor the producers of the services to be exported; the Sales contract(s), pro
forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction between the supplier(s) and exporter(s) are
attached; AND the Sales contract(s), pro forma invoice(s), or purchase order(s) and finance lease(s) evidencing the transaction
between the supplier(s) and buyer are attached.
C. Commitment Fee/Facility Fee Agreement (Guarantees and Credit Guarantee Facilities only)
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Attachment I: Credit Information Requirements
1. INFORMATION ON THE BORROWER:
If the primary source of repayment for the transaction is a corporate guarantor provide only 1a), 1b) and 1 c)
on the borrower;
If
current information (within the last six months) as described below is on file at EXIM, indicate Guarantee
or Policy #_________________________________________________________
If the primary source of repayment is the borrower, provide the information noted in 1 a) – 1 g) below (note
optional information described in part 3):
a) Company description and ownership
Provide a concise description of the company origin, legal status, facilities, business activities and primary
markets.
Provide the name of each owner of at
least 10% of company shares and his/her ownership percent.
b) Related party information
Provide names and a brief description of subsidiaries, parent com
pany, and/or commonly owned companies
(“related parties”).
Indicate which, if any, of the related parties account for more than 25% of the borrower’s sales or purchases
during the last fiscal year.
Indicate which, if any, related parties extend loans to the borrower or to whom the borrower extends loans, if
loans are material to the borrower. Materiality is defined as 10% of the borrower’s total assets.
Provide details of guarantees given on behalf of related parties by the borrower, if loans are material to the
borrower.
c) Credit agency report
Provide a credit agency report on the borrower not
older than six months from date of application,
Check if credit agency report is not applicable because the borrower is a financial institution
(bank), or a foreign government agency.
d) Creditor Bank or Supplier References
Provide a creditor bank reference prepared within six months of the application date. Report should include
bank name, address, and length
of relationship, amount, currency, and terms of secured and unsecured credit
and repayment experience.
If the borrower does not have any financial institution creditors, provide two supplier references.
Supplier references should be dated within six months of the application and include years of credit
experience, annual sales, the terms of sale, the amount of the last sale, the recent high credit, the amount
currently outstanding, details on any past due amounts, and repayment experience.
There are certain requirements for all financial statements, regardless of the amount of the transaction.
These are as follows:
Provide financial statements
for the previous three fiscal years, as well as interim statements if the latest
fiscal
year end statements
are dated mo
re than
nine month
s
from the date of application. When interim
statements are provided, also provide interim statements for the same interim period for the previous year (for
comparative purposes).
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
i)
e) Financial Statements
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A summary of significant accounting principles must accompany all financial statements. These should outline,
at a minimum, the depreciation methods and rates, valuation
methods for inventory, fixed assets and
investments and the inflation accounting method used, if any. For construction companies, a description of the
revenue recognition method should be included. Additionally, financial statements should break out
depreciation expense, gross interest expense, tax expense and current maturities of long-term financial
institution or supplier debt, if any.
For all financial statements that present combined or consolidated results, provide the percentage of total assets,
total liabilities, tangible net worth, sales, and net income represented by each entity that is participating in the
transaction as the buyer, borrower, guarantor or
end-user. A combining/consolidating worksheet would have all
this information.
There are certain additional financial statement information requirements that depend on the amount of the
financing request as follows:
iv)
For financed amounts of up to and including $1 million: Audited financial statements are preferred but not
required for non-financial institutions. Audited statements are required for financ
ial institutions. While English
language statements are preferred, EXIM will accept Spanish language financial statements.
For financed amounts of greater than $1 million up to and including $5 million: While English
language
statements are preferred, EXIM will accept Spanish language financial statements. Financial statements must be
audited by an external independent auditor.
vi)
For financed amounts of greater than $ 5 million: Financial statements must be audited by an external
independent auditor. Statements must be in English.
f) Market indications, if available, are as follows:
Name of rating agency: ________________________________ Rating:____________ Date: __________
Include the debt rating reports issued by
the rating agency, and if applicable, the prospectus for a debt or equity offering
during the two years prior to the application dates.
g) Supplemental Credit Questions
Provide the answers to the questions listed in Attachment C to the Medium-Term Credit Standards for transactions of
greater than $5 million up to and including $10 million where the primary source of repayment is a non-financial
institution that does not have market indications. These questions are located on EXIM's web site at
https://www.exim.gov/sites/default/files/forms/ebd-m-39-1.pdf
2.
INFORMATION ON THE CORPORATE GUARANTOR (S):
Not applicable. Refer to the Medium-Term Credit Standards at https://www.exim.gov/sites/default/files/forms/ebd-
m-39-1.pdf to determine in what situations corporate guarantors are required for medium term transactions.
If the corporate guarantor is not the primary source of repayment, provide 1 a), and 1 b) and 1 c) as described above.
If the corporate guarantor is the primary source of repayment, provide the information noted in 1 a) – 1 g)
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
ii)
iii)
v)
OMB 3048-0014
Expires 08/31/2022
EIB 03-02 (Rev. 2/2019)
Page 10 of 18
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
OPTIONAL ITEMS WHICH THE APPLICANT MAY ATTACH. (These may expedite the processing of your
application).
Calculation of the financial performance criteria of EXIM's Medium-Term Credit Standards on th
e borrower or
guarantor designated as the primary source of repayment.
Mitigating factors for any of the performance criteria that are not met.
Supplemental credit questions as detailed in 1 g) for deals of less than $5 million.
Translations
of Spanish language financial statements, if applicable.
Explanations of any adverse information contained in the credit report, references and/or financial statements,
including interims.
Financial spreads on the borrower and/or guarantor designated as the primary source of repayment. See EXIM's website
for spreading conventions, which should be used as guidelines.
3.
OMB 3048-0014
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EIB 03-02 (Rev. 2/2019)
Page 11 of 18
Attachment II: Pre-shipment Questionnaire
Complete this fo rm o nly if you are requ esting pre-sh ipment in surance coverage for yo ur transactio n. Details on pre-
shipment coverage can be found at http://www.exim.gov/sites/default/files/forms/ins-12-22.pdf
Details of Coverage Requested:
a) Provide the reason pre-shipment coverage is being requested: _______________________________________________
b) Indicate the date the contract was executed or the anticipated date of signing: ___________________________________
c) Indicate the estimated period between the contract date and the final shipment date of items: _______________________
d) Provide a schedule of any progress payments made or to be made by the borrower during the pre-shipment period, or
indicate none:
_________________________________________________________________________________________________
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
OMB 3048-0014
Expires 08/31/2022
EIB 03-02 (Rev. 2/2019)
Page 12 of 18
Attachment III: Used Equipment Information and Questionnaire
USED AND REFURBISHED EQUIPMENT
Equipment that has been previously owned or placed into service is
generally eligible for support under EXIM's
loan, guarantee and insurance programs, provided certain criteria are met. To be eligible for EXIM support, used
equipment, including equipment that has been refurbished in the U.S., must meet the following eligibility criteria:
1 To be considered U.S. content, the used equipment must be of original U.S. manufacture, AND, if previously
exported, must have been in use in the U.S. for at least one year prior to export.
2
The U.S. costs associated with the refurbishment of the equipment are eligible for EXIM support, provided
they meet EXIM's foreign content policy parameters. EXIM can support the lesser of 85 percent of the
U.S. Contract Price of the item or 100 percent of the actual U.S. content of the item provided that (a) the item is shipped
from the U.S. and (b) the foreign content of the item does not exceed 50 percent of the item's total production cost.
3. If the used equipment is of either original foreign manufacture or original U.S. manufacture, previously exported
and has not been in use in the U.S. for at least one year prior to its proposed export, then EXIM will treat it as foreign
content and the following applies:
a. If the equipment is to be refurbished, the used equipment procurement cost is considered eligible foreign
content provided that this cost is less than 50 percent of the total proc
urement and refurbishment cost.
b. If the foreign content of the used
equipment exceeds 50 percent of the cost associated with the procurement and
refurbishment of the equipment, then only the U.S. refurbishment portion will be considered eligible for EXIM support.
4. Previously exported goods that benefited from EXIM financing in the pa
st will be considered eligible for EXIM
support provided that the original financing has been paid in full and that the equipment has been in use in the U.S. at least
one year.
5. The repayment term that EXIM offers for used and refurbished equipment will be consistent with EXIM's
international agreements for repayment terms based on contract value. EXIM, at its sole discretion, will determine the
remaining useful life of such equipment.
a. If the remaining useful life of the equipment is at least half the useful life of equivalent new equipment, then
EXIM may support a repayment term equal to that offered new equipment.
b. If th
e remaining useful life of the equipment is less than half the useful life of equivalent new equipment, then
EXIM may support a repayment term equal to the useful life remaining.
c. If the sale includes more than one item, including a mixture of new and used items, a weighted average of the
useful lives of all the items will be calculated by applying the rules of 5(a) and 5(b) above.
6. Foreign Content for used pieces should be determined by contacting the original manufacturer to ascertain the value
on a percentage basis of foreign components contained in the equipment during the manufacturing process. This percentage
should be applied to the supplier’s purchase price to determine the current value of foreign components. This value should
then be adjusted to account for the value of any additional foreign components installed during the refurbishment process.
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
OMB 3048-0014
Expires 08/31/2022
EIB 03-02 (Rev. 2/2019)
Page 13 of 18
3. Prices and Costs
Contract price: $ ____Foreign content included in the contract price: $___________
_
U.S. supplier's purchase price: $______________ Purchase Date: ________________
Cost of rebuilding/reconditioning: $________ Cost of spare parts included: _______
_
Description of rebuilding and/or spare parts__________________________________
4. Used Aircraft Only
Have all airworthiness directives been completed? ___Yes ___No
If no, describe the regulation or directive permits required for continued operation of the
aircraft:_______________________________________________________________________________________________
Number of cycle hours remaining on the airframe and engines: _________________________________________________
_
Months remaining before next maintenance "C" and "D" checks: _________________________________________________
Names of each previous owner and lessee with the corresponding acquisition dates: _________________________________
_
Signature: _____________________________________ Date: ______________________ Title: ______________________
_
Name
: ________________________________________________
_
Broker: _______________________________________
Administrator (if applicable): _____________________________
_
(For insurance program):
If you have questions about this questionnaire, please contact the Business Development Division (Telephone: 202.565.3900
or Fax: 202.565.3931). For questions concerning large aircraft, please contact the Transportation Division (Telephone:
202.565.3550 or Fax: 202.565.3558).
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
USED EQUIPMENT QUESTIONNAIRE
Complete a separate questionnaire for each item of used equipment.
1. Product information
Provide name and description of used equipment: _____________________________________________________________
Equipment History
a) year manufactured: ________________ b) hour meter reading: ______________ c) mileage: ________________________
d) where is equipment located? __________________ e) how long has the equipment been there?: ____________________
_
Is the product under warranty? _____Yes _____No
Term________ Description _________________________
Has the equipment been rebuilt/reconditioned?
By whom? __________________________ Location: ______________________ Date: ______________
Does this equipment have an independent mechanical certification, evaluation, or assessment? ___Yes ____No
Term: _______ _______ Description: ___________________________________
Has the equipment been rebuilt or reconditioned? Is the product under warranty? ___Yes ___No
2. Export/Import History
Was the equipment previously exported? _____Yes ____No
Did EXIM provide support? ____Yes ____No If yes, provide details.
Was the equipment imported to the U.S.?_____Yes ____ No
OMB 3048-0014
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EIB 03-02 (Rev. 2/2019)
Page 14 of 18
Attachment IV: Supplemental Information Requirements for Foreign Dealer Support
I. Requested Financing Amounts and Structures
For Supply Contracts or Pu
rchase Orders Amount identified in Item 5.A of t he application, please indicate amounts
requested for each of the following (total must accumulate to the amount in Item 5.A):
o Short-term only (for capital goods that will not be refinanced on a medium-term
basis together with spare
parts and other non-capital items):
$_______________
o Medium-term (for capital goods that will be refinanced on a medium-term basis): $__________________
__
II. Dealer Information
Do you or the exporter (please specify) have a distribution agreement with the proposed dealer? If so, is this an exclusive
relationship? ___________________________________________________________________________
How long have you or the exporter (please specify) been working with the proposed dealer?
_____________________________________________________________________________________________________
For how long, if at all, have you or the exporter extended credit to this dealer? __________________________________
_
What, if any, credit limits have been established? At what terms?
A) Parts _____________ B) Equipment ____________
Are guarantees or collateral required to support this credit? ____________________________________________________
_
Is a minimum level of sales per year required from this dealer? _______________________________________________
What financial and credit criteria have you established to qualify the dealer?
_____________________________________________________________________________________________________
How often do you conduct a credit review of this dealer? _____________ What are the terms extended by the dealer to
its customers? _________________________________________________________________________________________
What warranty support is provided to the dealer? ___________________________________________________________
How far past
due must the dealer be before shipments are discontinued?
______________________________________________________________
____________________________
___________
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
OMB 3048-0014
Expires 08/31/2022
EIB 03-02 (Rev. 2/2019)
Page 15 of 18
Attachment VI: Form of Fee Letter
This attachment is to be filled out 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.
[Letterhead of Borrower]
Date________________
Export-Import Bank of the United States
811 Vermont Avenue, N.W.
Washington, D.C. 20571
Attention: Vice President – Trade Finance and Insurance Division
[Lender]/ [Exporter]
1
[Address]
Re:
Undertaking with Respect to EXIM Commitment/Facility
2
Fees
Ladies and Gentlemen:
On [date of EXIM Application referred to below], [Lender]/[Exporter]
3
submitted a Preliminary Commitment/
Final Commitment
4
application form (the “EXIM Application) to the Export-Import Bank of the United States in
connection with the Lender’s proposal to extend financing to [Borrower] (the “Borrower”), to be guaranteed by EXIM, in
support of the acquisition of the goods and/or services described below (the “Goods and Services”) for a Net Contract Price
of U.S.$______________.
5
Description of Goods and Services:
__________________________________________________
6
In order to induce EXIM to provide its final commitment with respect to the transaction covered by the EXIM
Application, the Borrower hereby undertak
es unconditionally that, if EXIM issues a final commitment to provide its
guarantee with respect to such transaction, the Borrower will pay or cause to be paid to EXIM a guarantee commitment fee
(for a guaranteed loan) or the facility fee (for a credit guarantee facility), as the case may be, with respect to the transaction,
whether or not the transaction is consummated (including, without limitation, whether or not any credit or facility agreement
is executed or any promissory note is issued). [EXIM's commitment fee shall be paid on the uncancelled and undisbursed
balance of the export financing credit that the Lender proposes to establish in connection with the transaction.]/ [EXIM's
facility fee shall be determined as of the date of final commitment.]
7
The amount of the applicable fee or the basis for
calculating the amount, and the payment dates, shall be specified in the relevant notice of final commitment delivered by
EXIM to the Lender, with a copy to the Borrower.
1
Delete as appropriate.
2
Delete as appropriate.
3
Delete as appropriate.
4
Delete as appropriate.
5
6
7
Provide “Contract Price” on Goods and Services listed in Item 5 of the EXIM's Application.
Provide “Goods and Services Description” on Goods and Services listed in Item 4 of the EXIM
Application.
Delete as appropriate.
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
OMB 3048-0014
Expires 08/31/2022
EIB 03-02 (Rev. 2/2019)
Page 16 of 18
The Borrower acknowledges and agrees that[, unless the Borrower has canceled in writing any remaining
undisbursed balance of the guaranteed loan, EXIM's commitment fee shall continue to accrue and become due and payable
as described above during any period in which the Lender’s utilization of the EXIM's guaranteed facility is suspended.]/ [the
facility fee shall be due and payable as described above, notwithstanding cancellation of the relevant credit guarantee
facility.]
8
This undertaking with respect to the [commitment]/ [facility]
9
fees due to EXIM shall be governed by, and
construed and enforced in accordance with, the laws of the State of New York.
Very truly yours,
[BORROWER]
By _______________
Signature
Name ________________
Print
Title ________________
Title
8
Delete as appropriate.
9
Delete as appropriate.
Export-Import Bank of the United States
APPLICATION FOR MEDIUM-TERM INSURANCE OR GUARANTEE
OMB 3048-0014
Expires 08/31/2022
EIB 03-02 (Rev. 2/2019)
Page 17 of 18
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 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 _____________________
of ____________________________ and that as such I am authorized to execute this application
on behalf of _______________________________.
(Title)
(Name of Applicant)
(Name of Applicant)
In witness whereof, I have hereunto signed my name this ___________ day of ______. 20___.
OMB 3048-0014
Expires 08/31/2022
EIB 03-02 (Rev. 2/2019)
Page 18 of 18
By:
(Authorized Officer)
Name:
Title:
Tel. #:
Email:
Name of Applicant:
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 2 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# 3048-0014 Washington, D.C. 20503.
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Export-Import Bank of the United States APPLICATION FOR (Export-Import Bank of the United States)

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Completed 26 January 2021

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