OMB No.: 3048-0031
08/31/2022
EIB 10-02 (Rev. 2/2019)
Page 1 of 3
APPLICATION FOR EXPRESS INSURANCE
1. Primary reason for application:
How did you learn about EXIM?
*Exporter Legal Name:
D&B#:
Tradestyle:
Business Address:
*Total Number of Employees:
*City:
*State:
*Zip + 4:
Country:
Contact Person:
Position Title:
Phone #:
E-mail:
*Primary Industry NAICS
2
:
Brokerage:
*Annual Sales Volume:
*Minority-owned business:
*Women-owned business:
*Veteran-owned business:
*Corporate Ownership:
Yes
No
EXIM Regional Office
Broker
Bank
U.S. Export Assistance Center
EXIM City/State Partner Other
(describe):
risk mitigation financing
extend more competitive terms
YES NO
YES NO YES NO
EXIM
SBA
2. Do you have a credit line with a financial institution (exclude overdraft protection and credit cards)
3. Do you have a SBA export Working Capital Loan or EXIM Working Capital Loan?
4. Average total of annual export credit sales over the last three years for you and your affiliates:
$
5. Do you wish to insure export credit sales made by your affiliates? (If yes, please attach names/business addresses of each)
YES
NO
Does each affiliate invoice export credit sales in its own name or trade style?
YES
NO
YES
NO
Are the credit decisions of each affiliate centralized with this applicant?
YES
NO
If ‘No,’ provide comment:
7. Are the products:
6. Product and/or services to be exported & NAICS (if known):
New
Used
8. Do you sell Capital Goods to foreign manufacturers or producers?
YES
NO
(if yes, attach explanation)
9. Are the Products to be covered under the policy:
Manufactured or reconditioned in the U.S.?
YES
NO
All made or reconditioned with more than 50% U.S. content?
(If no, attach explanation)
YES
NO
Shipped from the U.S.?
YES
NO
Used to support Nuclear Energy?
YES
NO
Sold to Military entities or Security Forces?
YES
NO
On the U.S. Munitions List?
(part 121 of title 22 of the Code of Federal Regulations)
YES
NO
Environmentally Beneficial?
YES
NO
Supporting Renewable Energy?
YES
NO
10. For SBA defined Small Businesses Only:
A. Was each of the products to be covered under the policy manufactured or reconditioned with more than 50% U.S. content
(comprised of all direct and indirect costs including but not limited to labor, materials, research, and administrative costs, but
excluding net profit)?
NO
YES
C. If the answer to (a) is “No” you may also obtain coverage on an aggregated basis for all products on an invoice, provided that a
Content Report is submitted at the time of shipment (please see applicable Fact Sheets for information on aggregation). Please
indicate if you are seeking coverage on an aggregated basis. Please note that you may answer “Yes” to either or both (b) and
(c).
NO
YES
B. If the answer to (a) is “No” because one or more of your products contains less than 50% U.S. content, then coverage is
available for the U.S. content only in each product with less than 50% U.S. content. Please indicate if you are seeking coverage for
products with less than 50% U.S. content.
NO
YES
11. Policy Payment Limit Requested: $ (maximum export credit receivables outstanding at any one time)
Are the products of each affiliate the same as the applicant's?
If no, list them in question #6.
Yes
No
Decline to Answer
Yes
No
Decline to Answer
Yes
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
1
, including corporate owners and subsidiaries.
1
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.
2
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.
*Does the exporter have any affiliates?
