OMB No. 3048-0023
08/31/2022
EIB-92-50 (Rev. 2/2019)
Page 1 of 5
APPLICATION
FOR SHORT-TERM MULTI-BUYER
EXPORT CREDIT INSURANCE POLICY
Brokerage:
How did you learn about EXIM?
EXIM Regional Office Broker
Bank
U.S. Export Assistance Center
EXIM City/State Partner
Other
(describe):
risk mitigation financing
extend more competitive terms
NO
YES
SBA
YES NO
EXIM
YES
NO
$
Environmentally Beneficial?
NO
YES
Supporting Renewable Energy?
NO
YES
On the U.S. Munitions List?
(part 121 of title 22 of the Code of Federal Regulations)
NO
YES
No
Yes
1. Primary reason for application:
3. Do you have a credit line with a financial institution (exclude overdraft protection and credit cards)
4. Do you have a SBA export Working Capital Loan or EXIM Working Capital Loan?
5. Average total of annual export credit sales over the last three years for you and your affiliates:
6. Do you wish to insure export credit sales made by your affiliates?
(If yes, please refer to “additional named insured” eligibility criteria in question # 26. Answers to all remaining questions must include eligible
affiliates you wish to add.)
7. Product and/or services to be exported & NAICS (if known):
9.
(a)
For SBA defined Small Businesses Only: 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)?
YES NO
(b)
If the answer to 9(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.
YES NO
(c)
If the answer to 9(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
Sheet for information on aggregation). Please indicate if you are seeking coverage on an aggregated basis.
YES NO
* PLEASE NOTE THAT YOU MAY ANSWER “YES” TO EITHER OR BOTH (b) AND (c) ABOVE.
(d)
For Non-SBA Defined Small Businesses: Was each of the products to be covered under the policy
manufactured or reconditioned with more than 50% U.S. content (labor, materials and direct overhead, but
excluding net profit)?
YES NO
10. Do you sell Capital Goods to foreign manufacturers or producers?
YES
NO
11. Are the Products to be covered under the policy:
Manufactured or reconditioned in the U.S.?
NO
YES
Shipped from the U.S.?
NO
YES
Sold to Military entities or Security Forces?
NO
YES
Used to support Nuclear Energy?
NO
YES
Note: Your buyers, their guarantors (if any), and end users of the products must be in countries where EXIM is able to provide support, see EXIM's Country Limitation Schedule (CLS) at
http://www.exim.gov. There may not be trade measures or sanctions against the good produced with the
U.S. export under Section 201 of the Trade Act of 1974. For a list of products and countries with Anti-Duping or Countervailing Duty sanctions, see section AD/CVD Orders available at
http://www.usitc.gov/trade_remedy/731_ad_701_cvd/investigations/active/index.htm. Trade sanctions are product and country specific (i.e., all firms within a country are subject to the
order, unless a specific firm is explicitly excluded).
(if yes, attach explanation)
2. Coverage Type Requested:
Comprehensive (Commercial & Political) Political Only
8. Are the products:
New Used
Yes
No
Decline to Answer
*Veteran-owned business:
Yes
No
Decline to Answer
*Women-owned business:
Yes
No
Decline to Answer
*Minority-owned business:
*Annual Sales Volume:
*Total Number of Employees:
*Corporate Ownership:
*Primary Industry NAICS
2
:
*Exporter Legal Name:
Tradestyle:
*Business Address:
*City:
*State:
*Zip + 4:
Contact Person:
Country:
Position Title:
Phone #:
E-mail:
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.
*Does the Exporter have any affiliates
2
?
Yes
No
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.
