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MULTI-BUYER SELECT RISK POLICY (MBSR) EXCLUSIONS WORKSHEET (Export-Import Bank of the United States)

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BROWSE EXPORT-IMPORT BANK OF THE UNITED STATES (DC) FORMS

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OMB No. 3048-0053
Expires 02/28/2022
MULTI-BUYER SELECT RISK POLICY (MBSR)
EXCLUSIONS WORKSHEET
Instructions:
Select and list the sales you wish to exclude. Add additional pages, if needed.
"Non-Standard" Exclusions must be EXIM authorized, and are available only for multibuyer policies with deductibles.
The Multi-Buyer Select Risk EXIM Policy Portfolio should represent at least 50% of the exporter’s Total Eligible Export
Credit Sales in U.S. dollars, excluding standard exclusions. Eligible Export Credit Sales are sales that comply with EXIM
programs and policies.
Please refer to the 2nd page of this form for guidance on calculating the Multi-Buyer Select Risk EXIM Policy Portfolio.
All endorsed exclusions are locked-in for the policy period.
Premiums must be paid on all "Reportable Transactions" as required by the insurance policy, except for the endorsed exclusions.
Sign the worksheet certification on the 2nd page of this form.
STANDARD EXCLUSIONS
Unconfirmed Irrevocable Letters of Credit
Payments at Sight (SDDP or CAD)
Sales to Subsidiaries and Affiliates
Sales to Canada
Any Invoice of $10,000 or less
None requested
NON-STANDARD EXCLUSIONS
Instructions:
Please complete the information for each desired exclusion category. Any combination of categories is permitted.
A. Sales to Top Corporates (Companies with revenues > $100,000,000):
Buyer Name
City/Country
Total Annual Credit Sales
Payment Terms
B. Sales to Prime Customers (Companies that paid you promptly, < 60 days slow, for three consecutive years):
Buyer Name
City/Country
Total Annual Credit Sales
Payment Terms
C. Sales to the following Country (ies) are to be excluded:
Country
Total Annual Credit Sales
EIB 18-01 3/2018
OMB No. 3048-0053
Expires 02/28/2022
CALCULATING THE MULTI-BUYER SELECT
RISK (MBSR) EXIM POLICY PORTFOLIO
Total Eligible Export Credit Sales
Subtract Any Standard Exclusions
Adjusted Total Eligible Export Credit Sales (a)
Subtract Any Non-Standard Exclusions (b)
TOTAL MBSR EXIM POLICY PORTFOLIO (c)
[ a minus b ]
MBSR EXIM POLICY PORTFOLIO %
[ c divided a]
COMMENTS
CERTIFICATIONS
The representations made and the facts stated in this worksheet for the endorsement of sales exclusions are true, to the best of my knowledge and belief,
and I have not misrepresented or omitted any material facts relevant to said representations. It is agreed that this worksheet shall form a part of the
Policy, if issued, and the truth of the representations and facts, and performance of every undertaking in this worksheet shall be a condition precedent to
any coverage under such Policy. I further understand that this certification is subject to the penalties for fraud against The U.S. Government (18 USC
1001).
(Applicant)
(Print Name and Title)
(Broker)
(Signature)
(Date)
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 EXIM and the Office of Management and Budget, Paperwork Reduction Project OMB# 3048-0053; Washington, D.C.
20503.
EIB 18-01 3/2018
0.00
0.00
0.00%
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MULTI-BUYER SELECT RISK POLICY (MBSR) EXCLUSIONS WORKSHEET (Export-Import Bank of the United States)

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Completed 4 October 2021

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