Fillable OMB 3048-0041 Expires: 02/28/2022 EXPORTERS CERTIFICATE! FOR USE (Export-Import Bank of the United States)

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EXPORTER’S CERTIFICATE!
OMB 3048-0041
Expires: 02/28/2022
FOR USE WITH A SHORT TERM
EXPORT CREDIT INSURANCE POLICY!
EIB!94)07!
Revised 6/2018!
Policyholders must keep this document and submit it with a Proof of Loss (Claim)
1. Name and Address of Policyholder: (to be completed by policyholder)
Name: ______________________________________________________________
Address: ____________________________________________________________
City: ____________________________________________ State: _______________________________ Zip Code: _____________________________________
Policy #: ____________________________________________________________
☐ The U.S. exporter is either the beneficiary of a letter of credit, or the recipient of funding under a direct buyer credit loan, or the
recipient of the buyer’s payment under a reimbursement loan under a Financial Institution Buyer Credit Policy or a Bank Letter
of Credit Policy. The U.S. exporter must complete and certify to sections A and B and sign.
OR
☐ The U.S. exporter is not a beneficiary
or recipient as described above. The U.S. exporter must complete and certify to sections A
and B and sign. NOTE: The policyholder must also obtain a Beneficiary Certificate EIB 92-37 from the beneficiary.
2. Name and Address of U.S. Exporter: (to be completed by U.S. Exporter)
Name: ______________________________________________________________
Address: ____________________________________________________________
City: ____________________________________________ State: _______________________________ Zip Code: _____________________________________
Tax ID #: ____________________________________________________________ Dun & Bradstreet #: _______________________________________________
Upon representation that the Export-Import Bank of the United States (“EXIM”) has issued an export credit insurance policy to the
policyholder identified above and, in consideration of the payment, acceptance or negotiation of an irrevocable letter of credit in
support of an export or the financing of an export or the receipt of funding as a result of the export, either to us or another beneficiary
we, the U.S. exporter, hereby certify to EXIM and to the policyholder that the policyholder has (check one):
☐ informed us of an irrevocable letter of credit with Identification No. related to the transaction
described in Section A and we have presented, or shall present, documents which are in compliance with the terms and conditions
of such irrevocable letter of credit; or
☐ to our belief, established an obligation of the foreign buyer named in Section A to make repayment of funds on specified terms in
support of an export for which we or another beneficiary will receive payment or have received payment on ; or,
☐ to our belief, provided a financing facility to the foreign buyer named below in support of the export described in Section A which
has been made on a documentary collection, sight payment basis, the proceeds of which will be paid to us or another beneficiary.
Part A – Transaction, Products and Services and U.S. Content
1. The above referenced irrevocable letter or credit or the buyer’s obligation to pay the policyholder is in support of an export
transaction described as follows:
a. Buyer’s Name: ____________________________________________________
Address:
EXPORTER’S CERTIFICATE!
OMB 3048-0041
Expires: 02/28/2022
FOR USE WITH A SHORT TERM
EXPORT CREDIT INSURANCE POLICY!
EIB!94)07!
Revised 6/2018!
b. Description
and quantity
of product(s)/
service(s):
c. The product(s) are: ☐ New ☐ Used. If used, attach Used Equipment Questionnaire form EIB 11-03.
d. Place of Shipment: ______________________________________________ e. Date of Shipment: _______________________________________________
f. Contract Price to Buyer:
(i)
Products/Services
$
(ii)
Less discounts or similar allowances
$
(iii)
Plus total insurance, freight or other
delivery charges included in the transaction
$
Subtotal:
$
(iv)
Less cash payment, if any (not required)
$
(v)
Total final net delivered finance portion
$
2. (a) For SBA defined Small Businesses Only, certify to one of the following:
Each of the goods and/or services itemized in the invoice(s) was produced 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;
note: services are U.S. content if the U.S. exporter has Form I-9s on file for the personnel performing the services).
One or more of the goods and/or services itemized in the invoice(s) was produced with 50% or less 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;
note: services are U.S. content if the U.S. exporter has Form I-9s on file for the personnel performing the services) and I have
attached a list with Invoice #, Product Name and the dollar value of the U.S. Content % of each such product and/or service.
If a Content Report was submitted to the lender at the time of funding you may certify to one of the following:
The aggregate cost (comprised of all direct and indirect costs including but not limited to, labor, materials, research and
administrative costs, but excluding net profit; note: services are U.S. content if the U.S. exporter has Form I-9s on file for the
personnel performing the services) of all goods and/or services on one or more invoices is more than 50% U.S. content.
The aggregate cost (comprised of all direct and indirect costs including but not limited to, labor, materials, research and
administrative costs, but excluding net profit; note: services are U.S. content if the U.S. exporter has Form I-9s on file for the
personnel performing the services) of all goods and/or services on one or more invoices is 50% or less U.S. content. I have
attached a list with Invoice # and dollar value of the aggregate U.S. Content % of each such invoice.
(b) For Non-SBA Defined Small Businesses: Each of the goods and/or services itemized in the invoice(s) was produced in the
United States with more than 50% U.S. content (comprised of all direct costs including labor and materials, but excluding net
profit; note: services are U.S. content if the U.S. exporter has Form I-9s on file for the personnel performing the services); and
(c) If the products described above are commodities, all such commodities are exclusively of U.S. origin; and
(d) In each relevant case above, no value is added to the product by us after export from the U.S.
Part B – Certifications, Changes and EXIM Reliance
1.
Changes to Transaction, Products and Services and U.S. Content. With respect to Part A, if any of the certifications made therein
are discovered to be or become untrue, we will promptly notify the insured lender.
EXPORTER’S CERTIFICATE!
OMB 3048-0041
Expires: 02/28/2022
FOR USE WITH A SHORT TERM
EXPORT CREDIT INSURANCE POLICY!
2.
EXIM Reliance. The undersigned authorized officer, on our behalf, further certifies that the representations made and the facts
stated in this Exporter’s Certificate are true to the best of our knowledge and belief, and we have not misrepresented or
omitted any material facts. We understand that EXIM will rely on the certifications and
representations made in this
Exporter’s Certificate; we agree we are liable for any damages suffered by EXIM’s reliance. We also understand that these
certifications are subject to penalties for fraud and for providing false documentation, including, but not limited to, those penalties
provided for in Article 18 United States Code, Section 1001. We agree that presentation of invoices to an insured lender for
payment or disbursement under the EXIM Insurance is a confirmation and re-certification by us of the information and
certifications made herein. We agree to provide additional information with respect to any of the matters covered in this
Exporter’s Certificate upon EXIM’s reasonable written request.
3.
Certifications and Signature. Please refer to the Certifications and Covenants for Exporter’s Certificates for Use with A Short Term
Export Credit Insurance Policy (Part C) posted on EXIM’s website as document EIB 15-06. THE CERTIFICATIONS AND
COVENANTS FOR EXPORTER’S CERTIFICATES for use with A SHORT TERM EXPORT CREDIT INSURANCE POLICY ARE
INCORPORATED INTO THIS EXPORTER’S CERTIFICATE AS IF FULLY SET FORTH HEREIN. When signing this Exporter’s Certificate in
the space provided below, the undersigned authorized officer signing on our behalf certifies and represents that he or she is fully
authorized to sign on our behalf, and that HE OR SHE HAS READ the Certifications and Covenants for Exporter’s Certificates for Use
with A Short Term Export Credit Insurance Policy (Part C) referenced above AND IS CERTIFYING AND COVENANTING, as
appropriate, to all of the certifications, acknowledgements and covenants set forth in that document.
I, ____________________________, do hereby certify that I am the duly appointed and qualified _____________________________________________
of _______________________________ and that as such I am authorized to execute this Exporter’s Certificate on behalf of
__________________________________.
In witness whereof, I have hereunto signed my name this ______________________________ day of ________________________, ________________ .
Name of U.S. Exporter:
_______________________________________________________________________________________________________________________
By: ____________________________________________________________________________________________________________________ (Authorized Officer)
Name: ________________________________________________________________________________________________________________
Title: __________________________________________________________________________________________________________________
Tel. #: _____________________________________________________ Email: ___________________________________________________
If the U.S. exporter cannot make any or all of the required certifications as they are presented here, EXIM must be contacted to
request written permission to delete or alter the certification, without which the insurance policy may not be valid.
NOTICES
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 # 3048-0041, Washington, DC 20503.
EIB!94-07!
Revised 6/2018!
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Completed 26 January 2021

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