Form EIB 92-64 EIB 92-64 Application for Exporter Short Term Single Buyer Insuran

APPLICATION FOR EXPORTER SHORT-TERM SINGLE-BUYER
EXPORT CREDIT INSURANCE POLICY

OMB No. 3048-0018
PENDING 2024

PRINT FORM
This application is to be completed by an exporter in order to obtain a short-term insurance policy covering sales to a single
foreign buyer. Repayment terms can be up to 360 days.
An online version of this application is available on EXIM’s web site. EXIM encourages customers to apply on line to facilitate our
review and provide customers a faster response time. Additional information on how to apply for EXIM insurance can be found
on EXIM’s web www.exim.gov IMPORTANT: The Guarantor, Buyer and End User must be foreign entities in countries for which
EXIM is able to provide support. See EXIM's Country Limitation Schedule. Check the EXIM Convicted Parties List to determine if
there are any prohibitions or restrictions on your ability to insure a transaction.
Send this completed application to EXIM, 811 Vermont Ave., NW, Washington, D.C. 20571. EXIM will also accept emailed PDF and
faxed applications. EXIM will not require the originals of these applications to be mailed. The application must be a PDF scan of
the original application and all required documents. (Fax number 202.565.3380, Email exim.applications@exim.gov)

APPLICATION FORM
Under corporate ownership, provide name of ultimate parent company, if there is a corporate owner. For number of employees
and sales volume, aggregate the information for the company and all its affiliates1 including corporate owners and subsidiaries.

Applicant/Exporter Legal Name:
Tradestyle Name:
UEI #:

DUNS #:
Business Address:
City:

State:

Zip+4
Yes

Country:

No
Is there is corporate ownership of Applicant:
Name of ultimate parent company:
Does the Applicant have any affiliates:
Yes No Applicants primary industry NAICS2 code:
Total Number of Employees (for Applicant and any affiliated companies):
Annual Sales Volume (for Applicant and any affiliated companies):
Contact Person:
Position/Title:
Phone:

Email:
Woman-owned business:
Minority-owned business:
Veteran-owned businss:
Disability-owned business:

Fax:

Yes

No

Decline to answer

Yes
Yes
Yes

No
No
No

Decline to answer
Decline to answer
Decline to answer

Race and/or Ethnicity (Select all that apply):
American Indian or Alaska native
Asian

Hispanic or Latino
Black or African American
Middle Eastern or North African
Native Hawaiian or Pacific Islander White
Decline to answer

Brokerage:
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.

EIB 92-64 (Rev. 9/2024)

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OMB No. 3048-0018
PENDING 2024

1. GENERAL QUESTIONS
A. Type of Coverage Requested
Comprehensive Risk (Political Risk and Commercial)

Political Risk Only

B. Qualification for Coverage
Will the Applicant have title to the products at the time they are shipped?
Will the Applicant directly invoice the Buyer?

 Yes
 Yes

No
No

If you answered No to either, you may not be eligible for coverage. Call EXIM or your broker for assistance.
C. Indicate whether the sale represents a:
Confirmed Order

Sale in negotiation

Response to a bid

D. Primary Reason for applying for this policy
Risk mitigation
Financing
Extend more competitive terms
E.

Is this a resubmission of a previously withdraw, returned or denied application, or a renewal
policy for the same Buyer or a related entity?
Yes. If Yes, indicate the previous transaction number:
No

2. PARTICIPANTS
Provide information on the additional participants to the transaction.
Buyer
The Buyer is the entity that contracts with the Exporter for the purchase of U.S. goods and services.
Buyer's Legal Name:
Position Title:
Business Address:
Postal Code:

Country:

Contact Person:
E-mail:
City:
Phone:

State/Province:
Fax:

Supplier (if different than the Exporter above)
The Supplier is the U.S. company that manufactures the goods and services to be exported.
Supplier's Legal Name:
Position Title:
Business Address:
Postal Code:

EIB 92-64 (Rev. 9/2024)

Contact Person:
E-mail:
City:
Country:

Phone:

State/Province:
Fax:

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Guarantor(s) (if applicable)
The Guarantor is the person or entity that agrees to repay the credit if the Buyer does not. Refer to the EXIM
Short- Term Credit Standards to determine in what circumstances personal or corporate Guarantors are
required.


Is a Guarantor(s) involved in this transaction?
Yes
No
If Yes, is the Guarantor:
an individual
a company?
Guarantor’s Legal Name:
Contact Person:
Position Title:
E-mail:
Business Address:
City:
State/Province:
Postal Code:
Country:
Phone:
Fax:
End-User (if different than Buyer and if already known)
The End-User is the foreign entity that uses the U.S. goods and services.
Check if the End-User is also the Buyer.
End-User's Legal Name:
Contact Person:
Position Title:
E-mail:
Business Address:
City:
Postal Code:
Country:
Phone:

State/Province:

Fax:

Agent (not insurance Broker)
An Agent is a business entity or individual 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 which will receive compensation in
some form for their services.
Is an Agent involved in the transaction?
Yes
No
If Yes, add the agent information below:

Agent's Legal Name:
Position Title:
Business Address:
Postal Code:

Contact Person:
E-mail:
City:
Phone:

Country:


State/Province:
Fax:

Related Parties
Describe any direct or indirect ownership or family relationship that exists between any of the participants.
If none, so indicate:
None

Primary Source of Repayment (PSOR)
The PSOR is the entity whose financial statements or credit information form the basis of EXIM’s evaluation of
reasonable assurance of repayment, i.e. the entity whose financial statements EXIM uses to supply calculate the
ratios for Short-Term Credit Standards compliance. For this transaction, indicate whether the PSOR is:
the Buyer
a corporate guarantor, or
a business combination, (e.g. the consolidated or combined financial statements of the Buyer and one or
corporate guarantors
Indicate which entities comprise the combination:
Is the PSOR:

Sovereign

Public Non-Sovereign

Is the PSOR a financial institution?
Does the PSOR have a market rating?

Yes
Yes

Private

No
No


If Yes, indicate the name of the rating agency, rating,
and the date of the rating:


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OMB No. 3048-0018
PENDING 2024

3. TRANSACTION DESCRIPTION AND ELIGIBILITY
Provide a description of the products or services, including their NAICS codes.
1.
2.
3.
4.
5.
6.
7.
8.

Are these products manufactured or reconditioned in the U.S.?
Are these products shipped from the U.S.?
Are these products on the Munitions Control list?
Are these products sold to military entities or security forces?
Are these products used to support nuclear energy?
Are the products used?
Are the products new?
Are the products capital goods that will be used to produce exportable products?

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No
No
No

(PLEASE NOTE THAT YOU MAY ANSWER “YES” TO EITHER OR BOTH (b) AND (c) BELOW)
9. (a) For SBA Defined Small Business Only: Was each of the products 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) with no value added after shipment?
Yes
No
(b) If the answer to 8(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 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
(c) If the answer to 8(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
No
shipment. Please indicate if you are seeking coverage on an aggregated basis.
Yes
(d) For Non-SBA Defined Small Business: 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,
Yes
No
but excluding net profit), with no value added after shipment?
10. Do these products or their use meet EXIM’s requirements for an environmentally beneficial
Yes
determination? If Yes, provide an explanation:

11. Do these products or their use meet EXIM's requirements for a renewable energy
determination? If Yes, provide an explanantion.

Yes

No

No

12. Will any value be added to the product after export from the U.S. prior to delivery to the Buyer?
If Yes, provide an explanation:
No
Yes

13. Has the transaction been considered by any other export credit insurer?
If yes, provide an explanation:

EIB 92-64 (Rev. 9/2024)

Yes

No

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4. FINANCED AMOUNTS AND STRUCTURE
Enter the percentages for each payment term the exporter will extend to the Buyer:
Payment terms requested

(No. of days - Please check applicable box)
Sight

PAYMENT TYPE
Open Account

1-30

31-60

61-90 91-120 121-180 181-270 271-360

NA

Cash Against Documents (CAD)
Promissory Note
Sight Draft Documents Against Acceptance (SDDA)
Sight Draft Documents Against Payment (SDDP)
Unconfirmed Irrevocable Letter of Credit (UILC)

Number of shipments:

Single

Multiple under one sales contract

Expected date(s) of shipment:
Estimated shipment volume to be insured:
If multiple shipments, expected highest amount outstanding during the shipment period:
Other security available:

None

Standby LC

Personal Guarantee(s)

Receivables

Inventory

Corporate Guarantee(s)

Real Property

Cash

Other:

Amount ready to ship:

5. Credit Information Requirements
Directions: The required credit information depends on whether the Primary Source of Repayment (PSOR)
is the Buyer or Corporate Guarantor, or a Financial Institution Guarantor, and on the amount of credit
support requested.
Provide details of the Exporter's experience with the Buyer:
Does the Exporter have any experience selling to the Buyer?
If Yes, provide the following information:
Date of first sale to the Buyer:
Date of first credit sale to the Buyer:

EIB 92-64 (Rev. 9/2024)

Yes

No

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Enter the credit experience information below:
Current Year
MM/YYYY to MM/YYYY
to

Yearly Credit Experience

Prior Year 1
MM/YYYY to MM/YYYY

Prior Year 2
MM/YYYY to MM/YYYY

to

to

Total Amount Sold
Total Amount Sold on Credit
Highest Amount Outstanding
for which Exporter has been
Paid
Payment Terms - Transaction
Type. (Choose from: Open
Account; Cash Against
Documents; Unconfirmed
Irrevocable LC; Promissory
Note; Documents Against

Acceptance; Documents Against
Payment)



Payment Terms - Term Length/
Tenor. (Choose from: Sight
Payment; 1-30 days; 31-60 days;
61-90 days; 91-120 days;
121-180 days; 181-270 days;
271-360 days)

Amount now owing: $
Payment History:











Prompt

30 days slow

31-60 days slow



61-90 days slow

90+days slow

No experience

Is there an amount past due?

Yes

No

If yes, enter amount due and due dates:
Provide reasons for past-dues:
If past-dues were caused by foreign exchange problems, does applicant have evidence of local currency
deposits on all payments?
Yes
No
Please refer to the Short-Term Credit Standards found on our website to determine what information
is required in your application based on the dollar amount requested.

6. Special Coverages (select if applicable)
Insure Sales by Affiliates (Additional Named Insured): Export credit sales of the applicant’s verified
subsidiaries, affiliates, or tradestyles are eligible for addition under a policy. “ANI’s” must invoice export
credit sales in their own name. Policyholders and their approved ANI’s have equal policy rights and
requirements. However, policy and buyer coverage limits are not duplicative. Any claim payments are
made only to the policyholder. EXIM may require additional financial, credit or credit procedures
information to assess insurance risk when qualifying ANIs. The “Additional Named Insured Endorsement”
formally documents ANI additions.
Does each affiliate invoice export credit sales in its own name or tradestyle?
Are the credit decisions of each affiliate centralized with this applicant?
If No, please comment:

Yes
Yes

No
No

Are the products of each affiliate the same as the Applicant's products described in Question
1.D. on page 2?
Yes No
If No, please list the affiliate's products in Question 1.D.
EIB 92-64 (Rev. 9/2024)

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Provide the following information about the Additional Named Insured. Continue on an attachment for
multiple affiliate ANIs.

Legal Name:
Business Address:
City:

State:

Country:

Nine Digit Zip/Postal Code:

Relationship to Applicant:
Role in the transaction:
Contact person:
Email:
Services (please attach a copy of your sample services contract). Export credit sales of services and
charges for materials and equipment necessary to render services are eligible for addition under the policy.
The sale of services and related charges must be set forth in a written contract of sale between the
policyholder and buyer with invoiced billings to be made no later than 30 days following the month the
services were performed.
Services must be performed by the policyholder’s (or its ANIs) personnel headquartered in the U.S. or those
headquartered in the U.S. but temporarily assigned in the buyer’s country. Services coverage does not include
cancellation of the written contract of sale, any services that were not performed, charges relating to use of
foreign made equipment, or confiscation of the policyholder’s (or ANIs) U.S. or foreign equipment by any party.
The “Services Endorsement” formally documents the addition of services under the policy. A Services
Endorsement is not required for product sales whose invoices build-in nominal ancillary services.
Overseas Warehouse
Export credit insurance is available for sales to foreign buyers from your overseas warehouse(s) used to
store inventory. The warehouse must be bonded and either owned or controlled by the policyholder
through either its agent, branch, subsidiary or itself. The policyholder is required to retain title to the
warehoused products. For most products, the sale out of the warehouse must occur no later than 180 days
from the date of shipment from the U.S.
The Warehouse Endorsement does not provide any property or casualty coverage on the products while
they are in the warehouse. Specific political risk-only coverage can be purchased for the warehousing
period if you also elect to add the Consignment Endorsement coverage. This additional coverage protects
against the following events which prevent you from fulfilling a foreign buyer’s purchase order:
-Buyer cannot import the products into its country due to the imposition of a law or cancellation/nonrenewal of a license;
-War, insurrection or a government’s confiscation or other arbitrary action against the buyer’s (or
guarantor’s) business;
-Imposition of any law or regulation preventing the export of the products from the country in which the
products are held in consignment.
-Please provide the following information:
Neither
Owned or controlled by the Applicant
Bonded
(a) Select the warehouse type:
If Neither, please explain:
(b) Warehouse location: Country:
City:
State/Province:
Pre-Shipment
Provide details of the coverage requested, including the reason why pre-shipment coverage is requested:

Indicate the date the contract was executed or the anticipated date of signing:
Indicate the estimated period between the contract date and the final shipment date:
EIB 92-64 (Rev. 9/2024)

(Years)

(Months)
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Provide a schedule of progress payments made or to be made by the Buyer during the pre-shipment
None
period, or indicate "None"

Foreign Currency
Identify the country and currency you wish to be insured:
Bulk Agriculture
Delivery to the Buyer in the U.S.
China and Transformational Export Program (CTEP)
To determine if your transaction is eligible for Sec. 402 consideration, the answer to at least one of the
following two questions must be "Yes":
Is your transaction facing competition from an entity backed by the People's Republic
of China (PRC) - Section 402(A)?
Is your transaction one of the ten Transformational Export Areas or a related service
- Section 402(B)?

Yes
Yes

No
No

At least one Transformational Export Area value must be selected in the table below if you have responded
"Yes" to the 402(B) question immediately above.

Transformation
al Export Areas

Export Value

The value of the export
largely consists of
technology used to...

Buyer End
Use
The foreign
buyer will use
the exports to...

Justification

Artificial intelligence

...make the best decision given changing
circumstances using computerized system,
without direct human input or intervention

Biotechnology

...use biological processes for industrial
and other purposes

Biomedical Sciences

..diagnose and/or treat medical conditions
in humans with advanced medical
equipment and processes

Wireless communications
equipment

...distribute information by means of digital
electromagnetic transmission without the
need for wires, optical fibers, or
othersynthesized materials

Quantum computing

...facilitate the implementation and use of
quantum computers (application of qubit
superposition processing)

Renewable energy, energy
efficiency, energy storage
1. Renewable energy
EIB 92-64 (Rev. 9/2024)

...generate or use of energy produced
from a naturally renewable source
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2. Energy efficiency

...reduce energy loss or consumption in a
system or application

3. Energy storage

...store energy with a capacity of 1kWh

Semiconductor and
semiconductor
manufacturing

...make use of semiconductors or the U.S.
semiconductor industry

Emerging financial
technologies

...improve or automate the delivery and
use of financial services

Water treatment and
sanitation

...produce or distribute potable water
for human consumption, or collect and/
or treat wastewater, regardless of origin

High-performance
computing

...process more than 500 terabytes/day or
exceed a speed of 500 teraflops/second

Does this transaction require flexibilities to move forward? If yes, please provide a brief description below and your
request will be reviewed by EXIM's DTEP division. If necessary, you can directly contact the CTEP team by sending
an email to CTEP@exim.gov

7. Comments (please provide any additional comments)

EIB 92-64 (Rev. 9/2024)

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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
(Title)

of

and that as such I am authorized to execute this application
(Name of Applicant)

on behalf of

.
(Name of Applicant)

In witness whereof, I have hereunto signed my name this

day of __

__

. 20

.

Signature

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 1.5 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# 3048-0018 Washington,
D.C. 20503.

EIB 92-64 (Rev. 9/2024)

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