Assignment by Insured to Financial Institution of a Medium-Term Policy

• Legal Form Number: EIB 94-08
• Issuer: Export-Import Bank of the United States
• Section: Export-Import Bank of the United States

EIB-94-08

Revised 5/12Page 1 of 2

EXPORT-IMPORTBANK

of theUNITEDSTATES

NOTIFICATION AND ASSIGNMENT

BY INSURED TO FINANCIAL INSTITUTION

OF MEDIUM TERM EXPORT CREDIT INSURANCEPOLICY

Date: _______________________

The undersigned Insured, subject to the provisions of this Notification and Assignment, hereby assigns Policy Number _______________

(hereafter, the "Policy") to the financial institution named below (hereafter "Assignee") and hereby notifies the Export-Import Bank of the

United States (Ex-Im Bank) of such Assignment.

This Notification and Assignment relates to all transactions covered by the Policy.

This Notification and Assignment is subject to the conditions set forth on the back of this form, and execution by the Assignee and Insured

constitute their acceptance of these conditions.

_________________________________________ _________________________________________

Name of Assignee Name of Insured (as specified in the Declarations)

_________________________________________ __________________________________________

Assignee Address Insured Address

_________________________________________ __________________________________________

Name (Print of Type) Name (Print of Type)

_________________________ _______________ _________________________ _______________

Title and Date Signed Title and Date Signed

Please list us in the Ex-Im Bank Lender Referral List as a potential assignee using the following name and telephone #:

__________________________________ __________________

The above notification is hereby acknowledged for Export-Import Bank of the United States

By: _______________________________________ _______________________________ Date: _________________

Name of Broker if any:

Broker No:

PLEASE SUBMIT FOUR SIGNED ORIGINALS

EXECUTED ORIGINALS WILL BE PROVIDED TO THE ASSIGNEE, INSURED, AND BROKER.

WHO TO CONTACT

Please send or ask your insurance agent or broker to submit this completed form to:

EXPORT-IMPORT BANK OF THE U.S. TRADE FINANCE DIVISION

811 VERMONT AVE, NW, WASHINGTON, DC 20571

Tel (202) 565-3400 or 1-800-565-EXIM, Fax (202) 565-3684, Internet http://www.exim.gov

Signature of Officer Signature of Officer

(Printed Name and Title)

Last Page | >

Next Page

Previous Page

< | First Page

Print Form