Assignment Form - Short Term Multi-Buyer Insurance Policy

• Legal Form Number: EIB 92-31
• Issuer: Export-Import Bank of the United States
• Subject Matter: Insurance
• Section: Export-Import Bank of the United States

Export

-

Import Bank of the United

States

Notification by Insured of Amounts Payable

under

Multi-Buyer Export Credit Insurance Policy

Date:

A.General Information

Policy

No.

Insured:

Assignee:

B. Notification

The Insured hereby notifies the Export-Import Bank of the United States (EXIM Bank) that, in accordance with

the information contained herein, it has assigned its interest to claim payment(s) which may become due under

the Policy.

This Assignment relates to:

1. All transactions covered by the Policy:

2.

All

transactions

with

buy

e

rs

in

th

e

following

coun

tries:

3.

All

transactions

with

the

following

buyers:

4. The following specific transaction(s): (Use additional sheets if necessary).

Country Buyer

Contract Price of

Sale

or

Gross

Invoice Value of

Shipment

Invoice

Date or

Number

Date

Reported on

Monthly

Report Form

5. Other. If this No. 5 is checked, the Insured and the Assignee agree that:

C. Conditions of Notification

1. The Assignee agrees that:

EIB-92-31

Revised 11/22 Page 1 of 2

(b) in the event EXIM Bank approves the Insured's claim for payment, a wire transfer will be made to an

assignee designated by the insured on the "Notice of Claim and Proof of Loss".

(a) there may be multiple assignments made to various assignees under this policy and EXIM Bank does not

determine which assignee, if any, may have an interest in any particular claim payment; and

(a) this notification is not an assignment of the Policy, does not give the Assignee any right to file a claim or

sue under the referenced Policy, and does not create any duty or obligation to the Assignee except as set forth

in subparagraph 2 below;