Disclosure of Lobbying Activities

• Legal Form Number: LLL
• Issuer: Export-Import Bank of the United States
• Subject Matter: Guarantee, Insurance, Loan, Working Capital
• Section: Export-Import Bank of the United States

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046

(See reverse for public burden disclosure.)

1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:

a. contract a. bid/offer/application a. initial filing

b. grant b. initial award b. material change

c. cooperative agreement c. post-award For Material Change Only:

d. loan year _________ quarter _________

e. loan guarantee date of last report ______________

f. loan insurance

4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name

and Address of Prime:

Tier ______,

if known

:

Congressional District,

if known

: Congressional District,

if known

:

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number,

if applicable

: _____________

8. Federal Action Number,

if known

: 9. Award Amount,

if known

:

$

10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (

including address if

(

if individual, last name, first name, MI

):

different from No. 10a

)

(

last name, first name, MI

):

11. Signature:

Print Name:

Title:

Telephone No.: _______________________

Authorized for Local Reproduction

Standard Form LLL (Rev. 7-97)

Information requested through this form is authorized by title 31 U.S.C. section

1352. This disclosure of lobbying activities is a material representation of fact

upon which reliance was placed by the tier above when this transaction was made

or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This

information will be available for public inspection.

required disclosure shall be subject to a

not more than $100,000 for each such failure.

Prime Subawardee

Federal Use Only:

Date:

who fails to file the Any person $10,000 and than civil penalty of not less

4c

PRINT