Medium-Term Insurance or Guarantee

• Legal Form Number: EIB03-02
• Issuer: Export-Import Bank of the United States
• Subject Matter: Guarantee, Insurance
• Section: Export-Import Bank of the United States

OMB 3048-0014

Expires 10/31/2025

EIB 03-02 (Rev. 5/2022)

Page 1 of 11

This application is to be used for insur ance and guarantee transactions, including Domestic Financing, with financed

amounts of $25 million or less (ex cluding financed exposure fee/premium) an d repayment terms between twelve mont hs

and seven years. An online version of this a pplication is available on EXIM’s website. EXIM encourages customers to

apply on-line, as it will facilitate our review and allow customers a faster respons e time. If you are requesting a medium-

term direct loan, please email a completed application to exim.applications@exim.gov. Please note that

applications must be a signed and dated PDF and include all required application attachments.

Please note that if your financing reques t is between $20 and $25 million or a direct loan for any amount,

excluding exposure fee, the transactio n will be subject to U.S. flag shippin g requirements. For more informati on,

visit EXIM’s website: https://www.exim.gov/policies/us -flag-shipping-requirements.

FINANCING

TYPE REQUESTED

Product

☐

Loan Guarantee

☐

Sovereign

☐

Public Non-sovereign

☐

Private Sector

MGA No. (if known): ____________________

☐

Finance Lease Guarantee

☐

Sovereign

☐

Public Non-sovereign

☐

Private Sector

☐

Direct

Loan

☐

Sovereign

☐

Public Non-sovereign

☐

Private Sector

☐

Insurance

☐

Sovereign

☐

Public Non-sovereign

☐

Private Sector

Coverage Type

☐

Comprehensive Risk

☐

Political Risk

Conversion of a Preliminary Commitment or a Letter of Interest

☐

No

☐

Yes The EXIM reference number is :

Resubmission

☐ Check if this is a resubmission of an app lication that was previously deemed incomplete or

was withdrawn for other r easons. The EXIM reference nu mber is: _____________

Renewal

☐

MTR (Medium-Term Repetitive Insurance Policy)

PARTICIPANTS:

Items marked with an asterisk (*) are required fields. Under corpor ate ownership, provide the name of the ultimate

parent company, if there is a corporate owner. For nu mber of employees and sales volum e, aggregate for the company

and all its affiliates, including corpor ate owners and subsidiaries.

Applicant: The applicant may be any exporter, fina ncial institution, supplier, the primary borrower, buyer or

controlling sponsor associated with the transaction. ☐ Check if the applicant has been as sisted by a city or state

export agency and provide the name of t he agency: ____________________ ______________________________

*Applicant Name: ___________________ ____________________________ ______________________________ __

Tradestyle: ________________________ ____________________________ _________________________ _______

*Business Address: _______________ _________________________________ ___________________________ __

*City: _______________________ *State: ___ __________ *Zip/Postal Code: __ _______ *Country: ____________

Contact Person: __________________ _______________ Position Tit le: ____________________________ ____

Phone: ___________________________ _____________ Email: ________ ______________________________

Duns No. ___________________ UEI N o.1 __________________ Taxpayer ID N o. ________________

1A Unique Entity Identifier (UEI) No. is a 12-character unique number assigned to all entities (public and private companies, individuals, institutions or

organizations) who must register in SAM.gov to do business with the federal government. If your entity is registered in SAM.gov, your UEI has already

been assigned and is viewable in SAM.gov. If you do not have a UEI No., then you must register your entity. Visit https://sam.gov/content/home to see

if your entity has a UEI No. or to register your entity. A UEI No. is required for the Applicant at time of application and is also required for the Borrower

and Lender(s). [NOTE: As the UEI No. process becomes fully clarified, EXIM’s instructions will be updated accordingly and more information will be

added to assist an Applicant and any other affected transactional parties with this process, but it was not ready prior to submission for OMB rev iew.]

Export-Import

Bank of the

United States

APPLICATION FOR

MEDIUM-TERM

INSURANCE, DIRECT

LOAN OR GUARANTEE