Report of Overdue Accounts under Short-Term Policies

• Legal Form Number: EIB 92-27
• Issuer: Export-Import Bank of the United States
• Subject Matter: Insurance
• Section: Export-Import Bank of the United States

EXPORT-IMPORT BANK-REPORT OF OVERDUE ACCOUNTS UNDER SHORT TERM POLICIES

(please type or print all information)

POLICY NUMBER :( ) - Report for period: _______________________ _________

(Prefix) (Number) (Month) (Year)

POLICYHOLDER:___________________________________

Contact:_________________________________

Tel:________________ Fax: ________________

E-mail:_______________

BROKER:________________________________

Date Received

EXIM use only

OVERDUE REASON

Cash Flow / Commercial Problems*

Foreign Exchange Problems (local payment made)

Insolvency*

Dispute* (Product; terms; documents; etc.)

Slow Pay Typical

Natural Disaster

Buyer Re-Organizing

Other*

*Please attach detailed explanation of the overdue item and prospect for recovery

We hereby certify that this report is a true and complete statement as required by the policy, that we have read the additional notes and instructions on the reverse side and that we understand this form to the pertinent conditions of the

policy.

Name of Preparer: ________________________________________ Phone: ( ) _________-_____________________

Signature: _______________________________________________ Date Prepared: __________________________, _____ Page No.____ of ____ pages

(Month) (Day) (Year)

OMB 3048-0027

01/31/2025

EIB 92-27

Revised 11/10

Item Buyer Name COUNTRY Actual Payment

Terms

EOL Shipment

Confirmation #

Shipment

Date

EOL Shipment

Report Date Due Date SHIPMENT

AMOUNT

OVERDUE

AMOUNT REASON

1

2

3

4

5

6

7

8

PAGE TOTALS

complete only on last page ----> REPORT TOTALS

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