Short Term Bank Letter of Credit Insurance Application Prepare and file this application ONLINE! at EXIM Online

• Legal Form Number: EIB92-34
• Issuer: Export-Import Bank of the United States
• Subject Matter: Insurance
• Section: Export-Import Bank of the United States

OMB No.

3048-0009

01/31/2029

APPLICATION FOR SHORT-TERM LETTER OF CREDIT

EXPORT CREDIT INSURANCE POLICY

Application Number (For EXIM Use Only):

This application is to be completed by a financial institution (or a broker acting on its behalf) in order to obtain a short-term letter

of credit insurance policy. An online version of this application is available on EXIM web site. EXIM encourages customers to

apply online, as it will facilitate our review and allow customers a faster response time. Additional information on how to apply for

EXIM insurance can be found at EXIM's web site, www.exim.gov

Send this completed application to EXIM at 811 Vermont Ave NW, Washington, D.C. 20571. EXIM will also accept e-mailed pdf

and faxed applications. EXIM will not require the originals of these applications to be mailed. The application must be PDF scans

of original applications and all required attachments. (Fax # 202.565.3380, e-mail exim.applications@exim.gov)

APPLICANT (items marked with an asterisk (*) are required

*

Applicant Name:

*Phone#:

Fax#:

*E-mail:

Contact Person:

Position Title:

*DUNS #:

*U

EI #:

*NAICS

Code:

*Street Address:

*City:

*State:

*Zip Code:

*Country:

Website:

Does the Applicant have a market rating? Yes No

If yes, indicate the name of the rating agency, rating, type of rating, outlook, and the date of the rating.

Please provide the

following information from the applicant's most recent audited financial statements.

Are the financial statements combined or consolidated? Statement Period (fiscal):

Financial Statement Dates:

Yes No

Do the Statement Dates above apply to both the Balance Sheet and Income Statement?

Yes No

Did auditor provide a qualifying opinion?

Auditor:

Net Income:

Total Assets:

Minority Owned?

Woman Owned?

Veteran Owned?

Disability-Owned?

EIB92-34

Revised 06/2025

Opinion:

Net Loans:

Equity:

Yes No

Decline to Answer

Yes No

Decline to Answer

Yes No Decline to Answer

Yes No Decline to Answer

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