Short Term Express Insurance Application

• Legal Form Number: EIB10-02
• Issuer: Export-Import Bank of the United States
• Subject Matter: Insurance
• Section: Export-Import Bank of the United States

OMB No.: 3048-0031

04/30/2025

EIB 10-02 (Rev. 7/2021) Page 1 of 4

APPLICATION FOR EXPRESS INSURANCE

1. Primary reason for application:

How did you learn about EXIM?

*Exporter Legal Name: D&B#: Tradestyle:

Business Address: *Total Number of Employees:

*City: *State: *Zip + 4:

Country: Contact Person:

Position Title: Phone #:

E-mail:

*Primary Industry NAICS2:

Brokerage:

*Annual Sales Volume:

*Minority-owned business:

*Corporate Ownership:

Yes No

EXIM Regional Office Broker Bank U.S. Export Assistance Center

EXIM City/State Partner Other (describe):

risk mitigation financing extend more competitive terms

YES NO

YES NO YES NO

EXIM

SBA

2. Do you have a credit line with a financial institution (exclude overdraft protection and credit cards)

3. Do you have a SBA export Working Capital Loan or EXIM Working Capital Loan?

4. Average total of annual export credit sales over the last three years for you and your affiliates: $

5. Do you wish to insure export credit sales made by your affiliates? (If yes, please attach names/business addresses of each) YES NO

Does each affiliate invoice export credit sales in its own name or trade style?

YES NO

YES NO

Are the credit decisions of each affiliate centralized with this applicant? YES NO If ‘No,’ provide comment:

7. Are the products:

6. Product and/or services to be exported & NAICS (if known):

New Used

8. Do you sell Capital Goods to foreign manufacturers or producers? YES NO (if yes, attach explanation)

9. Are the Products to be covered under the policy:

Manufactured or reconditioned in the U.S.? YES NO All made or reconditioned with more than 50% U.S.

content?

(If no, attach explanation)

YES NO

Shipped from the U.S.? YES NO Used to support Nuclear Energy? YES NO

Sold to Military entities or Security Forces? YES NO On the U.S. Munitions List?

(part 121 of title 22 of the Code of Federal Regulations) YES NO

Environmentally Beneficial? YES NO Supporting Renewable Energy? YES NO

Are the products of each affiliate the same as the applicant's? If no, list them in question #6.

*Veteran-owned business: Yes No Decline to Answer

Yes No Decline to Answer

Items marked with an asterisk (*) are required fields. Under corporate ownership, provide name of ultimate parent company, if there is a corporate owner. For

number of employees and sales volume, aggregate for the company and all its affiliates1, including corporate owners and subsidiaries.

*Does the exporter have any affiliates?

1Affiliations exist when one individual or entity controls or has the power to control another or when a third party or parties control or have the power to control

both. Factors such as common ownership, common management, previous relationships with or ties to another entity, and contractual relationships may cause

affiliation. The complete definition of affiliation is found at 13 C.F.R. § 121.103.

2A company’s Primary Industry NAICS codes is the NAICS that accounts for the largest share of sales for the most recently completed fiscal year. The full

definition of “primary industry” is set forth at 13 C.F.R. § 121.107.

*Disability-owned business: Yes No Decline to Answer

Race (One or more boxes may be selected.):

American Indian or Alaska Native Asian

Black or African American Native Hawaiian or Pacific Islander

White Other

Ethnicity: Hispanic or Latino Not Hispanic or Latino

Yes No Decline to Answer

*Woman-owned business:

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