Short Term Financial Institution Buyer Credit Insurance Application

• Legal Form Number: EIB92-41
• Issuer: Export-Import Bank of the United States
• Subject Matter: Insurance
• Section: Export-Import Bank of the United States

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OMB No. 3048-0019

Expires 05/31/2028

APPLICATION FOR FINANCIAL INSTITUTION BUYER CREDIT

SHORT-TERM EXPORT CREDIT INSURANCE POLICY

An online version of this application is available on EXIM’s web site. EXIM encourages customers to apply online,

to 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, 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 scan of the original application and all required documents.

(Fax number: 202.565.3380, E-mail: exim.applications@exim.gov)

APPLICATION FORM

Under corporate ownership, provide name of ultimate parent company, if there is a corporate owner.

Applicant/Lender

The applicant is the Financial Institution that extends the EXIM-insured loan to the Buyer. If your Financial

Institution is new to the FIBC program, please refer to the Short-Term Credit Standards for how to qualify as an

FIBC-insured Lender.

Woman-owned business:

Minority-owned business:

Veteran-owned business:

Disability-owned business:

Yes

Yes

Yes

1. GENERAL QUESTIONS

A. Coverage Types Requested

Risk coverage

Comprehensive Risk (political and commercial risk)

Political Risk (political risk only)

Is this a resubmission of an application that was previously deemed incomplete, was withdrawn for

other reasons, or are you requesting renewal for another policy?

Yes – please indicate previous transaction number:

B. Primary Reason for applying for this policy

Extend more competitive terms

Page 1 of 7

No

No

No

No

Race and/or Ethnicity (Select all that apply)

White Decline to Answer

Native Hawaiian or Pacific islander

Applicant's Legal Name DUNS #

Contact Person:Title Email

Business Address: City: State/Province:

Postal Code: Country: Phone: Fax:

UEI Number:

Primary Industry NAICS Code: Does the Applicant have any affiliates?:

Is there corporate ownership?:

Annual Sales Volume ($)

YesYes

No

Yes

Yes No

Name of the ultimate parent company:

Decline to answer

Decline to answer

Decline to answer

Decline to answer

No

Risk Mitigation

EIB 92-41 (Rev. 6/24)

Financing

American Indian or Alaska Native Hispanic or Latino

Middle Eastern or North African

Asian Black or African American

Number of Employees

Brokerage

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