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 01/31/2025

APPLICATION FOR FINANCIAL INSTITUTION

SHORT-TERM, SINGLE-BUYER INSURANCE

This application is to be completed by a Financial Institution (or a Broker acting on its behalf) in order to obtain a

Short-Term Insurance Policy covering transactions to a foreign Buyer. Repayment terms can be up to 360 days.

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.

Applicant Legal Name: DUNS#:

Contact Person: Position Title: _____________________ E-mail:

Business Address: ____________________________________ City: _____________________ State/Province:

Postal Code: _____________________ Country: ________________Phone: _____________________Fax:

Broker

Name of Brokerage:

Contact Person:

E-mail:

Phone number: Fax:

Woman-owned business:

Minority-owned business:

Veteran-owned business:

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Yes

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Yes

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Yes

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No



No



No

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Decline to answer

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Decline to answer

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Decline to answer

1. GENERAL QUESTIONS

A. Coverage Types Requested

Risk coverage

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Comprehensive Risk (political and commercial risk)

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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?

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Yes – please indicate previous transaction number:

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No

B. Primary Reason for applying for this policy

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Risk Mitigation

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Financing

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Extend more competitive terms

EIB 92-41 (Rev. 7/2021)

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