Application for Short Term Multi-Buyer Insurance Prepare and file this application ONLINE! at EXIM Online

• Legal Form Number: EIB92-50
• Issuer: Export-Import Bank of the United States
• Subject Matter: Insurance
• Section: Export-Import Bank of the United States

OMB No. 3048-0023

5/31/2028

APPLICATION FOR SHORT-TERM MULTI-BUYER

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)

Items marked with an asterisk (*) are required fields. Under corporate ownership, provide the name of the 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.

Exporter

*Exporter Legal Name: Tradestyle Name:

*Business Address: *City *State: *Zip + 4:

Country:

Contact Person: Title: Phone #:

E-mail: Fax:

*DUNS #: *UEI #: *Primary Industry NAICS1:

*Annual Sales Volume: $ *Total Number of Employees:

*Does the Exporter have any affiliates2?

Yes No

*Is there corporate ownership?:

Yes No

Name of ultimate parent company:

*Woman-owned Business: Yes No

*Minority-owned Business: Yes No

Asian

White

Hispanic or Latino

*Veteran-owend Business: Yes No

Decline to answer

Middle Eastern or North African

*Disabiity-owned Business: Yes No

1A 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

13C.F.R. § 121.107.

2Affiliations 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.

Brokerage:

General Questions

EXIM Regional Office Broker U.S. Export Assistance Center

Bank EXIM REPP

1. How did you learn about EXIM?

Other (explain):

Risk Mitigation Financing Extend more competitive terms

2. Primary reason for application:

Political Only

Comprehensive (Commercial & Political)

3. Coverage Type Requested:

No

Yes

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

5.

Do you have an (a) SBA Working Capital Loan? Yes Yes No

No (b) EXIM Working Capital Loan?

6. Do you wish to insure export credit sales made by your affiliates? Yes No

(If yes, please refer to “additional named insured” eligibility criteria on page 3 under Special Coverages. Answers to all remaining questions must include

eligible affiliates you wish to add)

Products

1. Products and/or services to be exporter:

2. Products NAICS code (if known):

Note: Your buyers, their guarantors (if any), and end users of the products must be in countries where EXIM is able to provide support, see EXIM's Country Limitation Schedule (CLS) at

http://www.exim.gov. There may not be trade measures or sanctions against the good produced with the

U.S. export under Section 201 of the Trade Act of 1974. For a list of products and countries with Anti-Duping or Countervailing Duty sanctions, see section AD/CVD Orders available at

http://www.usitc.gov/trade_remedy/731_ad_701_cvd/investigations/active/index.htm. Trade sanctions are product and country specific (i.e., all firms within a country are subject to the

EIB-92-50 (Rev. 7/2024) Page 1 of 6

P R I N T

American Indian or Alaska Native

Native Hawaiian or Pacific Islander

Race and/or Ethnicity (Select all that apply):

Black or African American

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