Short Term Multi-Buyer/Multi-Buyer Select Risk Insurance Application

• 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

01/31/2025

EIB-92-50 (Rev. 7/2021)

Page 1 of 5

APPLICATION

FOR SHORT-TERM MULTI-BUYER

EXPORT CREDIT INSURANCE POLICY

Brokerage:

How did you learn about EXIM? EXIM Regional Office Broker Bank U.S. Export Assistance Center

EXIM City/State Partner Other (describe):

risk mitigation financing extend more competitive terms

NO

YES

SBA YES NO EXIM YES NO

$

No

Yes

1. Primary reason for application:

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

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

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

6. Do you wish to insure export credit sales made by your affiliates?

(If yes, please refer to “additional named insured” eligibility criteria in question # 26. Answers to all remaining questions must include eligible

affiliates you wish to add.)

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

9. (a) For SBA defined Small Businesses Only: Was each of the products to be covered under the policy

manufactured or reconditioned with more than 50% U.S. content (comprised of all direct and indirect costs

including but not limited to, labor, materials, research and administrative costs, but excluding net profit)?

YES NO

(b) If the answer to 9(a) is “No” because one or more of your products contains less than 50% U.S. content

then coverage is available for the U.S. content only in each product with less than 50% U.S. content.

Please indicate if you are seeking coverage for products with less than 50% U.S. content.

YES NO

(c) If the answer to 9(a) is “No” you may also obtain coverage on an aggregated basis for all products on an

invoice, provided that a Content Report is submitted at the time of shipment (please see applicable Fact

Sheet for information on aggregation). Please indicate if you are seeking coverage on an aggregated basis.

YES NO

* PLEASE NOTE THAT YOU MAY ANSWER “YES” TO EITHER OR BOTH (b) AND (c) ABOVE.

(d)

For Non-SBA Defined Small Businesses: Was each of the products to be covered under the policy

manufactured or reconditioned with more than 50% U.S. content (labor, materials and direct overhead, but

excluding net profit)?

YES NO

10. Do you sell Capital Goods to foreign manufacturers or producers? YES NO

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

order, unless a specific firm is explicitly excluded).

(if yes, attach explanation)

2. Coverage Type Requested: Comprehensive (Commercial & Political) Political Only

8. Are the products: New Used

Yes No Decline to Answer

*Veteran-owned business:

Yes No Decline to Answer

*Woman-owned business:

*Annual Sales Volume:

*Total Number of Employees:

*Corporate Ownership:

*Primary Industry NAICS2:

*Exporter Legal Name: Tradestyle:

*Business Address:

*City: *State: *Zip + 4:

Contact Person:

Country:

Position Title: Phone #:

E-mail:

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 affiliates2?Yes No

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.

Yes No Decline to Answer

*Disability-owned business:

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

American Indian or Alaska Native Asian Black or African American

Ethnicity:

Native Hawaiian or Pacific Islander OtherWhite

Hispanic or Latino Not Hispanic or Latino

EXPORT-IMPORT BANK

of the UNITED STATES

Yes No Decline to Answer

*Minority-owned business:

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