Short Term Single Buyer Insurance Application Prepare and file this application ONLINE! at EXIM Online

• Legal Form Number: EIB92-64
• Issuer: Export-Import Bank of the United States
• Subject Matter: Insurance
• Section: Export-Import Bank of the United States

Decline to answer

APPLICATION FOR EXPORTER SHORT-TERM SINGLE-BUYER

OMB No. 3048-0018

5/31/2028

EXPORT CREDIT INSURANCE POLICY

This application is to be completed by an exporter in order to obtain a short-term insurance policy covering sales to a single

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 on line to facilitate our

review and provide customers a faster response time. Additional information on how to apply for EXIM insurance can be found

on EXIM’s web www.exim.gov IMPORTANT: The Guarantor, Buyer and End User must be foreign entities in countries for which

EXIM is able to provide support. See EXIM's Country Limitation Schedule. Check the EXIM Convicted Parties List to determine if

there are any prohibitions or restrictions on your ability to insure a transaction.

Send this completed application to EXIM, 811 Vermont Ave., NW, Washington, D.C. 20571. EXIM will also accept emailed PDF and

faxed applications. EXIM will not require the originals of these applications to be mailed. The application must be a PDF scan of

the original application and all required documents. (Fax number 202.565.3380, Email exim.applications@exim.gov)

APPLICATION FORM

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

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

Applicant/Exporter Legal Name:

Tradestyle Name:

UEI #:

DUNS #:

Business Address:

City: State: Country:

Is there is corporate ownership of Applicant:

Zip+4

Yes No

Name of ultimate parent company:

Does the Applicant have any affiliates: Yes No Applicants primary industry NAICS2 code:

Total Number of Employees (for Applicant and any affiliated companies):

Annual Sales Volume (for Applicant and any affiliated companies):

Contact Person:

Position/Title:

Phone: Fax:

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

Yes No Decline to answer

Yes No Decline to answer

Decline to answer

Decline to answer

No

Yes

Yes No Decline to answer White

Black or African American

Native Hawaiian or Pacific Islander

Email:

Woman-owned business:

Minority-owned business:

Veteran-owned businss:

Disability-owned business:

Brokerage:

1 Affiliations 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.

2 A 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.

EIB 92-64 (Rev. 9/2024) Page 1 of 10

American Indian or Alaska native Asian

Hispanic or Latino

Middle Eastern or North African

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