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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 single foreign buyer. Repayment terms
can be up to 360 days.

An online version of this application is available on Ex-Im Bank's web
site. Ex-Im Bank encourages customers to apply on line, as it will
facilitate our review and allow customers a faster response time.
Additional information on how to apply for Ex-Im Bank insurance can be
found at Ex-Im's web site [http://www.exim.gov](http://www.exim.gov/).

Send this completed application to Ex-Im Bank, 811 Vermont Ave NW,
Washington, D.C. 20571. Ex-Im Bank will also accept e-mailed pdf and
faxed applications. Ex-Im Bank will not require the originals of these
applications to be mailed. The application must be PDF scans of original
applications and all required attachments. (Fax number 202.565.3380,
e-mail exim.applications@exim.gov)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**APPLICATION FORM**

**Applicant/Lender**

The applicant is the financial institution that extends the Ex-Im Bank
insured loan to the buyer.

  ------------------------------ ----------------------------------------
  Applicant legal name:          State:

  Contact person:                Country:

  Position title:                E-mail:

  Street Address:                Phone:

  City: Postal Code:             Fax:
  ------------------------------ ----------------------------------------

**Broker (if applicable):**

  -------------- --------------------------------------------------------
  Name of        
  Broker:        

  Ex-Im Bank     
  Broker #:      

  Contact        
  Person:        

  Phone number:  

  Fax:           

  E-mail:        
  -------------- --------------------------------------------------------

**1. GENERAL QUESTIONS**

**A. Coverage Types Requested**

Risk coverage

Comprehensive Risk

Political Risk

Type of credit

Buyer credit (based on applicant's relationship with the buyer or
guarantor)

Supplier credit (based on the applicant's relationship with the exporter
or supplier)

Is this a resubmission of a previously withdrawn, returned or denied
application, or a renewal for an existing policy?

Yes

No

If yes, indicate previous transaction number:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**B. Primary Reason for applying for this policy**

Risk Mitigation

Financing

To offer more competitive terms

**C. Primary point of contact for this applicant/application**

Lender

Broker

**2. SPECIAL COVERAGES**

Check the boxes for the special coverages that apply to this
transaction. Complete and attach the requested forms,

where applicable.

+-----------------------+-----------------------+-----------------------+
| Shipment to address   | Services              | Additional Named      |
| in the U.S.           |                       | Insured Attachment    |
|                       |                       | III - ANI required    |
+-----------------------+-----------------------+-----------------------+
| Foreign Currency      | Bulk Agriculture      | Documentary Cover     |
| Coverage              |                       | (question applicable  |
|                       |                       | only to supplier      |
| -indicate currency    |                       | credits)              |
| \_\_\_\_\_\_\_\_      |                       |                       |
|                       |                       | Attachment II         |
| \- currency of supply |                       | required              |
| contract              |                       |                       |
|                       |                       |                       |
| US dollar             |                       |                       |
|                       |                       |                       |
| foreign currency      |                       |                       |
+-----------------------+-----------------------+-----------------------+
| Warehouse --          | Other                 |                       |
| Attachment IV         |                       |                       |
| Required              |                       |                       |
+-----------------------+-----------------------+-----------------------+

**3. PARTICIPANTS**

Provide information on the additional participants to the transaction.

**Exporter**

The exporter is the U.S. entity that contracts with the buyer for the
sale of the U.S. goods and services.

  -------------------------------- --------------------------------------
  Applicant legal name:            State:     

  Contact person:                  Country:     

  Position title:                  E-mail:     

  Street Address:                  Phone:     

  City:      Postal Code:          Fax:     
  -------------------------------- --------------------------------------

**Supplier**

  ----------------------------------- -----------------------------------
  Supplier legal name:                State:     

  Contact person:                     Country:     

  Position title:                     E-mail:     

  Street Address:                     Phone:     

  City: Postal Code:                  Fax:
  ----------------------------------- -----------------------------------

The supplier is the U.S. entity that manufactures the goods and/or
performs the services to be exported. Check if the exporter is the
supplier and there are no additional suppliers. Enter any additional
suppliers, or check various:

  --------------------------------- -------------------------------------
  Buyer legal name:                 Postal Code :     

  Contact person:                   Country:     

  Position title:                   E-mail:     

  Street Address:                   Phone:     

  City:                             Fax:     
  --------------------------------- -------------------------------------

**Buyer** The buyer is the entity that contracts with the exporter for
the purchase of U.S. goods and services.

**Guarantor**

The guarantor is the person or entity that agrees to repay the credit if
the buyer does not. Refer to the short-term credit standards to
determine in what circumstances personal or corporate guarantors are
required.

Is a guarantor involved in this transaction? Yes No

  --------------------------------- -------------------------------------
  Guarantor legal name:             

  Contact person:                   Country:     

  Position title:                   E-mail:     

  Street Address:                   Phone:     

  City:      Postal Code:           Fax:     
  --------------------------------- -------------------------------------

If yes, is the guarantor an individual or a company?

**End-user**

The end-user is the foreign entity that uses the U.S. goods and
services:

Check if the end-user is also the buyer.

  ---------------------------------- ------------------------------------
  End-user legal name:               Province :     

  Contact person:                    Country:     

  Position title:                    E-mail:     

  Street Address:                    Phone:     

  City:      Postal Code:            Fax:     
  ---------------------------------- ------------------------------------

**Agent:**

An agent is a business entity or individual located in the country of
the borrower or buyer who has assisted in the sourcing, packaging,
and/or preparation of a request for support from Ex-Im Bank, and which
will receive compensation in some form for their services.

Is an agent involved in this transaction? yes no

If yes, add the agent information below:

  ------------------------------ ----------------------------------------
  Agent legal name:              Province :     

  Contact person:                Country:     

  Position title:                E-mail:     

  Street Address:                Phone:     

  City:      Postal Code:        Fax:     
  ------------------------------ ----------------------------------------

**Related Parties**

Describe any direct or indirect ownership or family relationship that
exists between any of the participants. If none, so indicate:

None.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Primary Source of Repayment (PSOR)**

The PSOR is the entity whose financial statements form the basis of
Ex-Im Bank's evaluation of reasonable assurance of repayment, i.e. the
entity whose financial statements Ex-Im Bank uses to supply calculate
the ratios for short-term credit standards compliance. For this
transaction, indicate whether the PSOR is:

the buyer,

the corporate guarantor, or

business combination, (e.g. the consolidated or combined financial
statements of the buyer and one or more corporate guarantors.). If
business combination, indicate which entities comprise the
combination\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Is the PSOR a financial institution? Yes No

Select the risk category: Private sector Public sector

Does the PSOR have a bond rating? Yes No

If yes, indicate the name of the rating agency, rating, and the date of
the rating.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**4. TRANSACTION DESCRIPTION AND ELIGIBILITY**

Provide a description of the products or service, including their NAICs
code, if known:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer the following questions about the products or services.

Is each product produced or manufactured in the United States? yes no

Has at least one-half of the value, exclusive of mark-up, been added by
labor or material exclusively of United States origin? yes no

Are these products on the munitions control list? yes no

Are the products new or used? new used

Are the products capital goods that will be used to produce exportable
products? yes no

Will any value be added to the product after export from the U.S.? yes
no

If yes, provide an explanation:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Has this transaction been considered by any other export credit insurer?
yes no

If yes, provide an explanation:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**5. FINANCED AMOUNTS AND STRUCTURE**

Enter the %s for each payment term the exporter will extend to the buyer

  ------------ ------- ------- ------- ------- ------- ------- ------- -------
  Payment                                                              
  terms                                                                
  requested                                                            
  (number of                                                           
  days)                                                                

  Payment type Sight   Up to   Up to   Up to   Up to   Up to   Up to   Up to
                       30      60      90      120     180     270     360

  Cash Against                                                         
  Documents                                                            

  Sight Draft                                                          
  Documents                                                            
  Against                                                              
  Payment                                                              

  Sight Draft                                                               
  Documents                                                            
  Against                                                              
  Acceptance                                                           

  Open Acct.                                                           

  Prom Note                                                            
  ------------ ------- ------- ------- ------- ------- ------- ------- -------

Enter the details of the transaction below:

This application is for: Single financing

Revolving line

Indicate whether: the transaction is still being negotiated

> the financing mandate has been received

Credit Limit requested: \$
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Requested effective date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**6. CREDIT INFORMATION ON THE PSOR**

The information requested in Attachment I: Credit Information is
attached.

**7. NOTICES AND CERTIFICATIONS**

**Anti-Lobbying Disclosure Form**

Please sign the Anti-Lobbying Statement (Attachment V) and, if
applicable, the Disclosure Form available at
www.exim.gov/pub/ins/pdf/lll.pdf and include a copy of the signed
form(s) with your application.

**Certifications**

The applicant certifies that neither it, nor its Principals, have within
the past 3 years been a) debarred, suspended, declared ineligible from
participating in, or voluntarily excluded from participation in, a
Covered Transaction, b) formally proposed for debarment, with a final
determination still pending, c) indicted, convicted or had a civil
judgment rendered against it for any of the offenses listed in the
Regulations, d) delinquent on any substantial debts owed to the U.S.
Government or its agencies or instrumentalities as of the date of
execution of this application; or e) the undersigned has received a
written statement of exception from Ex-Im Bank attached to this
certification, permitting participation in this Covered Transaction
despite an inability to make certifications a) through d) in this
paragraph.

The applicant further certifies that it has not and will not knowingly
enter into any agreements in connection with the Goods and Services with
any individual or entity that has been debarred, suspended, declared
ineligible from participating in, or voluntarily excluded from
participation in a Covered Transaction. All capitalized terms not
defined herein shall have the meanings set forth in the Ex-Im Bank
Suspension and Debarment Regulations at 12 C.F.R. Part 413
(Regulations). The applicant is not listed on any of the publicly
available debarment lists of the following international financial
institutions: World Bank Group, African Development Bank, Asian
Development Bank, European Bank for Reconstruction and Development and
the Inter-American Development Bank.

In addition, the applicant certifies that neither the applicant nor
anyone acting on its behalf, such as agents, has engaged, or will
engage, in any activity in connection with this transaction that is a
violation of the Foreign Corrupt Practices Act of 1977, 15 U.S.C. 78dd-1
et seq. (which provides for civil and criminal penalties against
companies and individuals who directly or indirectly make or facilitate
corrupt payments to foreign officials to obtain or keep business).
Further, the applicant has not engaged, and will not engage, in any
activity in connection with this transaction that is a violation of the
Arms Export Control Act, 22 U.S.C. 2751 et seq., the International
Emergency Economic Powers Act, 50 U.S.C. 1701 et seq., or the Export
Administration Act of 1979, 50 U.S.C. 2401 et seq. The applicant has not
been found by a court of the United States to be in violation of any of
these statutes within the preceding 12 months, and to the best of its
knowledge, the performance by the parties to this transaction of their
respective obligations does not violate any other applicable law.

The applicant certifies that neither the applicant nor anyone acting on
its behalf in connection with this transaction is currently under charge
or has been, within the past 5 years, convicted in any court or subject
to national administrative measures of any country for bribery of
foreign public officials.

Further, the applicant certifies that the representation made and the
facts stated in this document and any attachments are true, to the best
of its knowledge and belief, and it has not misrepresented or omitted
any material facts, and if any of the certifications made herein become
untrue, Ex-Im Bank will be promptly informed of such changes. The
applicant further understands that these certifications are subject to
the penalties for fraud against the U.S. Government (18 USC 1001, et
seq.).

**Notices**

The applicant is hereby notified that information requested by this
application is done so under authority of the Export-Import
BankEIB-92-64 (07/06)

Act of 1945, as amended (12 USC 635 et seq.); provision of this
information is mandatory and failure to provide the requested
information may result in Ex-Im Bank being unable to determine
eligibility for support. The information provided will be reviewed to
determine the participants' ability to perform and pay under the
transaction referenced in this application. Ex-Im Bank may not require
the information and applicants are not required to provide information
requested in this application unless a currently valid OMB control
number is displayed on this form (see upper right of each page).

Public Burden Statement: Reporting for this collection of information is
estimated to average 1 hour per response, including reviewing
instructions, searching data sources, gathering information, completing,
and reviewing the application. Send comments regarding the burden
estimate, including suggestions for reducing it, to Office of Management
and Budget, Paperwork Reduction Project OMB# 3048-0009, Washington, D.C.
20503.

Applicant (Financial Institution) Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name and title of authorized officer:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of authorized officer:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

# Attachment I: Credit Information Requirements

Directions: The required credit information depends on the type of PSOR
(non-financial institution or a financial institution) and on the amount
of credit support requested. Check the boxes that are applicable to your
transaction.

**1.** **The PSOR is not a financial institution**

[a) Provide details of the applicant's experience with the
buyer]{.underline}

> Does the applicant have any experience with the buyer? yes no

If yes, provide the following information:

Date of first transaction with the buyer:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of first credit transaction with the buyer:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Has the applicant visited the buyer? yes no

If yes, indicate the date of the last visit and provide a call
report.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Describe the credit facilities extended to the buyer: short-term

medium-term

long-term

> security
>
> none

Total credit limit available to the buyer/corporate guarantor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Total outstanding short-term balances
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Total outstanding medium-term or long-term balances
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Credit performance satisfactory unsatisfactory

> Has the applicant ever had credit insurance for the buyer or corporate
> guarantor before? yes no

If yes, enter the name of the insurer, and coverage dates and amounts
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> [b) Provide the applicable supporting financial information on the
> PSOR.]{.underline}
>
> Check the box that applies to your transaction and provide the
> information noted below the box

The transaction is for an amount up to \$1 million:

-   A credit report on the PSOR dated within six months of the
    application

-   Two trade references on the PSOR of similar amounts and payment
    terms and dated within six months of the application

-   the applicant's credit memorandum on the PSOR

-   the applicant's call report on the PSOR (if applicable)

-   audited or signed unaudited financial statements with notes for the
    last 2 fiscal years which adequately disclose financial condition
    and afford a reasonable basis for reliance on the information
    provided

The transaction is over \$1 million

-   A bank reference on the PSOR not older than 6 months from the date
    of application

-   A credit report on the PSOR dated within six months of the
    application

-   Two trade references on the PSOR of similar amounts and payment
    terms and dated within six months of the application

-   The applicant's credit memorandum on the PSOR

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-   The applicant's call report on the PSOR (if applicable)

-   Three fiscal year end audited financial statements with notes and
    the most recent interim statements with notes if the last fiscal
    year end is more than nine months prior to application

**2.** **PSOR is a financial institution**

> a\) Provide details of the applicant's experience with the financial
> institution guarantor. Include dates and amounts of previous
> transactions with the PSOR or indicate none
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> b\) Provide the applicable supporting financial information on the
> PSOR:

Check the box that applies to your transaction and provide the
information noted below the box

The transaction is for an amount up to \$1 million:

-   One short-term debt rating of the PSOR from S&P, Moody's or Fitch.
    Rating must be B, P-3 or F3 or better.

The transaction is for between \$1,000,001 and \$10,000,000

-   One short-term debt rating of the PSOR from S&P, Moody's or Fitch.
    Rating must be B, P-3 orF3 or better.

-   If the PSOR does not have an acceptable current market rating,
    provide most recently published audited financial statements that
    adequately disclose financial condition and were prepared in
    accordance with accounting principles that afford a reasonable basis
    for reliance on the information provided.

**Attachment II. Documentary Cover Attachment**

If the credit is a supplier credit, and documentary cover is requested,
provide the following:

-   A bank reference on the exporter dated within six months of the
    application

-   Two trade references on the exporter dated six months of the
    application

-   Financial statements on the exporter as follows

> \$500,000 or less signed by an authorized office for the exporter
>
> \$500,001 - \$999,999 reviewed by a CPA with notes attached
>
> \$1,000,000 or more audited by a CPA with opinion and notes attached

Note that typically documentary cover is only provided for a supplier
credit when the exporter/supplier is a small business. Call Ex-Im Bank's
Trade Finance and Insurance Division at 202-565-3600 with further
questions.

**Attachment III: Additional Named Insured Questionnaire**

Indicate the name of the additional named insured as follows:

Legal
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

State:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Country:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Zip/ Postal Code:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Relationship to Applicant:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Role in the transaction:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Contact:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Attachment IV -- Warehouse Information**

If you requested the Special Coverage -- Warehouse, answer the following
questions about the warehouse

Warehouse Type: Owned or controlled by exporter

> Bonded warehouse
>
> Neither, provide details

Warehouse Location**:**

City \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

State/Province \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Country\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Attachment V**

**Anti-Lobbying Statement for Loan Guarantees and Loan Insurance**

The undersigned states, to the best of his or her knowledge and belief,
that:

If any funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with this commitment
providing for the United States to insure or guarantee a loan, the
undersigned shall complete and submit Standard Form-LLL, \`\`Disclosure
Form to Report Lobbying,\'\' (available at
www.exim.gov/pub/ins/pdf/lll.pdf) in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering
into this transaction imposed by section 1352, title 31, U.S. Code. Any
person who fails to file the required statement shall be subject to a
civil penalty of not less than \$10,000 and not more than \$100,000 for
each such failure.

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**Signature**

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**Title**

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