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Apply | Applications and Forms
Insurance Applications and Forms
Instructions: Most of these forms can be filled in on line, then printed, signed and mailed to the Ex-Im Bank, but they cannot be saved to your computer. Some forms, however, can be saved to your computer. Savable forms are labeled with this graphic: 
More information about fillable forms is available in the Guide for Fillable Forms.
| APPLICATIONS | Exporter Short-Term | PDFs |
File Size | File Size |
| EIB92-50 | ST Multi-Buyer Policy Application, ESC/ENB/ENVIRONMENT Prepare and file this application ONLINE! at Ex-Im Online |
|
331 Kb | 94 Kb |
| EIB10-02 | Application for Express Insurance Prepare and file this application ONLINE! at Ex-Im Online |
|
1,446 Kb | |
| EIB92-51 | Special Buyer Credit Limit Application for ST Multibuyer Policies Prepare and file this application ONLINE! at Ex-Im Online |
|
83 Kb | |
| EIB92-64 | Application for Exporter Short-Term, Single-Buyer Insurance |
|
695 Kb | |
| Exporter Medium-Term | ||||
| EIB03-02 | Medium-Term Insurance or Guarantee Application (Adobe PDF format) |
|
1101 Kb | |
| Lender Short-Term | ||||
| EIB92-34 | ST Bank Policy Application (ELC, EBD, EBS, EBM) Prepare and file this application ONLINE! at Ex-Im Online |
 |
151 Kb | 298 Kb |
| EIB92-36 | Issuing Bank Credit Limit Application under a ST Bank Letter of Credit (ELC) Policy | |
228 Kb | |
| EIB92-41 | Application for Financial Institution Short-Term, Single-Buyer Insurance Prepare and file this application ONLINE! at Ex-Im Online |
|
489 Kb | 185 Kb |
| EIB92-31 | Assignment under ST Multi-Buyer Policies (no enhancements) | |
94 Kb | |
| EIB92-53 | Enhanced Assignment for ST Small Business (ENB), Small Business Environmental (ENV) Policies | |
86 Kb | |
| EIB99-17 | Enhanced Assignment under Exporter Short-Term Single-Buyer Policy | |
133 Kb | |
| EIB92-32 | Assignment under Exporter Short-Term Single-Buyer Policy | |
91 Kb | |
| Lender Medium-Term | ||||
| EIB03-02 | MT Term Insurance or Guarantee Application Prepare and file this application ONLINE! at Ex-Im Online |
|
1101 Kb | |
| EIB94-08 | Assignment by Insured to Financial Institution of a Medium-Term Policy ("(doc)umentary") | |
302 Kb | |
| FORMS | ||||
| EIB92-27 | Report of Overdue Accounts under Short-Term Policies | |
410 Kb | |
| EIB09-01 | Report of Overdue Accounts under all other Programs Prepare and file this report ONLINE! at Ex-Im Online |
|
262 Kb | |
| EIB92-29 | Report of Premiums Payable for Exporters | |
493 Kb | |
| EIB94-07 | Exporter Certificate (Short-Term) | |
177 Kb | |
| EIB-11-05 | Exporter's Certificate for Loan Guarantee & MT Insurance Programs | |
178 Kb | |
| CERT-12-001 | Certifications and Notices for Exporter Certificates | |
118 Kb | |
| EIB11-03 | Used Equipment Questionnaire | |
471 Kb | |
| EIB99-14 | Trade Reference Form | |
88 Kb | |
| LLL | Disclosure of Lobbying Activities | |
145 Kb | |
| EIB92-30 | Report of Premiums Payable for Financial Institutions | |
383 Kb | |
| EIB92-37 | Beneficiary Certificate & Agreement for Banks and Financial Institutions | |
151 Kb | 290 Kb |
| EIB92-61 | Defense Products Questionnaire | |
58 Kb | |
| GUIDANCE DOCUMENTS | ||||
| Guide-12-001 |
Promissory Note Single Disbursement or Consolidation Note Medium Term Single Buyer Insurance Policy |
|
30 Kb | |
| Guide-12-002 |
Promissory Note Multiple Disbursment Grid Note Medium Term Single Buyer Insurance Policy |
|
31 Kb | |
| Guide-12-003 |
Brazil Promissory Note Single Disbursement or Consolidation Note Medium Term Single Buyer Insurance Policy |
|
33 Kb | |
| Guide-12-004 |
Brazil Promissory Note Multiple Disbursment Grid Note Medium Term Single Buyer Insurance Policy |
|
32 Kb | |
| Guide-12-005 |
Dominican Republic Promissory Note Single Disbursement or Consolidation Note Medium Term Single Buyer Insurance Policy |
|
28 Kb | |
| Guide-12-006 |
Dominican Republic Promissory Note Multiple Disbursment Grid Note Medium Term Single Buyer Insurance Policy |
|
28 Kb | |
| Guide-12-007 | Mexican Promissory Note Fixed Rate Single Disbursement | |
32 Kb | |
| Guide-12-008 | Mexican Promissory Note Floating Rate Single Disbursement | |
39 Kb | |
| Guide-12-009 | Mexican Promissory Note Fixed Rate Definitive - All Credits Public | |
10 Kb | |
| Guide-12-010 | Mexican Promissory Note Floating Rate Definitive - All Credits Public | |
14 Kb | |
| Guide-12-011 |
Russian, Ukraine, and Kazaksthan Promissory Note Single Disbursement or Consolidation Note
Medium Term Single Buyer Insurance Policy |
|
30 Kb | |
| Guide-12-012 |
Russian, Ukraine, and Kazaksthan Promissory Note Multiple Disbursment Grid Note
Medium Term Single Buyer Insurance Policy |
|
31 Kb | |
| Guide-12-013 | Venezuelan Promissory Note Floating Rate Serial - All Credits |
|
46 Kb | |
| Guide-12-014 | Venezuelan Promissory Note Fixed Rate Serial Note - All Credits | |
41 Kb | |
| Guide-12-015 |
Venezuelan Promissory Note Floating Rate Global Note
Medium Term Sovereign Insurance Transactions |
|
20 Kb | |
| EIB-11-05 | Exporter Certificate for Loan Guarantee & MT Insurance Programs | |
178 Kb | |
| Brokers only | ||||
| EIB92-79 | Broker Registration, Standards of Service, Automatic Deposit Form/Commission Schedule | |
255 Kb | |
| INSTRUCTIONAL DOCUMENTS | ||||
| Inst-12-001 | Medium-Term Application Guidelines | |
196 Kb | |
| Inst-12-002 | Spreading Guidelines for Financial Statements |
|
228 Kb | |
| Inst-12-003 | Lender Referral List including Potential Assignees |
|
660 Kb | |
Inst-12-004 |
Short Term Credit Standards |
|
447 Kb | |
| Inst-12-005 | Medium-Term Credit Standards |
|
297 Kb | 325 Kb |
| Inst-12-006 | Small Business Export Credit Insurance Premium Rate Table |
|
207 Kb | |
| Inst-12-008 | ST Multi-Buyer Extending Credit (DCL) [FACT SHEET] |
|
324 Kb | |
| Inst-12-009 | List of Credit Reports |
|
106 Kb | |
| Inst-12-010 | Short-Term Insurance Foreign Content Policy |
|
21 Kb | |
| Inst-12-011 | Short-Term Multi-buyer Export Credit Insurance Policy for Exporters (Policy Text) | |
108 Kb | |
| Inst-12-012 | Short-Term Single-Buyer Export Credit Insurance Policy for Exporters (Policy Text) | |
379 Kb | |
| Inst-12-013 | Medium-Term, Single Buyer, Single Sale, Single Shipment, Multiple Shipments or Repetitive Sales (Policy Text) |
|
592 Kb | |
| Inst-12-014 | Medium-Term Bank-to-Bank Credit Line Export Insurance |
|
26 Kb | |
| Inst-12-015 | MT Starting Points for Debt Obligations |
|
19 Kb | |
| Inst-12-016 | Standard Repayment Terms |
|
137 Kb | |
| Inst-12-017 | Filing claims on Multi-buyer Insurance Policies: Mistakes to Avoid | |
296 Kb | |
| Inst-12-018 | Compare Multi-Buyer Policies |
|
398 Kb | |
| Inst-12-019 | Compare Single-Buyer and Small Business Multi-Buyer Policies |
|
364 Kb | |
| Inst-12-020 | Compare Single-Buyer and Multi-Buyer Policies |
|
101 Kb | |
| Inst-12-021 | Small Business Multi-Buyer Insurance |
|
347 Kb | |
| Inst-12-022 | Multi-Buyer Insurance |
|
243 Kb | |
| Inst-12-023 | Short-Term Single-Buyer Insurance | |
216 Kb | |
*The attached list contains contact information for insurance brokers that are registered with Ex-Im Bank. The list, organized by city and state, contains both headquarters and regional offices of registered brokers. Updates and other revisions to the list should be sent to Ms. Shontelle Bragg, Business Development, at Shontelle.bragg@exim.gov
Page updated August 29, 2011
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