Export Credit Insurance Applications and Forms
page last updated 2012-Dec-20
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
EIB92-50
ST Multi-Buyer Policy Application, ESC/ENB/ENVIRONMENT
Prepare and file this application ONLINE! at Ex-Im Online
331 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
Prepare and file this application ONLINE! at Ex-Im Online
695 Kb
Exporter Medium-Term
EIB03-02
Medium-Term Insurance or Guarantee Application (Adobe PDF format)
Prepare and file this application ONLINE! at Ex-Im Online
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
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
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
EIB11-05
Exporter's Certificate for Loan Guarantee & MT Insurance Programs
118 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
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
EIB11-05
Exporter Certificate for Loan Guarantee & MT Insurance Programs
118 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
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
page last updated 2012-Dec-20
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 |
EIB92-50 | ST Multi-Buyer Policy Application, ESC/ENB/ENVIRONMENT Prepare and file this application ONLINE! at Ex-Im Online |
331 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 | |
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 | |
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 | |
EIB11-05 | Exporter's Certificate for Loan Guarantee & MT Insurance Programs | 118 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 | |
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 | |
EIB11-05 | Exporter Certificate for Loan Guarantee & MT Insurance Programs | 118 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 | |
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