Form Eib 92-27 Export-Import Bank-Report Of Overdue Accounts Under Short Term Policies

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OMB 3048-0027

02/28/2018

EXPORT-IMPORT BANK-REPORT OF OVERDUE ACCOUNTS UNDER SHORT TERM POLICIES

(please type or print all information)

) -

Report for period: _______________________

_________

POLICY NUMBER :(

(Prefix)

(Number)

(Month)

(Year)

OVERDUE REASON

Date Received

Cash Flow / Commercial Problems*

POLICYHOLDER:___________________________________

Foreign Exchange Problems (local payment made)

Insolvency*

:_________________________________

Contact

Dispute* (Product; terms; documents; etc.)

Slow Pay Typical

:________________

: ________________

Tel

Fax

Natural Disaster

:_______________

E-mail

Buyer Re-Organizing

Other*

BROKER:________________________________

*Please attach detailed explanation of the overdue item and prospect for recovery

Actual Payment

EOL Shipment

Shipment

EOL Shipment

SHIPMENT

OVERDUE

Item

Buyer Name

COUNTRY

Due Date

REASON

Terms

Confirmation #

Date

Report Date

AMOUNT

PAGE TOTALS

complete only on last page ---->

REPORT TOTALS

We hereby certify that this report is a true and complete statement as required by the policy, that we have read the additional notes and instructions on the reverse side and that we understand this form to the pertinent conditions of the

policy.

Name of Preparer: ________________________________________

Phone: (

) _________-_____________________

Signature: _______________________________________________

Date Prepared: __________________________, _____

Page No.____ of ____ pages

(Month)

(Day)

(Year)

EIB 92-27

Revised 11/10