Req F, T+F, T+F-comb and Phys Request for guarantee for Loss on Claim only (F), for Loss on Production and Loss on Claim (T+F, T+F-comb) and for Physical Loss (Phys)
1. Applicant’s name, address and reference	Date	F	(exporter/bank)
T+F	(exporter)
Phys

2. EKN's reference	EKN's guarantee offer number	Refers to combined guarantee (T+F-comb)
Yes No
3. Exporter (has to be stated only if the applicant is lender)	Name as in contract
Postal address
4. Buyer/equivalent, borrower	Name as in contract/agreement
Postal address	Country
5. Goods, services
6. The transaction in accordance with the guarantee offer *)	Yes No - the following items are not in accordance with the guarantee offer
7. Assignment / pledging of contract / agreement and guarantee	The rights under the contract / agreement and the guarantee are to be assigned to / pledged to
8. Contract amount / loan amount etc in the contract currency/ loan agreement currency, b, c and d not to be filled in by lender *)	a) Contract amount excl price escalation (if any) / loan amount	b) Local costs included in a)
c) Price escalation	d) Local costs included in c)
e) Interest and other financial costs	Interest rate p a including financial costs reported in 8 e) % fixed/floating
In case of floating interest:
g) Interest base (e.g. Libor + 6 months)	h) Margin	i) Applicable interest rate in 8 e)
1)	1)	1)
2)	2)	2)
9. Late interest clause in the supply contract/ loan agreement?	Late interest clause in the supply contract / loan agreement? Yes No

*) See instructions overleaf	2.01e / 140522 / KSo

10. Invoicing / loan disbursements	The invoices, loan disbursements specified below refer to
partial delivery(equiv.) / partial disbursement	final delivery (equiv.) / final loan disbursement. (This guarantee offer will not then be used for further deliveries / loan disbursements.)
D 11. Date for shipment / loan disbursement, amount in the contract currency and invoice number (exporter) / rate of exchange (lender). If the request refers to T+F, fill in planned dates and amounts in item a, b and c.	a) Date	b) Sales amount / loan	c) Interest incl. financial costs	d) Invoice number / rate of exchange
See appendix
12. Date for contract / agreement etc *)	a) Date for signing the contract / agreement	b) Date for unconditional contract / agreement
c) Date when adv payment was received (needs not to be stated by the lender)	d) Date when the stipulated L/C was issued and / or other security was obtained
13. Date / period for contract works or consulting works, etc.	Date or period
Assembly or assembly supervision expected to take place during the period
Installation and plant expected to be ready for starting-up
Contract works / consulting works expected to take place during the period
14. Guarantee for Loss on Production *)	Guarantee requested for the sum of SEK
15. Guarantee for Physical Loss *)	Guarantee requested for the sum of SEK during the period
16. Payment of premium *)	in advance in arrears (due dates for interest and credit amounts stated in the enclosed repayment plan)
17. Payment plan / disbursement plan	Payment plan appended Disbursement plan appended (only for lenders)
18. Circumstances concerning debarment list, notice served of suspicion of a crime or judgement and agents	Are there any new circumstances in comparison with those previously stated by the applicant in the application for guarantee concerning debarment list, notice served of suspicion of bribery, under charge or judgement concerning bribery or similar criminal acts, or agent’s costs? Yes No If yes, and these circumstances have not been previously reported, state the detailed circumstances below or in an appendix.
19. CSR (To be filled in only in case of request for guarantee in favour of exporter)	Has the applicant received information about working conditions and environmental impact additional to the information previously provided in the application for guarantee or in a Supplementary form for application for guarantee or extension of guarantee offer under “Working conditions at the buyer company” or “Environmental impact of transaction”? Yes No If yes, state the additional information below or in an appendix.

*)	See instructions below

The OECD has adopted a recommendation to combat bribery against public officials. In reference hereto, and pursuant to the provisions of Swedish legislation relating to bribery etc. in both the public and private sector, EKN requests the applicant to make the following declaration.

We hereby declare that

we understand the importance of the development, application and documentation of an appropriate control system to combat bribery;

neither we, any involved group company nor anyone else acting on our behalf has given or will give a bribe or other improper reward in conjunction with the export transaction specified in the application;

we are aware that EKN’s liability for the guarantee may be extinguished and that indemnification amounts received, including interest from time the time when indemnification is paid out, must be repaid to EKN if we, any involved group company or anyone else acting on our behalf, has given, or will give a bribe or other improper reward as set out above; and

we will hold EKN harmless in relation to all costs and expenses incurred because we, any involved group company or anyone else acting on our behalf, has given or will give a bribe or other improper reward as set out above.

Note that bribery in the cases stated here, among others, is a criminal offence under Swedish law; see Chapter 10, sections 5a-5e of the Penal Code.

Company name	Contact persons (preferably two names)
Signature	Telephone number
E-mail address

Supplementary statements (filled in by EKN ) - applicable instead of or in addition to the information given in the request

Sign. Changes/additions made by the applicant (………………………………………………………………………..…………… ) by phone/letter/visit on…………………………………………………………….

Instructions for completing the form

General.	The request for guarantee in respect of Loss on Claim must have been received by EKN at the latest within one month after the claim has arisen / loan disbursement. (However, see below regarding Loss on Claim if combined guarantee.)

The request for guarantee in respect of Loss on Production and Loss on Claim must have been received by EKN at the latest one month after an unconditional supply contract (equiv) exists (refers to guarantee for exporter only) and/or unconditional supply contract (equiv) and loan agreement exist (refers to combined guarantee for exporter and lender). With regard to a certain performance, eg payment in advance, availability of security, which according to the conditions in the supply contract as well as in the loan agreement should be fully fulfilled within 60 days of supply contract/loan agreement coming into force, it is, however, sufficient that the form is received by EKN at the latest 3 months after the unconditional contract/agreement comes into force.

Item 6.	If the transaction agreement has been altered so that it is no longer in accordance with what is laid down in the guarantee offer, eg with regard to the question of terms of payment, this may mean that the guarantee offer is no longer binding on EKN. If changes of this nature are being considered, the specific approval of EKN is needed if the validity of the guarantee offer is to be maintained. By agreement is meant the applicant's own agreement in the transaction.

Item 8	If the request for guarantee refers to T+F and / or T+F-comb the total amount according to the agreement shall be stated in this item. If the request refers to guarantee for Loss on Claim only the amount with regard to present shipment/loan disbursement shall be stated.

Item 8g-i	In case of floating interest rate state the interest base in item 8g), e.g. Libor +6 months, and in 8h) state the applicant's margin above the interest base. If other fees are to be included in the guarantee please state their size and due dates. In item 8i) please state the interest rate which has been used to calculate the interest and other financing costs listed in item 8e).

Item 12	An unconditional contract/agreement is deemed to exist once the conditions stipulated for its entering into force have been fulfilled. However, a condition stipulating the existence of an EKN-guarantee may be disregarded in this connection.

Item 14	This item should only be filled in where a guarantee for Loss on Production is required and a guarantee offer is issued by EKN.

Item 15	This item should only be filled in where a guarantee for Physical Loss is required and a guarantee offer is issued by EKN. (Special guarantee covering the risk that property used in work abroad be expropriated or damaged as a result of political events such as acts of war, revolution or similar occurrence.)

Item 16	Premium can be paid in two alternative ways, in advance or in arrears. If the guarantee holder wishes to pay the premium in arrears, a premium payment commitment on form 7.01e and a repayment plan shall be attached to the request for guarantee.