Supplementary form for Application for issue of an extension concerning guarantee offer for loss on claim in favour of lender (to be completed by the exporter) Do not use this form if a guarantee offer has been issued for a combined guarantee to the exporter and lender

Lender	Date
1 Exporter	Name and organisation number, if any
Postal address (state country if not Sweden)
2 Buyer/equivalent, (debtor)	Name (as in contract)
Postal address	Country
3 The transaction is as described under items 1-8 and item 17 of the Supplementary form to the Application for Guarantee	Yes No – state differences below or in appendix
4 Questions concerning the circumstances of the applicant’s counterparty in the transaction as stated in items 9-10 and 17 of the Supplement form for application for export credit guarantee in favour of lender	If, after issue of the guarantee offer or previous extension of that offer, the exporter has gained knowledge of circumstances of the buyer/debtor or other counterparty in the transaction whereby: The counterparty is declared bankrupt or is the subject of a business reorganisation process, composition/arrangement or similar procedure. A cross-default in a contract of the counterparty has been invoked. The counterparty has received demands for payment of due debts in addition to those previously specified in the application for a guarantee or an extension of a guarantee offer. Another event has occurred at the counterpart that may be expected to represent a substantially increased risk of a loss on claims or other contractual rights as against the counterparty. No Yes If yes, and this has not been previously reported in accordance with the prescribed duty of information under a previously submitted Supplementary form, state the detailed circumstances below or in an appendix.

2.03e / 140314 / KSo

5 Circumstances concerning debarment lists, bribery or agent’s costs	New circumstances in comparison with those previously stated by the exporter in items 13-16 of the Supplementary form for application for guarantee or extension of guarantee offer concerning debarment lists, agents, cooperation with other contractors, notice served of suspicion of bribery, under charge or judgment concerning bribery or similar criminal acts. No Yes If yes, and these circumstances have not been previously reported, state the detailed circumstances below or in an appendix.
6 CSR	Has the exporter received information about working conditions and environmental impact additional to the information previously provided under items 11-12 of the Supplementary form for application for guarantee or extension of guarantee offer under “Working conditions at the buyer company” or “Environmental impact of the transaction”? No Yes If yes, state the additional information below or in an appendix.

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

Additional information (to be completed by EKN ) – applies instead of or in addition to the information provided in the Supplementary form

Amendments/supplements have been made by the exporter (…...………………………………………………………) by telephone/letter/visit (date) …………………………………………………………..	Sign.

Instructions for completing the form

General	An extension of a guarantee offer to a lender requires that the exporter in the transaction to be financed also submit a supplementary form to the lender’s application.

As regards references in items 3-6 to information about the exporter’s export transaction previously provided in a Supplementary form for application for a guarantee in favour of lender, the exporter’s duty of information includes amendments and supplements not previously reported.

For instructions on completing items 2-6 of this Supplementary form, please see the instructions given for the corresponding items in the Supplementary form for application for a guarantee in favour of lender.