REQUEST - BILL OF EXCHANGE GUARANTEE Request for a guarantee commitment to be issued
1. Applicant’s name, address and reference	Date

2. EKN’s reference	EKN’s guarantee offer no.
3. Exporter	Name (as in contract)	Organisation number
Postal address
4. Buyer (debtor, acceptor)	Name (as in contract)
Postal address	Country
5. Export goods, services
6. The notified Bill of Exchange acquisition is in accordance with the guarantee offer.	Yes No – the items specified below or in appendix are not in accordance with the guarantee offer.
7. Bill of exchange amounts covered by this request	a) Currency	b) Bill of exchange amount
8. Financing	The acquisitions covered by the request in relation to the offer issued are:
Partial acquisition Final acquisition. The guarantee offer is not intended to be used for additional acquisitions.
9. Date of acquisition of bill(s) of exchange	a) Date	b) Bill of exchange amount
10. Information concerning debarment list and notice served of suspicion of crime/judgement	Is the information in the application correct concerning debarment list and notice served of suspicion of bribery or other criminal act or judgement of such criminal acts? Yes No – if no state detailed information below or in an appendix.

3.03e / 140314 / KSo

The OECD has adopted a recommendation to combat bribery of public officials. Accordingly, and as provided by Swedish law on bribery etc. in both the public and private sector, EKN requests that 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, nor any group company involved or anyone else acting on our behalf, has given or will give any bribe or other improper benefit in conjunction with the loan 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 group company involved or anyone else acting on our behalf, has given, or will give any bribe or other improper benefit as described above; and

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

Note that bribery in the cases stated here, amongst other, 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 - including area code
E-mail address

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

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

Instructions for completing the form

General	The request for a guarantee commitment in respect of a bill of exchange guarantee must have been received by EKN no later than one month after acquisition of the bill of exchange to which it relates.

Item 6	If the bill of exchange acquisition conditions have changed so that they are no longer in accordance with what is laid down in the guarantee offer, this may mean that the offer is no longer binding on EKN. If such changes are being considered, the specific approval of EKN should be sought.

Item 10	The applicant has in connection with the application for a bill of exchange guarantee provided information regarding debarment, notice served of suspicion of a crime , under charge or judgement. The applicant may here state whether any change has taken place in the said aspect compared to what was stated in the application.