OVERSEAS
PRIVATE INVESTMENT CORPORATION
FINANCE APPLICATION PROCESS
Welcome to the OPIC Finance Application Process. To start, please click on the “Form 115-Application” button below and complete the Loan Request Summary. If you wish to attach the Supporting Documentation to the Loan Request Summary, you may do so at any time, but it is not required for an initial submission. An OPIC staff member will review the Loan Request Summary (and any Supporting Documentation that you provide) and contact you with further instructions.
FORM 115 -- APPLICATION
For a description of OPIC’s loan origination process and the answers to frequently asked questions (FAQs), please click here: [Link to FAQs document].
Questions? Please email: [email protected]
Application for Financing (Form 115)
OMB No. 3420-0015
Expiration Date: _______
Overseas Private Investment Corporation
1100 New York Avenue, NW Washington, DC 20527-0001
An Agency of the United States Government
This form requests information from potential OPIC clients that is required by OPIC’s governing legislation - the Foreign Assistance Act (FAA) of 1961, Title IV, as amended - to assist OPIC in determining whether a project and its sponsor(s) meet eligibility criteria for OPIC financing, specifically with regard to the soundness of the project, the qualifications of the sponsor(s), creditworthiness, and legislative and regulatory compliance. Complete responses to the questions are required on this form to apply for OPIC support per the FAA.
Responses to questions which call for estimates or projections should take the form of good faith statements made to the best of the applicant’s knowledge and belief. Statements of fact provided to OPIC in this document must be accurate as of the date of execution of this document. In addition to other rights and remedies available to OPIC, misrepresentations or failure to disclose relevant information may result in criminal prosecution pursuant to 22 USC 2197(n), as well as a default or termination if a commitment is issued. Neither submission nor acceptance of this application implies that the project is eligible for financing or that financing will be provided.
Client information contained in this form will be deemed designated as confidential commercial information in accordance with OPIC's Freedom of Information Act (FOIA) regulations (22 CFR 706), and will be treated as confidential commercial information to the extent permitted by applicable law. As a federal agency, OPIC may not collect, or sponsor the collection of, information unless it displays a valid OMB Control Number with an expiration date that has not expired. Information in Form SF-LLL will be reported to Congress and available for public inspection.
Paperwork Reduction Act Notice: This information is required to obtain benefits. The public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to Essie Bryant, Agency Clearance Officer, 1100 New York Ave., NW, Washington, DC, 20527 and Wendy Liberante, Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.
Please click “Next” after reading the information above.
NEXT
LOAN REQUEST SUMMARY
The Loan Request Summary consists of 12 questions that will enable OPIC personnel to make a preliminary determination of whether the project meets the basic eligibility requirements for OPIC support.
QUESTION 1: IDENTIFY THE PROJECT COMPANY/BORROWER
OPIC provides direct loans and loan guaranties that are used to undertake long-term investment projects (each a “Project”) in OPIC eligible countries (each a “Project Country”) [link to country list]. The entity that directly undertakes the Project in the Project Country (the “Project Company”) may also be the entity that has the direct borrowing relationship with OPIC or is the direct beneficiary of an OPIC-guaranteed loan (the “Borrower”), but sometimes they are different entities, depending upon the proposed structure of the transaction. Please list the location and contact information for the Project Company and Borrower.
|
|
|
Same as Project Company |
Project Company |
Borrower |
Name: |
Name: |
Address (incl. city and country): |
Address (incl. city and country): |
Office Phone Number(s): |
Office Phone Number(s): |
Fax Number(s): |
Fax Number(s): |
E-mail(s): |
E-mail(s): |
|
|
Is the address of the Project Company the location of the Project? (Yes/No) |
|
If “No,” please list the specific location of the Project (city, country): |
NEXT
QUESTION 2: IDENTIFY THE Authorized Representative
Please provide contact information for the individual who will be signing the completed application; i.e. shareholder in or executive of the Project Company or Borrower, financial advisor, legal counsel, etc.
|
Name and Title of Representative: |
Relationship to the Project Company or Borrower: |
Address: |
Office Phone Number(s): |
Cell/Mobile Phone Number(s): |
Fax Number(s): |
E-mails(s): |
NEXT
BACK
QUESTION 3: IDENTIFY tHE OWNERS of the PROJECT COMPANY/Borrower
Please list ultimate beneficial owners of the Project Company. For example, if the Project Company is wholly owned by another company, and that other company is owned 50-50 by two individuals, that other company is the intermediate owner of the Project Company (with 100% direct ownership), and the two individuals are the ultimate beneficial owners of the Project Company (each having 50% indirect beneficial ownership). The table below allows you to list each direct owner, and if applicable, to list each indirect owner under the relevant direct owner. You need not list any party that owns (directly or indirectly) less than 5% of the Project Company. For owners with less than 5%, state “Multiple, less than 5%” and list the sum of their ownership shares so that you may account for 100% of the Project Company ownership.
If there is more than one layer of ownership (i.e. some of the ownership is indirect) please attach a diagram showing the ownership structure [link to upload function].
Please note that to be eligible for OPIC Financing, the Project Company/Borrower must be at least 50.1% (i.e. majority) owned by private entities (i.e. a government or parastatal entity is not the majority owner) and must have the meaningful involvement of the U.S. private sector (see Question 4 on next page). |
Direct Owner Name |
Country of Citizenship (for Individuals) or Incorporation (for Entities) |
Identification Information |
Percent Direct Ownership of Project Company/Borrower |
Ownership of this Entity includes Entities that Indirectly Own 5% or more of the Project Company/Borrower |
|
|
|
|
Y/N |
|
|
|
|
Y/N |
|
|
|
|
Y/N |
|
|
|
100% |
Y/N |
BACK
NEXT
QUESTION 4: IDENTIFY THE U.S. CONNECTIONS.
For a Project to qualify for OPIC Financing, there must be meaningful involvement of the U.S. private sector (the “Qualifying Sponsor(s)”) with the Project.
How does OPIC define U.S.? (any one of the following)
How does OPIC measure meaningful U.S. involvement?
How does OPIC measure the duration of U.S. involvement?
Please list the Qualifying Sponsor(s) information (including a U.S. address, if possible) and the nature of each entity’s involvement with the Project.
|
NEXT
BACK
QUESTION 5: CATEGORIZATION OF U.S. PARTIES INVOLVED WITH THE PROJECT
OPIC Finance’s support for a Project Company/Borrower can take the form of a direct loan or a loan guaranty. By law, only those Projects that significantly involve a U.S. small business are eligible for the direct loan product. The loan guaranty product is open to all eligible Project Companies/Borrowers.
How does OPIC define U.S. Small Business?
Include the revenues, worth and employees of all majority-owned affiliates. Also, if the enterprise is majority-owned by another business (but not funds or individuals), include the consolidated revenues, worth and employees, as applicable.
Please list all Qualifying Sponsors that are U.S. small businesses. ____________________________________
____________________________________
OPIC also gathers additional demographic information:
Is any Qualifying Sponsor (check all that apply):
___ a woman-owned business? ___ a minority-owned business?
|
BACK
NEXT
QUESTION 6: Project Description
Please provide a brief description of the Project, making sure to address the following items:
|
BACK
NEXT
QUESTION 7: Project Costs
Please list the types and estimated amounts of all Project costs. Please be as specific as possible and remember to include estimates of any applicable project development/transaction costs (e.g. engineering or other consulting services, market studies, legal fees, financing fees, etc.) For expansions of existing operations, include only the costs associated with the expansion.
|
||
US$ |
% |
|
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
|
$ |
% |
Total Project Costs |
$ |
100% |
BACK
NEXT
QUESTION 8: Project Funding
Please indicate sufficient sources of funding to cover 100% of the Project costs. The types listed below are sample categories for your reference. You may edit the categories as necessary to match the types of funding specific to your Project.
|
||
US$ |
% |
|
Debt: |
$ |
% |
OPIC loan (indicate proposed term) |
$ |
% |
Other term debt (indicate proposed term and collateral) |
$ |
% |
Supplier financing |
$ |
% |
|
|
|
Subordinated Debt: |
|
|
Shareholder subordinated loans |
$ |
% |
Third party subordinated debt |
$ |
% |
|
|
|
Equity: |
$ |
% |
Cash |
$ |
% |
In-kind contribution |
|
|
Other (please describe) |
$ |
% |
Total Project Funding |
$ |
100% |
BACK
NEXT
QUESTION 9: WHAT Collateral and/OR Credit Enhancements ARE AVAILABLE
OPIC requires a collateral/credit enhancement package (the “Security Package”) tailored to the specific risks of each Project. The purpose of this Security Package is to provide a secondary source of repayment if the Project’s cash flow is insufficient to service the debt as scheduled. Following are indicative categories of collateral/credit enhancement that OPIC may require. Please indicate below those categories that may be available (check all that apply):
____ Pledge of shares of the Project Company/Borrower
____ Liens/Mortgages on Project Company/Borrower assets (Specify types/locations: ___________)
____ Liens/Mortgages on U.S. assets (Specify types/locations: _____________)
____ Guaranties from creditworthy individuals or companies (Specify name(s) of guarantor(s): __________)
____ Irrevocable standby letter(s) of credit
____ Debt Service Reserve Account
____ “Key Man” Life Insurance
____ Other (describe:____________________________)
|
BACK
NEXT
QUESTION 10: Management Experience and Track Record
Briefly describe relevant experience that the investors/shareholders and/or key Project managers have in the Project sector and Project Country. For each individual listed below please specify that person’s relationship to the Project (i.e. shareholder, CEO, etc.)
|
BACK
NEXT
Question 11: Private Sector Sources of Financing
OPIC does not compete with private sector providers of project financing. Therefore, OPIC requires that Project developers: (a) evaluate the possibility of obtaining project financing from private sources and (b) decide to pursue OPIC financing because private financing is not available on terms sufficient to make the investment viable or because of specific benefits OPIC participation will bring to the investment. |
|
|
Have you evaluated the possibility of obtaining financing for the Project from private sector sources? |
Yes |
No |
Have you determined that private sector financing is not a viable option for the Project? |
Yes |
No |
If Yes, please list the reasons why private sector financing is not a viable option for the Project (check all that apply):
____ Private Sector financing is not available at all in the Project Country.
____ Private Sector financing is available, but not on terms (tenor, pricing) that would be viable for the Project.
____ Other (describe):
|
|
|
BACK
NEXT
QUESTION 12: HOW DID YOU LEARN ABOUT OPIC?
OPIC is interested in knowing what types of communications about its programs are most effective. Please select the source of your initial information about OPIC:
____ OPIC’s website or other social media (Twitter, Facebook, etc.)
____ OPIC-sponsored workshop or event
____ OPIC speaker at an industry event
____ Other US Government Agency (e.g. State/Embassy, Commerce, Treasury, TDA, DOD, USEXIM, etc.)
____ Enterprise Development Network (EDN) or other financial advisor
____ Past or present OPIC client.
____ Other (describe: ______)
BACK
NEXT
Select Addressee
Please select an addressee to receive your application materials. If you are already working with an OPIC Origination Officer, please feel free to select their name from the menu below. If not, please select the OPIC Information Officer.
Officer Name:
Officer Email:
Please submit the following documents in support of your application:
|
For an existing Project Company: - Annual Financial Statements (audited, if available; most recent 3 years) - Quarterly Financial Statement (most recent quarter)
For a public corporation: - 10K (most recent 3 years) - 10Q (most recent quarter)
For a private corporation: - Annual Financial Statements (audited, if available; most recent 3 years) - Quarterly Financial Statement (most recent quarter) - Tax Returns (most recent 3 years)
For a partnership: - Annual Financial Statements (audited, if available; most recent 3 years) - General Partner information, including (i) current signed Statement of Net Worth (assets, liabilities, net worth) and (ii) ownership
For an individual: - Current Signed Personal Financial Statement (assets, liabilities, net worth) - Tax Returns (most recent 3 years)
|
2. Bank and Trade References (For each private corporation, partnership or individual, please provide three bank references and three trade references.) |
3. Complete Business Plan/Preliminary Information Memorandum
The following checklist details the items to include in the business plan. Please provide as complete a business plan as possible.
Project Summary
Project Ownership and Management
Project Sector/Target Market/Economics
Legal, Economic, Political Environment and Government Participation
Project Strengths/Risks and Risk Mitigation
|
4. Financial Model (Please electronically attach a detailed model of financial projections of the Project over the requested term of the OPIC loan. Describe the primary financial model assumptions and justification for such assumptions. If the Project is an expansion please ensure that the model includes that last two fiscal years of operations as the basis for the projections.)
The model should include detailed assumptions as to the Project’s budget, revenue, expenses, financing terms, timing of equity contributions, loan disbursement schedule, etc. The model must include an income statement, balance sheet and cash flow statement projecting the financial performance of the Project over the life of the OPIC loan. The model must also include the calculation of the following ratios Cash Flow to Debt Service, Current Assets to Current Liabilities, Total Indebtedness to Tangible Net Worth, Return on Assets, and Internal Rate of Return. |
FORM 115 Signature and Certifications
Authorized Representative |
|
“Under penalty of law, I certify that the statements and information provided herein are true to and correct to the best of my knowledge and belief.” |
|
Signature: |
|
Print name and title: |
Date: |
D-U-N-S NUMBER
Please provide the D-U-N-S Number for the entity that will be the Borrower under the proposed OPIC financing (usually the Project Company).
A D&B® D-U-N-S® Number is a unique nine-digit sequence, with an optional 4 digit extension for some locations. A D-U-N-S number is recognized as the universal standard for identifying and keeping track of over 100 million businesses worldwide. Dun & Bradstreet (D&B) provides a D-U-N-S Number, a unique nine digit identification number, for each physical location of a business. OPIC uses the D-U-N-S Number to facilitate public reporting requirements applicable to OPIC’s programs.
If
a D-U-N-S®
Number
is not available when this application is submitted to OPIC, a
D-U-N-S Number may be obtained after the date of this application;
provided
that, such D-U-N-S Number is obtained and reported to OPIC prior
to the issuance of an OPIC financing commitment.
D-U-N-S Number assignment is FREE for all businesses. A D-U-N-S
number may be obtained by accessing the following website: http://fedgov.dnb.com/webform
|
TRANSPORTATION INSURANCE CERTIFICATION
|
OPIC seeks to ensure that American insurance companies have an opportunity to compete for transportation insurance business associated with the export of goods to projects supported by OPIC programs. To encourage fair and open competition for this business, OPIC requires certain certifications from investors receiving its support. Please complete section A, B, or C below, whichever is applicable. |
A. No such certification is required from an Applicant that does not have a controlling interest in fact in the Project Company. If the Applicant does not have a controlling interest in fact in the Project Company, please check the box below.
□The Applicant does not have a controlling interest in fact in the Project Company. |
B. In those instances where the Applicant does have or will have a controlling interest in fact in the Project Company, OPIC requires that the Applicant certify that each contract for the export of goods from the United States in connection with the establishment of the Project contain a clause requiring that United States insurance companies have a fair and open competitive opportunity to provide insurance against risk of loss for such export of goods. If the Applicant is able to so certify, please check the box below.
□ The undersigned certifies that each contract for the export of goods from the United States in connection with the establishment of the Project does have or will have a clause requiring that U.S. insurance companies have a fair and open competitive bid opportunity to provide insurance against risk of loss for such exports. |
C. In those instances where the Applicant does have or will have a controlling interest in fact in the Project Company, but is unable to provide the certification requested immediately above, please check one of the boxes below and provide details, explaining why you cannot do so at this time. In providing an explanation, please make specific references, as applicable, to project country, legal or other impediments. |
□ Laws of the project country prohibit use of American insurance services for transportation insurance. |
□ There are no U.S. exports associated with the establishment of this Project. |
□ All transportation insurance associated with the export of U.S. goods to the Project is or will be arranged through the Applicant’s worldwide insurance program. It is not practicable to alter these arrangements for U.S. exports to the Project. |
□ All transaction insurance associated with the export of U.S. goods to the Project is or will be arranged by a Project participant who is other than the Applicant under such Project participant’s insurance provider(s). It is not practicable to alter these arrangements for U.S. exports to the Project. |
□ Other (Please explain): |
ANTI-LOBBYING CERTIFICATION
|
DISCLOSURES REGARDING USE OF LOBBYISTS |
|
|
|
|
|
FOR THOSE APPLYING FOR OPIC DIRECT LOANS |
|
A |
All government agencies, including OPIC, are required by law to obtain from applicants for direct loans in excess of $150,000 a certification that no federal funds have been or will be paid to any Person for influencing or attempting to influence a Member of Congress, Congressional staff, or employee of the Executive Branch in connection with their loan applications. Federal law prohibits federal funds, including OPIC loan proceeds, from being used to pay outside lobbyists or the salaries of applicant’s regular employees who are engaged in lobbying activities with respect to the applicant’s loan application. Payments to consultants, lawyers, accountants, or other Persons, including the applicant’s regular employees, for professional or technical services regarding the loan application are not prohibited. Applicants for federal loans in excess of $150,000 must also agree that if they use other than federal funds to hire an outside lobbyist to seek to influence approval of their application, they will file with the lending agency a disclosure form, Standard Form LLL - Disclosure of Lobbying Activities, which identifies the lobbyist who has been retained.
On the following pages are the following documents:
|
|
FOR THOSE APPLYING FOR OPIC LOAN GUARANTIES |
|
|
B |
All government agencies, including OPIC, are required by law to obtain from applicants for loan guaranties in excess of $150,000 a statement regarding whether they have used or intend to use a lobbyist to attempt to influence approval of their applications. A lobbyist is someone other than the applicant’s regular employee who is retained not to provide technical or professional services regarding the application but to attempt to use influence through written or oral communications with Members of Congress, Congressional staff, or employees in the Executive Branch. If an applicant for a loan guaranty has used or intends to use a lobbyist to attempt to influence action on its application, the applicant is also required to file with the agency a Standard Form LLL - Disclosure of Lobbying Activities, which identifies the lobbyist who has been retained. On the following pages are the following documents:
(ii) Standard Form LLL - Disclosure of Lobbying Activities, which must be completed and filed with OPIC only if a lobbyist has been or will be paid to attempt to influence OPIC’s action on the undersigned’s application. |
|
|||
CERTIFICATE REGARDING LOBBYING FOR APPLICATIONS FOR OPIC DIRECT LOANS |
|||
The undersigned certifies, to the best of his or her knowledge and belief, that:
Submission of this statement is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. §1352. Any Person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
|
|
|||
CERTIFICATION REGARDING LOBBYING FOR APPLICANTS FOR OPIC LOAN GUARANTIES |
|||
If any funds have been paid or will be paid, to any Person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this commitment providing for the United States to guarantee or insure a loan, the undersigned shall complete and submit Standard Form LLL – Disclosure of Lobbying Activities, in accordance with its instructions.
Submission of this statement is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. §1352. Any Person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
|
|
|||
SELF-DISCLOSURE OF LOBBYING ACTIVITIES |
|||
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. §1352. |
|||
1 |
Type of Federal Action: Contract Grant Cooperative Agreement Loan Loan Guarantee Loan Insurance
|
||
2 |
Status of Federal Action: Bid/Offer/Application Post-Award
|
||
3 |
Report Type: Initial Filing Material Change -- Year, quarter or date of last report: |
||
4 |
Reporting Entity: Prime Subawardee -- Tier, if known: |
||
|
Name:
|
||
Address:
|
|||
City:
|
State:
|
Zip:
|
|
Congressional District, if known :
|
|||
5 |
Reporting Entity in No. 4 is a Subawardee, enter the Name and Address of the Prime. |
||
|
Name:
|
||
Address:
|
|||
City:
|
State:
|
Zip:
|
|
Congressional District, if known :
|
|||
6 |
Federal Department/Agency :
|
||
7 |
Federal Program Name/Description :
|
||
|
CFDA Number, if applicable:
|
||
8 |
Federal Action Number, if known : |
9 |
Award Amount, if known : |
10 |
A |
Name of lobbying entity (if an individual, last name, first name, MI):
|
||
|
Address:
|
|||
City:
|
State:
|
Zip:
|
||
B |
Name of individual performing services (including address if different from 10A) (last name, first name, MI): |
|||
Address:
|
||||
City:
|
State:
|
Zip:
|
||
Signature:
|
||||
Print Name:
|
||||
Title:
|
||||
Tel. No.:
|
||||
Information requested through this form SF-LLL is authorized by title 31 U.S.C §1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. §1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any Person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. |
||||
FEDERAL USE ONLY:
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | OPIC |
File Modified | 0000-00-00 |
File Created | 2021-01-30 |