Form OPIC-129 Sponsor Disclosure Report

Sponsor Disclosure Report

Overseas Private Investment Corporation

1100 New York Avenue, NW, Washington, D.C. 20527

An Agency of the United States of America

INSTRUCTIONS

Certain Definitions Used in this Form: As used herein, the following terms, when capitalized, have the meanings ascribed to them below:

“Address” means full street address, including street and location, municipality, province, state, country, and postal or zip code. For an individual, the “Address” to be provided must be such individual’s permanent residence or domicile.

“Affiliate” means, with respect to any Person, any other Person that is directly or indirectly controlled by, or under common control with, such Person; except that, with respect to a Reporting Company, only other Persons covered by or subject to SEC reporting requirements applicable to such a Reporting Company.

“Control” means (including, in addition to “control”, the terms “controlling” and “controlled by”) means possession, directly or indirectly, of the power to direct or cause the direction of the management and policies of any Person, whether through the ownership of partnership interests or voting securities, by contract or otherwise.

“Knowledge” means:

1. for an individual, the knowledge of such individual;

2. for a corporation or limited liability company, the knowledge of any of the executive officers, directors, or managing members, as applicable;

3. for a partnership (limited or otherwise), the knowledge of the executive officers or directors or, in the case of a limited partnership, the knowledge of the directors (or the managing member) of the general partner;

4. for a trust, the knowledge of the trustee;

5. for a not-for-profit entity, the knowledge of any of the executive officers or directors; and

6. for an investment fund, the knowledge of the directors (or the managing member) of the general partner, the investment manager, or the members of the investment committee.

“Name” means:

(i) with respect to an individual, such individual’s full legal name (including first name, middle name, last name) and if such individual is not a U.S. resident and:

(a) is of Arabic origin, please include the full four-part last name through the generation of the grandfather in the correct order or indicate that such individual does not have a four-part last name; or

(b) is of Spanish or Hispanic origin, please include the mother’s maiden name.

(ii) with respect to a Person other than an individual, the legal name as it appears on a Certificate of Incorporation, Certificate of Partnership, or similar document.

“Person” includes, without limitation, individuals, corporations, limited liability companies, joint stock companies, partnerships, associations, trusts, banks, trust companies, business trusts or other organizations, or limited liability companies, whether or not a legal entity, as applicable.

“Project” means the activity for which an application for OPIC financing support has been submitted. In the case of OPIC financing support for an investment fund, a “Project” is such investment fund.

“Project Company” means the entity identified as such in the Summary Information section of this form. In the case of an investment fund transaction, the “Project Company” is the investment fund.

“Reporting Company” means either a Person whose securities are registered pursuant to Section 15 USC 78(m) of the Securities Act of 1933, as amended, or is required to file reports with the SEC pursuant to the SEC Acts.

“SDR Party” means:

1. in the case of a Project where OPIC support will not be directly provided to an investment fund:

1. any person (physical or legal) that beneficially owns, directly or indirectly, at least 10% of the project company; and

2. any person (physical or legal) that will provide credit support or bear a significant managerial relationship to the project (other than individuals whose managerial relationship to the project is solely as an officer or director of the project company).

If any entity specified immediately above in sub-clauses (i)(a) or (i)(b) is an investment fund, the SDR shall be completed on behalf of the fund by the fund’s investment manager or general partner (or managing member).

2. in the case of a Project where OPIC support will be directly provided to an investment fund (a “Fund Borrower”):

1. the Fund Borrower’s general partner (or managing member);

2. the Fund Borrower’s investment manager;

3. each limited partner or investor (physical or legal) in the Fund Borrower that:

   1. is an affiliate of such Fund Borrower’s investment manager or general partner (or managing member); and

   2. beneficially owns, directly or indirectly, at least 10% of the Fund Borrower; and

4. each individual identified as a “key person”.

If the entities specified immediately above in sub-clauses (ii)(a) and (ii)(b) above have been newly formed for the purposes of managing the Fund Borrower, the persons beneficially owning at least 10% of such entities shall complete the SDR in their individual capacities.

For purposes of this definition, “SDR Parties” shall not include:

(i) the World Bank, regional development banks, multilateral and bilateral development institutions and their affiliates;

(ii) the United Nations or agencies thereof;

(iii) any international or regional organization whose members are exclusively governmental or quasi-governmental entities;

(iv) state-owned enterprises; and

(v) U.S. federal, state, regional or municipal governments, or any departments, agencies or instrumentalities thereof.

“SDR Submitting Party” means the SDR Party submitting this OPIC Form 129.

“SEC” means the U.S. Securities & Exchange Commission (or successor thereof).

“SEC Acts” means, individually or collectively, as the context requires, the Securities Act of 1933, the Securities Exchange Act of 1934, or the Investment Company Act of 1940, each as amended from time to time.

“Subsidiary” means, with respect to any person, any other Person that is directly or indirectly, more than fifty percent (50%) owned or is otherwise controlled by such Person; except that, with respect to a Reporting Company, only other Persons covered by or subject to SEC reporting requirements applicable to such Reporting Company.

Who Should File this Form: This form is required of SDR Parties and other Persons as determined by OPIC. Reporting Companies may respond to certain questions, as designated by this form, by attaching responsive information from applicable SEC filings.

When Should this Form Be Filed: This form must be received from each SDR Party by OPIC before OPIC may issue a financing commitment. OPIC reserves the right to seek additional information from the provider of this form regarding the information contained herein or the submission of this form from other Persons in connection with the Project prior to issuing a financing commitment.

Things to Remember when Completing this Form: All requested information must be provided completely and accurately in order to comply with requirements under the Foreign Assistance Act of 1961, Title IV, as amended. If the answer to a question is “not applicable” or “none”, please so indicate by stating “N/A” or “NONE”, as the case may be, or as otherwise instructed for a specific question.

OVERSEAS PRIVATE INVESTMENT CORPORATION

SPONSOR DISCLOSURE REPORT

OPIC Form 129

OMB 3420-0018

Expiration: _______

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, effects, 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.

Paperwork Reduction Act Notice: This information is required to obtain benefits. The public reporting burden for this collection of information is estimated to average 2.4 hours 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 Records Manager, Overseas Private Investment Corporation 1100 New York Ave., NW, Washington, DC 20527 and to the OPIC Desk Office at the Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.

I have read and agree to the terms and conditions listed above.

CANCEL

START

Note: Several of the questions in the Form 129 refer to specific defined terms that the user should understand before answering the question. To read and print the form instructions and defined terms, please click here. Please note that some of the questions give the user the option of attaching an explanatory document immediately upon answering the question. Otherwise, the user may attach supporting documentation at any time by clicking on the “Supporting Documentation” link at the bottom of each screen.

1. SDR SUBMITTING PARTY SUMMARY INFORMATION

Full Legal Name of the SDR Submitting Party:

What type of entity is the Person submitting this report? (check only one)

Individual

Corporation, Limited Liability Company, or Company

Partnership

Trust, Business Association or other entity

If the user chooses any type other than “Individual,” then the fields described in the following two rows should come up. If they did choose “Individual,” then they should not come up.

Name of the authorized representative submitting this report on behalf of the SDR Submitting Party (if the SDR Submitting Party is not an individual):

Contact Information for authorized representative– insert fields for physical address, phone, fax and email address

Name of the Project Company or Project (if the Project Company does not yet exist) –

[Pre-populate with the name of the Project Company/Project]

What is the relationship between the SDR Submitting Party and the Project? (check all that apply)

Direct or indirect, beneficial owner of 10% or more of the Project Company

Will provide credit support to the Project

Bears a significant managerial relationship to the Project

General partner (or managing member) of the Project Company

Investment fund manager of the Project Company

Required to complete the identification information only

2. SDR SUBMITTING PARTY IDENTIFICATION INFORMATION

If the user has chosen “Individual” as the entity type on the first screen, then the following questions should come up:

Identification Information for Individuals

Full Legal Name – this should pre-populate from the previous Screen

Nicknames or Aliases (if applicable):

Maiden Name and Married Name(s) (if applicable):

Date of Birth; Place of Birth

Please list all addresses where this individual resides and has resided over the course of the ten years immediately preceding the date hereof (for locations in the United States, include all states, territories, possessions, and the District of Columbia), beginning with place of current residence:

Choose one of the following with respect to this individual:

Never resided in the United States.

Currently resides in the United States at the most recent Address indicated above.

Last resided in the United States at the following Address:

Is the SDR Submitting Party doing business as a sole proprietorship? Yes No

(If the user answers “yes,” three text boxes should coming up asking for: trade (DBA) name, jurisdiction of registration (if any), and registration number (if any))

Country of citizenship - Insert a drop-down menu. Allow them to enter more than one country for dual citizenship.

If the user chooses “U.S.” citizenship in the drop-down, boxes that ask for 1) driver’s license number and state of issuance and 2) social security number should come up.

If the user chooses something other than “U.S.” citizenship in the drop-down, a box asking for passport number or equivalent should come up.

If the user has chosen “Corporation, Limited Liability Company or Company” as the entity type on the first screen, then the following questions should come up:

IDENTIFICATION INFORMATION FOR CORPORATIONS, LLCS AND COMPANIES

Legal Name as it appears on the certificate of incorporation or similar document:

Jurisdiction of Formation/Establishment: State (if applicable); Country

Address of the SDR Submitting Party:

Is the SDR Submitting Party a Reporting Company? Yes No

(If the user answers “yes,” then the following two questions should come up, if “no,” then they shouldn’t)

Is the SDR Submitting Party traded on a stock exchange regulated by the SEC? Yes No

(If the user answers “yes,” two little text boxes should appear asking for the name of the exchange and the company’s ticker symbol.)

Nature of most recent U.S. federal securities law filing (i.e. 10K, 10Q, other); date of such filing.

Is the SDR Submitting Party a U.S. Federal Taxpayer? Yes No

(If the user answers “yes,” then a box should appear asking for the U.S. Federal Taxpayer Identification Number.)

If the user has chosen “Partnership” as the entity type on the first screen, then the following questions should come up:

IDENTIFICATION INFORMATION FOR PARTNERSHIPS

Legal Name as it appears on the certificate of formation or similar document:

Jurisdiction of Formation/Establishment: State (if applicable); Country

Address of the SDR Submitting Party:

Is the SDR Submitting Party also the general partner of the Project Company? Yes No

(If the user answers “no,” provide a field for the user to enter the name of the general partner, if applicable)

Is the SDR Submitting Party a Reporting Company? Yes No

(If the user answers “yes,” then the following two questions should come up, if “no,” then they shouldn’t)

Is the SDR Submitting Party traded on a stock exchange regulated by the SEC? Yes No

(If the user answers “yes,” two little text boxes should appear asking for the name of the exchange and the company’s ticker symbol.)

Nature of most recent U.S. federal securities law filing (i.e. 10K, 10Q, other); date of such filing.

Is the SDR Submitting Party a U.S. Federal Taxpayer? Yes No

(If the user answers “yes,” then a box should appear asking for the U.S. Federal Taxpayer Identification Number.)

If the user has chosen “Trust, Business Association or Other Entity” as the entity type on the first screen, then the following questions should come up:

IDENTIFICATION INFORMATION FOR TRUSTS, BUSINESS ASSOCIATIONS OR OTHER ENTITIES

Legal Name as it appears on the agreement establishing such trust, business association or other entity:

Jurisdiction of Formation/Establishment: State (if applicable); Country

Address of the SDR Submitting Party:

Is the SDR Submitting Party a trust? Yes No

(If the user answers “yes,” then the following two questions should come up, if “no,” then they shouldn’t)

Name of the trustee:

Is the trustee an Affiliate of the SDR Submitting Party? Yes No

Is the SDR Submitting Party a Reporting Company? Yes No

(If the user answers “yes,” then the following two questions should come up, if “no,” then they shouldn’t)

Is the SDR Submitting Party traded on a stock exchange regulated by the SEC? Yes No

(If the user answers “yes,” two little text boxes should appear asking for the name of the exchange and the company’s ticker symbol.)

Nature of most recent U.S. federal securities law filing (i.e. 10K, 10Q, other); date of such filing.

Is the SDR Submitting Party a U.S. Federal Taxpayer? Yes No

(If the user answers “yes,” then a box should appear asking for the U.S. Federal Taxpayer Identification Number.)

If the user has chosen any type of entity except “Individual” on the first screen, then the following questions should also come up:

3A. For each director, member, general partner, and executive officer (as applicable) of the SDR Submitting Party, please provide the following identification information. If the SDR Submitting Party is a non-profit entity, the identification information for trustees or directors shall only be required as requested by OPIC.

If the SDR Submitting Party is a Reporting Company and would like to upload information from applicable U.S. federal securities filing(s) that is responsive to this question rather than filling out the fields below, please click here: (insert button and ability to upload a document).

Full Name:

Title/Relationship to SDR Submitting Party (e.g. CEO, Director)

Address:

Date of Birth

Country of Citizenship – Have a drop-down box.

If the user has chosen “U.S.” as country of citizenship, fields asking for SSN, driver’s license number and jurisdiction should come up.

If the user has chosen any other country of citizenship, field asking for passport or similar identification number should come up.

Has the individual ever resided in the US? Yes No

3B. For each director, member, general partner, and executive officer (as applicable) of each Subsidiary of the SDR Submitting Party, please provide the following identification information. If the Subsidiary of the SDR Submitting Party is a non-profit, the identification information for trustees shall only be required as requested by OPIC.

If the SDR Submitting Party is a Reporting Company and would like to upload information from applicable U.S. federal securities filing(s) that is responsive to this question rather than filling out the fields below, please click here: (insert button and ability to upload a document).

Full Name:

Title (e.g. CEO, Director)

Name of the Subsidiary of the SDR Submitting Party

Address:

Date of Birth

Country of Citizenship – Have a drop-down box.

If the user has chosen “U.S.” as country of citizenship, fields asking for SSN, driver’s license number and jurisdiction should come up.

If the user has chosen any other country of citizenship, field asking for passport or similar identification number should come up.

Has the individual ever resided in the US? Yes No

3C. For each Affiliate of the SDR Submitting Party, please provide the following identification information:

If the SDR Submitting Party is a Reporting Company and would like to upload information from applicable U.S. federal securities filing(s) that is responsive to this question rather than filling out the fields below, please click here: (insert button and ability to upload a document).

What type of entity is the Affiliate of the SDR Submitting Party? (have drop-down box with individual, corporation, LLC, company, partnership, trust, other)

Full Name of Affiliate of the SDR Submitting Party:

Principal Address of Affiliate of the SDR Submitting Party:

Citizenship? Or Jurisdiction of Incorporation/Formation?

Is the Affiliate of the SDR Submitting Party a Reporting Company? Yes No

Is the Affiliate of the SDR Submitting Party a Subsidiary of the SDR Submitting Party? Yes No

[The rest of the questions are for the SDR Submitting Party. If the SDR Submitting Party is an individual, only part a. of the remaining questions should appear.]

4. Have any of the following parties ever previously requested U.S. Government financing?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

(If the user chooses “yes” on either part a or part b, then a box asking them for specifics – Agency from which it was requested, entity that requested it and their identification info – SSN, TIN, etc. – should come up.)

4. Are any of the following parties currently delinquent on any payment obligation, including taxes as well as other obligations, with respect to any amount owed to the U.S. Government?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

(If the user answers “yes” on part a, b or c, then a box asking them for specifics – Amount, Agency to which it is owed, other – should come up.)

4. Are any of the following parties currently: (1) debarred, suspended or declared ineligible from participating in any Federal program; (2) formally proposed for suspension or debarment, with a final determination still pending; or (3) voluntarily excluded from participation in a Federal transaction?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

(If the user answers “yes” on part a, b or c, then a box asking them to explain should come up.)

4. Have any of the following parties ever been the subject of a bankruptcy, receivership, or arrangement for the benefit of creditors or similar insolvency proceeding?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

(If the user answers “yes” on part a, b or c then they should have two choices: a button that will allow Reporting Companies to click and upload exhibit(s) or a series of fields where they enter information – nature of action(s), date(s), court(s), court docket number(s), parties involved, final disposition.)

4. Are any of the following parties currently under indictment or on parole or probation?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

4. Any executive officers or directors of the SDR Submitting Party Yes No

5. Any executive officers or directors of any Subsidiary of the SDR Submitting Party Yes No

(If the user answers “yes” on any part a through e, then a text box where they can provide an explanation should come up.)

4. Have any of the following parties ever been charged with or arrested for any criminal offense other than a minor motor vehicle violation?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

4. Any executive officers or directors of the SDR Submitting Party Yes No

5. Any executive officers or directors of any Subsidiary of the SDR Submitting Party Yes No

(If the user answers “yes” on any part a through e, then a text box where they can provide an explanation should come up.)

4. Have any of the following parties ever been convicted, placed on pretrial diversion, or placed on any form of probation, including adjudication withheld pending probation, for any criminal offense other than a minor motor vehicle violation?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

4. Any executive officers or directors of the SDR Submitting Party Yes No

5. Any executive officers or directors of any Subsidiary of the SDR Submitting Party Yes No

(If the user answers “yes” on any part a through e, then they should have two choices: a button that will allow Reporting Companies to click and upload exhibit(s) or a series of fields where they enter information – nature of action(s), date(s), court(s), court docket number(s), parties involved, final disposition.)

4. Have any of the following parties ever been found by a court of competent jurisdiction in a civil action or by the SEC or similar U.S. state agency to have violated any U.S. Federal or U.S. state securities law?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

4. Any executive officers or directors of the SDR Submitting Party Yes No

5. Any executive officers or directors of any Subsidiary of the SDR Submitting Party Yes No

(If the user answers “yes” on any part a through e, then they should have two choices: a button that will allow Reporting Companies to click and upload exhibit(s) or a series of fields where they enter information – nature of action(s), date(s), court(s)/agency(ies), court docket number(s), parties involved, final disposition.)

4. Are any of the following parties party to any consent judgment or agreement with the SEC that restrains or restricts its activities?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

4. Any executive officers or directors of the SDR Submitting Party Yes No

5. Any executive officers or directors of any Subsidiary of the SDR Submitting Party Yes No

(If the user answers “yes” on any part a through e, then they should have two choices: a button that will allow Reporting Companies to click and upload exhibit(s) or a series of fields where they enter information – nature of judgment(s)/agreement(s), date(s), parties involved.)

4. Have any of the following parties ever been involved as a plaintiff or defendant in any material litigation that has not been satisfied, settled or compromised over the course of the ten years immediately preceding the date hereof?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

(If the user answers “yes” on part a, b, or c, then they should have two choices: a button that will allow Reporting Companies to click and upload exhibit(s) or a series of fields where they enter information – nature of action(s), date(s), court(s), court docket number(s), parties involved, current status.)

4. With respect to any of the following parties, are there any pending or threatened administrative investigation or proceedings for which the imposition of a lien is or may be sought, or any lien(s) that has been ordered or imposed?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

(If the user answers “yes” on part a, b or c, then they should have two choices: a button that will allow Reporting Companies to click and upload exhibit(s) or a series of fields where they enter information – nature of case(s)/litigation(s), date(s), court(s), court docket number(s), names of creditor(s)/lienor(s), amount of judgment(s), status.)

4. Have any of the following parties ever been the subject of an investigation under the Foreign Corrupt Practices Act of 1977 (as amended) or other applicable law concerning corrupt business practices?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

4. Any executive officers or directors of the SDR Submitting Party Yes No

5. Any executive officers or directors of any Subsidiary of the SDR Submitting Party Yes No

(If the user answers “yes” on any part a through e, then a text box where they can provide an explanation should come up and a place where Reporting Companies can upload an attachment should be available.)

4. Have any of the following parties ever been convicted of, or been party to a final adverse determination of, an offense under the Foreign Corrupt Practices Act of 1977 (as amended) or any other applicable law concerning corrupt business practices?

1. SDR Submitting Party Yes No

2. Any Subsidiary of the SDR Submitting Party Yes No

3. Any Affiliate of the SDR Submitting Party, to the SDR Submitting Party’s Knowledge Yes No

4. Any executive officers or directors of the SDR Submitting Party Yes No

5. Any executive officers or directors of any Subsidiary of the SDR Submitting Party Yes No

(If the user answers “yes” on any part a through e, then a text box where they can provide an explanation should come up and a place where Reporting Companies can upload an attachment should be available.)

4. Have the following parties established and are they currently maintaining internal management and accounting practices and controls that are adequate to ensure compliance with all laws pertaining to corrupt practices that are applicable to the Project?

1. SDR Submitting Party Yes No

2. All Subsidiaries of the SDR Submitting Party Yes No

(If the user answers “no” on either part a or part b, then a text box where they can provide an explanation should come up.)

Signature Page

NOTIFICATION OF CREDIT INVESTIGATION: As part of the application process for OPIC financing, OPIC routinely undertakes credit investigations of applicants for such financing. OPIC considers such investigations to be an essential element in evaluating the qualifications of the project, the SDR Submitting Party, its Affiliates and Subsidiaries (as such terms are defined in the instructions), and the executive officers and directors of the SDR Submitting Parties and its Subsidiaries (the “Review Parties”). These investigations may involve the use of private consumer credit reporting firms, court clerks and government agencies. The investigations may focus on, but are not necessarily limited to, the financial responsibility, credit record, business reputation, character, overdue and unpaid tax obligations, criminal record, and general reputation of the Review Parties. The nature of the investigations will be at the discretion of OPIC, and, by signing below, the SDR Submitting Party consents to such investigations by OPIC and its agents. Under the Fair Credit Reporting Act, 15 U.S.C. §1681, the undersigned may be entitled to additional information regarding the nature and scope of any investigation of which it is the subject if requested by it in writing. In addition to performing such credit checks, OPIC is required to verify that each SDR Submitting Party (who has a Taxpayer Identification Number or a Social Security Number) is not delinquent on any Federal tax obligations. Signature of this form constitutes the undersigned’s consent to such investigations, checks and verification.

The undersigned, as either the SDR Submitting Party (in the case of an individual) or as the duly authorized representative of the SDR Submitting Party (in the case of Persons other than an individual), including the other Review Parties, as the case may be, certifies on behalf of the SDR Submitting Party and the other Review Parties that the information and certifications provided in response to the questions herein, under penalty of law (pursuant to 22 USC Section 2197(n)), are true and correct to the best of such Person’s knowledge after due inquiry, and that such Person has not misrepresented or omitted any material facts relevant to said representations. If after the date hereof the SDR Submitting Party comes into possession of any information material or relevant to said representation, the SDR Submitting Party agrees not to withhold it, and the undersigned agrees to communicate such knowledge to OPIC immediately by letter.

Full Name of SDR Submitting Party (pre-populated)

Space to type in Name of Authorized Person (if applicable)

Space to type in Title of Authorized Person (if applicable)

Electronic or PDF Signature of SDR Submitting Party or Authorized Person of the SDR Submitting Party