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pdfOVERSEAS PRIVATE INVESTMENT
CORPORATION
OFFICE OF INVESTMENT POLICY QUESTIONNAIRE
Welcome to OPIC’s Office of Investment Policy Questionnaire (“OIPQ”). If you wish to attach supporting
documentation, you may do so at any time, but it is not required for an initial submission. Analysts from
OPIC’s Office of Investment Policy will review the OIPQ, including any supporting documentation provided.
OPIC’s Office of Investment Policy reviews each potential OPIC-supported project for its: 1) expected
development impact in the host country; 2) anticipated impact on the U.S. economy and U.S. employment;
3) environmental, health, and safety elements; and 4) labor-related considerations. For a description of
OPIC’s Office of Investment Policy, please click here: https://www.opic.gov/who-we-are/our-investmentpolicies.
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OFFICE OF INVESTMENT POLICY QUESTIONNAIRE
OPIC-248
OMB 3420-0032
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, 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 OPIC support or that support
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
2.8 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 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.
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GETTING STARTED
OFFICE OF INVESTMENT POLICY QUESTIONNAIRE
In order to initiate the process, please click on the “Office of Investment Policy Questionnaire” button
above. As the U.S. Government’s development finance institution, OPIC takes its developmental mission
seriously. An integral part of the OPIC application process, the OIPQ enables OPIC to estimate the
potential long-term developmental impacts of each OPIC-supported project and to identify any potential
environmental and social considerations. Additionally, data collected in the OIPQ is aggregated and used
to satisfy OPIC’s U.S. Congressional reporting requirements.
The terms “Applicant”, “Project”, “Project Company”, and “Financial Intermediary” are defined below:
Applicants – Investors, lenders, insurers, reinsurers, or project sponsors seeking OPIC support.
Project -- A long-term investment in one or more OPIC eligible countries, including investments made by an
OPIC-supported Financial Intermediary.
Project Company -- The entity that directly undertakes the Project, which may or may not be the direct
beneficiary of OPIC’s support (depending on the proposed structure of the transaction).
Financial Intermediary – Investment funds, banks, insurance companies, or other financial institutions, entities,
or vehicles that receive OPIC support and provides debt, equity, and/or insurance directly to Projects.
All projects that OPIC supports are subject to OPIC’s Environmental and Social Policy Statement and
applicable International Finance Corporation Performance Standards and Environmental, Health and Safety Guidelines.
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Volume of potable water produced per year (m³)
# m³
# m³
Other
If Other, please answer the following questions:
Please describe the Project sector, with appropriate North American Industry Classification System (NAICS) code
What is the Project target client or customer?
Please provide the number of clients or customers currently served by the Project per year
_________#
Please provide the expected number of clients or customers served by the Project per year
as a result of this OPIC-supported investment (by 5th year)
_________#
3. PROJECT SITING
A
B
Project Site Location (please include GPS coordinates and, if available, a map of site location):
Please indicate whether the Project will be located in or near any of the following:
Natural forest areas, including primary forests, old growth forests, forests that serve as critical
carbon sinks or forests with high levels of biodiversity.
Yes
No
Areas on the United Nations List of Natural Parks, World Heritage Areas, or other internationally
recognized protected areas (such as wilderness areas, national monuments, or nature
preserves.)
Yes
No
Sensitive locations of national or regional importance including wetlands, floodplains, coral
reefs, mangrove swamps or areas prone to erosion, desertification or seismic activity.
Yes
No
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4. PROJECT ENVIRONMENTAL AND SOCIAL CHARACTERISTICS
A
Please indicate if the Project involves any of the following:
Construction of a dam or weir.
Yes
No
Production or trade in any product or activity deemed illegal under host country laws or
regulations or international conventions and agreement or subject to international phase-outs
or bans.
Yes
No
Resettlement of people or disruption of businesses.
Yes
No
If Yes, please estimate the number of people affected.
___________#
Use of previously contaminated sites.
Yes
No
Production or trade in radioactive materials.
Yes
No
Production or trade in or use of unbounded asbestos fibers.
Yes
No
Marine or coastal fishing practices harmful to vulnerable and protected species or damaging
to biodiversity or habitats.
Yes
No
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5. PROJECT HUMAN RESOURCE MANAGEMENT
A
Does (or will) the Project have written human resources policies?
Yes
No
Yes
No
Are terms of employment clearly communicated to each worker?
Yes
No
If Yes, please describe how employment terms are (or will be) communicated to each worker
and attach verifying documentation, such as a sample employment contract.
Yes
No
If Yes, please indicate the person who is (or will be) responsible for implementing the Project
Company’s human resource policies.
Yes
No
Does (or will) the Project have management experience in applying
international labor standards, such as those in the IFC Performance Standards?
Yes
No
If Yes, please attach a copy of the Project Company’s human resource policies (in English).
B
If Yes, please indicate the areas covered by the human resources policies:
Mechanism(s) for workers’ to express grievances (e.g., direct access to supervisors and/or the
human resources department, workers’ committees, and/or trade union reps, anonymous
hotline).
Disciplinary procedures.
C
If Yes, please specify.
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6. PROJECT LABOR-RELATED ISSUES
Does (or will) the Project involve the following?
A
Migrant or foreign workers (excluding foreign national management or highly-skilled non-manual
workers).
Yes
No
B
Workers under the age of 18 (directly or indirectly employed by the Project).
Yes
No
C
Restructuring which results in a major retrenchment (i.e., lays off significant numbers of
workers).
Yes
No
Yes
No
Yes
No
If Yes, please describe.
D
Known non-compliance with local laws or other applicable labor standards (self-diagnosed, or as
a result of official inspections or other audits).
If Yes, please describe.
E
Is there an onsite trade union?
If Yes, what percentage of workers are covered by a collective bargaining agreement?
____%
If Yes, please attach a copy of the collective bargaining agreement, if applicable.
F
Labor-related lawsuits against the Project.
Yes
No
Yes
No
If Yes, please describe.
G
Labor unrest in the last three years in the form of strikes or other general industrial disputes.
If Yes, please describe.
H
Ongoing or unresolved issues/disputes with a Project trade union.
Yes
No
I
Is there onsite security?
Yes
No
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C
D
Purpose of the transactions as a percentage of the outstanding value
of the Equity portfolio in A above.
Current Portfolio
Projected OPIC-supported
portfolio
Start-Up Capital
%
%
Working Capital
%
%
Expansion Capital
%
%
Equipment Purchase
%
%
Other (please specify):
%
%
Current Portfolio
Projected OPIC-supported
portfolio
Manufacturing
%
%
Agriculture
%
%
Construction
%
%
Transportation
%
%
Communication
%
%
Tourism
%
%
Trade/Retail
%
%
Energy
%
%
Services (please specify):
%
%
Other (please specify):
%
%
Business activities/sectors of clients as a percentage of the
outstanding value of the Equity portfolio in A above.
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6. PROJECT HUMAN RESOURCE MANAGEMENT
A
Does (or will) the Project have written human resources policies?
Yes
No
Mechanism(s) for workers’ to express grievances (e.g., direct access to supervisors and/or the
human resources department, workers’ committees, and/or trade union reps, anonymous
hotline).
Yes
No
Disciplinary procedures.
Yes
No
Are terms of employment clearly communicated to each worker?
Yes
No
If Yes, please describe how employment terms are (or will be) communicated to each worker
and attach verifying documentation, such as a sample employment contract.
Yes
No
If Yes, please indicate the person who is (or will be) responsible for implementing the Project
Company’s human resource policies.
Yes
No
Does (or will) the Project have management experience in applying international labor
standards, such as those in the IFC Performance Standards?
Yes
No
If Yes, please attach a copy of the Project Company’s human resource policies (in English).
B
C
D
If Yes, please indicate the areas covered by the human resources policies:
If Yes, please specify.
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7. PROJECT LABOR-RELATED ISSUES
Does (or will) the Project involve the following?
A
Workers under the age of 18 (directly or indirectly employed by the Project).
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If Yes, please describe.
B
Restructuring which results in a major retrenchment (i.e., lays off significant numbers of workers).
If Yes, please describe.
C
Known non-compliance with local laws or other applicable labor standards (self-diagnosed, or as a
result of official inspections or other audits).
If Yes, please describe.
D
Labor-related lawsuits against the Project.
If Yes, please describe.
E
Labor unrest in the last three years in the form of strikes or other general industrial disputes.
If Yes, please describe.
F
Ongoing or unresolved issues/disputes with a Project trade union.
If Yes, please describe.
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PART III – EFFECTS OF PROJECT ON THE U.S.
ECONOMY
1. PROJECT COUNTRY REGULATORY ENVIRONMENT
A
Does (or will) the Project occupy a monopoly position in any of its markets?
Yes
No
If Yes, please explain.
If No, please estimate how many firms currently provide the same or similar products and/or
services in the local market?
B
_____#
Does (or will) the Project Country government have majority ownership or effective management
control of the Project?
Yes
No
Yes
No
Yes
No
If Yes, please explain.
C
Are there any Project Country performance requirements (e.g., local content requirements or
incentives, minimum export requirements, maximum import requirements, or local hiring
requirements) that might affect Project imports, exports, or employment?
If Yes, please explain.
D
Does (or will) the Project result from or cause any Project Country reforms, new legislation, or new
regulations?
If Yes, please explain.
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PART IV – Investor / Representative Certification
Investor/Representative Certification
I hereby represent the information provided in this document is complete and accurate to the best of my
knowledge, and that I am an authorized representative of the Project or Financial Intermediary.
Signature:
Date:
Name and Title:
Telephone:
Email address:
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| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |