Self-Monitoring Questionnaire

Guidelines for Completing the

Self-Monitoring Questionnaire (SMQ)

Form: OPIC-162

OMB Number: 3420-0019

Expiration Date:

The following guidelines have been developed by OPIC’s Office of Investment Policy to help you complete the Self-Monitoring Questionnaire (“SMQ”). It discusses each question in detail and provides an example of a typical response where appropriate. In particular, this guide aims to clarify appropriate responses for the qualitative developmental impact questions that comprise a significant portion of the SMQ.

Should you have questions that are not addressed in this document, please consult our FAQ listing available on the OPIC Forms website. To obtain additional assistance, you may email [email protected]. To obtain a PDF of the SMQ for reference purposes only, please visit the following link

https://www.opic.gov/sites/default/files/files/opic-162-fy2015smq-for-public-use.pdf

The SMQ is comprised of four parts

Part I Project Summary: This section asks for project information, description and location.

Part IIA Project Country Effects: This section is to be completed by all OPIC Finance, Insurance and Reinsurance projects and by all OPIC Investment Funds and framework agreement/on-lending facility subprojects.

Part IIB Project Country Effects: This section is to be completed by Financial Intermediary transactions unless otherwise directed by OPIC staff from the Office of Investment Policy (OIP). As such, the term “financial intermediary” refers to, but is not limited to, general lending banks, specialized lending institutions, mortgage facilities, microfinance institutions, private equity funds, and other capital market transactions.

Part III U.S. Supplier and Procurement: This section is to be completed if the project has procured any goods and/or services from a U.S. Supplier during the reporting period.

Part IV Investor/Representative Certification section. The respondent will need to electronically sign the online form and is asked to provide up-to-date contact information.

The SMQ is due by June 30^th of each year unless otherwise specified.

Note: please provide all financial information in US dollars.

The terms “Project” and “Financial Intermediary” are based on definitions given to them in Appendix D of OPIC’s Environmental and Social Policy Statement, as referenced below:

Project – All facilities owned or controlled within a physical project boundary that constitute a commercially viable business unit eligible for OPIC support.

Financial Intermediary – Investment funds, banks or other financial institutions including insurance companies, or other entities or vehicles that receive financing, guaranties or insurance from OPIC and provide debt or equity investment directly to projects or enterprises (“Subprojects”).

Part I – Project Summary

Question 1: Project Information

Question

Explanation

1. Project Name

This refers to the name of the OPIC supported project. This information is typically prefilled on the electronic form, but can be edited by the respondent.

2. Contract/Loan #

This refers to OPIC Insurance contract number, OPIC Finance Loan number or current registration number assigned to the project investment. This number is typically prefilled on the electronic form.

3. Please provide the percentage of local ownership of the project if any.

This refers to local (host country) percentage of ownership, if applicable.

4. Is any of the local ownership comprised of a Small & Medium Enterprise (SME)?

If Yes, please provide the percentage that is owned by an SME.

OPIC defines SMEs as companies having up to 300 employees, total assets of up to $15 million, and total annual sales of up to $15 million. This question should be marked “yes” if the local owner meets the criteria described above. A single individual may also qualify as an SME for purposes of this question. If this question is not applicable, the response can be marked as “No”.

5. Do women-owned and/or managed businesses account for any local ownership?

If “Yes”, please provide the percentage of local ownership comprised of women-owned and/or managed businesses.

The U.S. Congress has requested that OPIC collect this information from its investors. As such, if the OPIC investor is a women-owned business, we ask that you indicate the status appropriately. This question does not apply to the project company (foreign enterprise) or OPIC clients that are publicly-held corporations.

6. Does the Project involve other Development Finance Institutions (DFIs)?

If yes, please check all that apply in the list provided. For “Other” option, please describe. Abbreviations are acceptable. OPIC reinsurance, co-insurance, or non-honoring sovereign guaranty projects apply to this question due to the additional participation of other insurance providers to support the project.

7. Do any of the U.S. investors in the Project (or one of its subsidiaries or affiliates) currently produce the same product(s) as that produced by this Project? If “Yes”, has the number of U.S. employees engaged in the U.S. production of this product been reduced as a result of this OPIC-supported investment?

OPIC is forbidden from financing “runaway” plants, in which the US company reduces its US operations and employment while increasing its overseas operations and employment. This question refers only to US production of the same or similar product as the Project.

If “Yes” has the number of U.S. employees engaged in the U.S. production of this product been reduced as a result of this OPIC-supported investment?

This question does not populate in the electronic version if the response to the previous is “No”.

(Intentionally Left Blank)

How many employees are currently employed by such U.S. company or its subsidiaries or affiliates that produce this product?

This only refers to employees involved in production of the same product as the project.

Question 2: Project Description

1. Project Type

The selection is prefilled in the electronic version and will either be selected as Financial Services or Non-Financial Services. If you believe an error has been made in the selection, please email [email protected] so that it can be corrected.

2. Describe the use of proceeds of this OPIC-supported investment.

How was the OPIC investment used in the project for this reporting period?

3. Has the description of the project changed since it was originally approved by OPIC?

This question refers to any material changes to the project since approval by OPIC. For example, the project has begun to manufacture or sell new product lines, or serve new international markets that were not envisioned at the time of OPIC consent for the project. Please check the appropriate box if you are answering “yes” to this question.

4. Project Site Region(s)

Please select for the available list a/all region(s) that apply to the project.

5. Project City and Country

Please list the host project’s host city and country. Example: Tbilisi, Georgia

Project Site Location (please include GPS coordinates)

Example: Washington DC’s GPS coordinates are:

38.8951118 - 77.0363658

N38° 53.7067', W077° 2.1819'.

If you do not know the longitude and latitude coordinates, you can use Google© Maps to find them. Google Maps

1. Open Google© Maps

2. Type address of project location into the appropriate field

3. Right click on location and select “What’s here”

4. A box will appear on the computer screen with address and GPS coordinates.

Click on the coordinates and they will populate in the address field in the upper left. You can then copy and paste into the SMQ GPS field.

6. Has the project become fully operational?

This question requires a Yes or No response.

If “Yes”, please provide the date the project became fully operational.

Please provide the month and year the project became operational in the spaces provided.

If “No” please specify the use(s) of the project funds during the reporting period: (select all that apply).

Please select all that apply from the options provided or Other with explanation.

7. Please provide the number of direct competitors currently in the project’s market.

Please list number of direct competitors in the market of the project.

8. Please specify the project’s most recently completed fiscal year and use data from this year to answer other fiscal year related questions throughout the form.

This refers to the fiscal year as determined by the project or investors accounting practices. Examples are 1/2015 to 12/2015, 7/2014 to 6/2015 and 10/2014 to 9/2015.

9. What is the total value of remittances (dividends, profits, loans/interest, royalties, etc.) from the project during the reporting period?

The project country

The U.S.

To other countries, excluding the U.S. and the project country

This question asks for the amount (in US dollars) of reflows to the U.S. and other countries for the reporting period. For example, interest and principal payments to OPIC would count as U.S. reflows, as would royalty payments made to the U.S. parent or patent owner. Examples of third country reflows would be principal and interest payments to foreign banks or dividend payments to non-U.S. project investors. If the project is an expansion, it is important to report only those remittances related to the expansion. If it is difficult to determine this, the portion of the project’s total capital represented by the expansion (e.g., 30%) multiplied by the project’s total remittances is sufficient. Please list remittances paid to the host country, The U.S. and any other countries in descending order of value.

10. What was the value of the project’s revenues over the reporting period: (If multiple product lines, please provide information on each product on a separate sheet.)

The project country

The U.S.

Other countries (in descending order of value)

This question asks for the total value of revenues earned in the reporting year. Examples of sources of revenue are:

• Sales

• Interest Income (Financial services)

• Fees Income (Financial services)

• Income from Leasing

11. This section applies to Non-Financial services projects only.

If the project is Non-Financial Services (as indicated in Question 2A), please check the appropriate project sector Classification and answer the questions associated with that classification.

• Agriculture/Agribusiness

  • Average agricultural yield (tonne/hectare)

  • Number of farmers that are linked to the project as:

    • Employees

    • Suppliers

    • Buyers

    • Contractors

• Education

  • Number of students enrolled

  • Number of local students enrolled (excluding children of foreign nationals)

• Energy

  • Please identify the type of energy generated (check all that apply)

    • Wind

    • Solar

    • Geothermal

    • Biofuels

    • Thermal (coal)

    • Thermal (natural gas)

    • Thermal (oil)

    • Hydro

  • Energy delivered to offtaker(s) in gigawatt hours (GWh)

• Energy Access

  • Number of new on-grid connections

  • Number of new micro-grid connections

  • Number of new household power systems installed

  • Number of new modern lighting devices sold

• Health

  • Number of patient consultations during the reporting period

• Housing

  • Number of new residential dwellings

  • Number of refurbished residential dwellings

• Information and Communications Technologies

  • Number of mobile subscriptions, including voice and/or data

  • Number of fixed data subscriptions

  • Number of fixed voice (telephone) subscriptions

• Transportation

  • Unites of cargo containers transported through the road/railway/port/airport per year in twenty foot equivalent units (TEUs).

  • Tonnes of bulk cargo transported through the road/railway/port/airport per year.

  • Number of passengers using transportation services per year.

• Waste & Sanitation

  • Amount of waste disposed per year (in tonnes)

  • Volume of wastewater treated per year (in m³)

• Water

  • Volume of potable water produced per year (in m³)

• Other

  • Please describe the project sector, with appropriate North American Industry Classification (NAICS) code.

Please select the classification that best describes the project’s industry and provide answers to the related questions asked. In the electronic form, only the questions associated with your selection will populate. If you cannot choose from the available choices, please select “Other” and provide an as comprehensive description as possible of the sector.

Please answer the questions associated with your project’s sector to the best of your ability.

(INTENTIONALLY LEFT BLANK)

(INTENTIONALLY LEFT BLANK)

(INTENTIONALLY LEFT BLANK)

12. What is the project target client or customer?

Please provide the total number of clients or customers served by the project during the reporting period.

Please provide a description of the project’s target client or customer. Examples are offtakers of an electricity generation unit, patients of a hospital, bank clients, and number of residents of a housing development.

Please also provide the number of clients/customers be served.

Part II A – Project Country Effects

(For Non-Financial Services Projects)

Question 1: Initial Sources of Project Proceeds (non-financial projects only)

1. This question asks for the debt, equity and other amounts that total the full amount of funding for the project.

Please provide the U.S. dollar amounts of debt, equity and other that total OPIC’s contribution to the project proceeds. (need help with the language here) Equity for OPIC will N/A.

2. This question asks for the debt, equity and other amounts that total sources of proceeds from the project itself.

What amount if any was from an offshore non-U.S. source?

Please provide the U.S. dollar amounts of debt, equity and other that total contribution to the project proceeds. (need help with the language here)

3. This question asks for U.S. sources other than the sponsor. (Please specify source and amounts per source)

What amount if any is from a U.S. public source? Examples: USAID, Export-Import Bank, U.S. Trade and Development Agency.

Please provide the U.S. dollar amounts of debt, equity and other that total contribution to the project proceeds. (need help with the language here)

4. This question asks for project country sources (please specify sources, countries, and amounts per country)

Please provide the U.S. dollar amounts of debt, equity and other that total contribution to the project proceeds. (need help with the language here)

5. This question asks for non-U.S. and non-project country sources (please specify sources)

Please provide the U.S. dollar amounts of debt, equity and other that total OPIC’s contribution to the project proceeds. (need help with the language here)

6. This question asks for Development Finance Institutions (International Finance Corporation, Inter-American Development Bank, etc.) Please specify

Please provide the U.S. dollar amounts of debt, equity and other that total contribution to the project proceeds. (need help with the language here)

7. This question asks for all other sources not specifically identified in A-F. Please specify.

Please provide the U.S. dollar amounts of debt, equity and other that total contribution to the project proceeds. (need help with the language here)

8. This question asks for the total of A-G for each category.

Please provide the TOTAL U.S. dollar amounts of debt, equity and other that total contribution to the project proceeds. (need help with the language here)

Question 2: Initial Uses of Project Proceeds (non-financial projects only)

A-E below refer to expenditures financed by the project proceeds total included in Q1 H.

1. This question asks for the U.S. dollar amount of proceeds used to make purchases or spent in the project country.

Of the amount reported in 2A how much will be spent on the procurement of goods and services from domestic suppliers?

Please provide response in U.S. dollars.

2. This question asks for the U.S. dollar amount of proceeds used to make purchases from the Unites States.

Please provide response in U.S. dollars.

3. This question asks for the U.S. dollar amount of proceeds used to make purchases from countries other than the project host country or the U.S.

Please specify countries and amounts per country in U.S. dollars.

4. This question asks for the U.S. dollar amount of proceeds used to for miscellaneous project costs, including costs not related to the procurement of assets/services (please specify what these costs represent, the countries in which these costs are incurred and amount per country)

Please describe the purchases, the country or countries where costs were incurred and amount per country.

5. This question asks for the total of the initial project proceeds uses.

Please provide response in U.S. dollars.

Question 3: Project Employment

1. Please provide the total current number of project direct employees for operations and management and during the construction phase (if applicable).

Total Current Direct Employment (Operations & Management)

• Local

  • Male

  • Female

    • Managerial

    • Professional/Technical

    • Unskilled Labor

• Foreign National

  • Male

  • Female

    • Managerial

    • Professional/Technical

    • Unskilled Labor

This question is asking for total current direct employees in the following categories: male, female, local, foreign national, managerial, professional/technical and unskilled labor. In the electronic form the total will automatically calculate. To avoid error messages at submission, please place zeros in any columns that do not apply.

2. Has the project utilized workers employed by third parties (i.e. through contractors/subcontractors) over the reporting period?

Please indicate if the project utilizes 3^rd party workers for physical construction, administrative needs or other operational needs. Please check all that apply.

Question 4: Project Construction and Temporary Employment (if applicable)

1. If your project has a construction phase and utilizes or utilized temporary construction workers, please provide the following. This also applies to seasonal employees if applicable.

Please provide the following categories: construction, seasonal male, female, local, and foreign national. If this question does not apply to your project or applies in part, please place zeros in the columns that do not apply to avoid any error messages.

Question 5: Job Quality

1. Does the project (or project company) offer employee development programs such as tuition reimbursement or formal mentorships to current non-management direct employees identified in question 1A of Part II?

If “Yes”, please describe what type of employee development programs are available to professional/technical and/or unskilled personnel.

This question requires a “Yes” or “No” response.

If response is “Yes”, please provide information regarding any of the programs you offer to enhance job quality in the space provided.

2. How many employees have been promoted during the reporting period?

Please indicate the number of employees promoted from unskilled positions to professional or technical positions.

Please indicate the number of employees promoted from professional or technical positions to managerial positions.

Please provide the number of employees promoted for each category listed. (Overall, unskilled to a higher level and professional or technical to managerial positions).

3. Please provide the average monthly wage (in local currency) that is paid to full-time equivalent unskilled employees identified in question 1A.

This question is asking for a monetary value in the local currency of the project’s host country.

4. Please provide the average monthly wage (in local currency) that is paid to full-time equivalent professional/technical employees identified in question 1A.

This question is asking for a monetary value in the local currency of the project’s host country.

Question 6: Human Resource Management

1. Does the project have written human resources policies?

Have there been any significant changes to the human resources policies during the reporting period?

If “Yes” please describe.

This question requires a “Yes” or “No” response.

If significant changes have been made, please describe in the area provided.

2. Please indicate the areas covered by the human resources policies: (Examples of Benefits: healthcare, life insurance, pension plan, vacation, maternity/paternity leave, childcare, etc.)

Is/are mechanism(s) in place for workers to express grievances (e.g., direct access to supervisors and/or human resources department, workers’ committees, and/or trade union reps, or an anonymous hotline?)

Do general conditions of work at the minimum, comply with local applicable labor laws (e.g., limits on hours of work, wages (including premium or overtime pay), sick leave, collective bargaining agreements)?

Are disciplinary procedures in place?

These questions require a “Yes” or “No” response.

If the respondent wishes to elaborate on any responses, additional documents of explanation can be uploaded at the end of the online SMQ form in the Supporting Documentation section.

3. Are terms of employment clearly communicated to each worker?

If “Yes”, please describe how employment terms are communicated to each worker and attach verifying documentation, such as a sample employment contract.

This question requires a “Yes” or “No” response.

Documents can be attached to the SMQ under the Supporting Documentation section.

4. Does the project management have experience in applying international labor standards such as those in the IFC Performance Standards?

If “Yes” please specify.

This question requires a “Yes” or “No” response. Please refer to the IFC’s Performance Standards, found on the IFC website www.ifc.org International certifications may include Fair Trade, SA8000, Rainforest Alliance, etc. A link to the English version is below. It is available in several languages: CLICK HERE

Link to PDF document of IFC Standards

http://www.ifc.org/wps/wcm/connect/115482804a0255db96fbffd1a5d13d27/PS_English_2012_Full-Document.pdf?MOD=AJPERES

Question 7: Project Labor-Related Issues
Has there been a significant change since the beginning of the reporting period in the number of employees, composition of employee’s demographics (gender, skill level, nationality/place of origin, etc.) of the workforce? If “Yes”, please describe.					This question requires a “Yes” or “No” response. If response is “Yes” please describe those changes in the space provided.
For B – K did the project involve the following during the reporting period?
Migrant or foreign workers (excludes foreign national management or highly-skilled non-manual workers)					This question requires a “Yes” or “No” response. If response is “Yes”, please provide the following information regarding the migrant or foreign workers: Number, National Origin, Skill Level, and Position and if they are living onsite at the project site. Foreign national management or highly skilled non-manual workers are exempt.
Workers under the age of 18 directly or indirectly employed by the project.					If response is “Yes”, please briefly describe the general duties of these workers and include the age of the youngest worker.
Restructuring that resulted in a major retrenchment (i.e. layoffs of significant numbers of workers) Did the project organization develop and implement a retrenchment plan?					If response is “Yes”, please describe the positions, skill levels, gender and the national origins of the workers who were dismissed. If a retrenchment plan has been developed, please describe and/or attach a copy. A typical retrenchment plan addresses issues such as consideration of alternatives to retrenchment; schedule of dismissals; retrenchment methods and procedures; selection criteria; severance payments; offers of alternative employment or assistance in retraining efforts; job placement.
Known non-compliance with local laws, OPIC labor related requirements, or other applicable labor standards (self-diagnosed, or as a result of official inspections or other audits)					If response is “Yes”, please describe the non-compliance in as much detail as possible what is being done to remedy the situation.
Is there an onsite trade union?					If response is “Yes”, please provide the percentage of workers covered by a collective bargaining agreement.
Labor-related lawsuits against the project?					If the response is “Yes”, please provide as much context as possible regarding the lawsuit(s) situation. Additional documents may be included by uploading them at the end of the SMQ
Labor unrest during the reporting period in the form of strikes or other general industrial disputes?					If the response is “Yes”, please provide as much context as possible regarding the labor unrest.
Ongoing or unresolved issues/disputes with a project trade union?					If the response is “Yes”, please provide as much context as possible regarding the unresolved issues or disputes.
Is there onsite security? If “Yes” are security guards armed? Is security publicly or privately contracted?					If response is “Yes” please answer the subsequent questions. Response is required.
Was the project or project organization required to submit to OPIC any reports on employment or labor practices or systems during the reporting period? If “Yes”, please list reports and dates of transmission of the reports. If a required report has not yet been submitted, please leave the date field blank and specify in the comments section why it has not been submitted and when it is expected to be submitted.					If reports have been submitted, please specify name and date of transmission to OPIC. Dates should be listed in the order of Day, Month, Year format (dd/mm/yyyy). If a report is due, but has not yet been transmitted, please list the name of the report, but leave the date blank. Please also explain reason for lateness of submission and expected date of transmission.
Question 7: Business Innovation
Please indicate if the project has operationalized a product, process, and/or technology that is new or not widely used in the domestic sector during the reporting period as a result of the OPIC-supported investment. Where applicable, please indicate whether any of these factors were new on uncommon in the project country and provide details.
Products and/or Services If “New” or “Uncommon”, please describe.					Please select New, Uncommon or No. If the response is New or Uncommon, please describe in the space provided.
Business Processes If “New” or “Uncommon”, please describe.					Please select New, Uncommon or No. If the response is New or Uncommon, please describe in the space provided.
Production and/or processing technologies If “New” or “Uncommon”, please describe.					Please select New, Uncommon or No. If the response is New or Uncommon, please describe in the space provided.
Has the project provided technical assistance (e.g. training of customers, industry counterparts, suppliers, technical expertise from fund manager) during the reporting period?					This question requires a “Yes” or “No” response. If “Yes” briefly explain the technical assistance provided.
Has the project secured voluntary sustainability certification from an internationally recognized certifying authority during the reporting period? If “Yes”, please identify.					These may include certifications such as: ISO 140000, 18001, 22000, EMAS, SA 8000, HACCP, OHSAS 18001 and/or other voluntary certifications. Please list any certifications the project has secured. This applies to new and existing certifications.
Question 8: Environmental and Community Benefits
As a result of the OPIC-supported investment, has the project implemented new initiatives (either corporate or project-related) that are directed at restoring and/or preserving the environment during the reporting period? If “Yes” please explain (e.g. paperless banking, favorable financing terms for project clients engaging in activities which preserve the environment.					This question requires a “Yes” or “No” response. If the response is “Yes”, please explain the activities which work to preserve the environment.
Did the project contribute money towards activities that benefit local communities (e.g. recreational facilities, schools, medical clinics, scholarship programs, other charitable activities) during the reporting period? If “Yes” please provide the value of these expenditures during the reporting period and describe these activities.					This question requires a “Yes” or “No” response. If the response is “Yes”, please provide the monetary value of the contributions in U.S. dollars and provide a description of the activities contributed to.
Does the project have an Environment and Social Management System (ESMS)? If “Yes” please explain or attach a copy of the ESMS (in English)					This question requires a “Yes” or “No” response. If the response is “Yes”, please explain the ESMS or attach a copy in English. A copy can be attached in the Supporting Documentation Section of the SMQ in OPIC Forms.
Question 9: Environmental Impact
Is the project currently in compliance with all conditions in the OPIC contract or consent with respect to environment, health and safety? If “No”, please describe the areas of non-compliance.					This question requires a “Yes” or “No” response. If the project is non-compliant with any conditions of the contract or consent, please describe in detail in the box provided. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Has the project been cited or fined for any violation of local or host country environmental, health or safety laws during the reporting period? If “Yes”, please explain briefly below.					This question requires a “Yes” or “No” response. If the project has been cited or fined for any violations as described, please explain briefly in the box provided. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Has the project submitted all OPIC-required reports on environment, health and safety during the reporting period? If “Yes”, please list reports and dates of transmission of the reports. If a required report has not yet been submitted, please leave the date field blank and specify in the comments section why it has not been submitted and when it is expected to be submitted.					This question requires a “Yes”, “No” or “Not Applicable” response. (Typically Financial Projects are not required to submit such reports) Please check your project documents or with the project sponsor to determine if such reports are required. If reports have been submitted, please specify name and date of transmission to OPIC. Dates should be listed in the order of Day, Month, Year format (dd/mm/yyyy). If a report is due, but has not yet been transmitted, please list the name of the report, but leave the date blank. Please also explain reason for lateness of submission and expected date of transmission.
Have there been any changes in the design or capacity of the project that result in increased hazards to workers, area residents, or the environment during the reporting period? If “Yes”, please explain briefly below.					This question requires a “Yes” or “No” response. If the project has experienced changes in design or capacity that result in increased hazards, please explain. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Have any accidents occurred that resulted in loss of human life or material impacts on the environment during the reporting period? If so, please describe briefly below.					This question requires a “Yes” or “No” response. If the project has experienced accidents resulting in loss of life, please explain. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Question 10: Project Country Regulatory Environment
Has the project resulted from our caused any project country reforms, new legislation, or new regulations during the reporting period? If “Yes”, please explain.		This question requires a “Yes” or “No” response. Please explain any “Yes” responses. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms if necessary.
Has the project partnered with or received support from a public entity (i.e.-a local development bank/federal or local government/NGO) during the reporting period? If “Yes”, please indicate the type of party involved and describe their involvement.		This question requires a “Yes” or “No” response. If the response is “Yes”, please select the appropriate box(es) and describe their involvement. Examples include: The host country government institutions may include ministries, state/regional organizations, or local government offices. Government support can be contributed in various ways but should be direct and measurable. For example, a local government that donates city-owned property for a housing project, a national government agency offering technical assistance, or a state agency providing construction support. The criterion for this question is additional support for the project from a host country government entity or a local non-governmental organization. The fact that OPIC, as a U.S. public sector entity, is involved in the project, is not sufficient to receive credit for this indicator.
Question 11: Project Operational Procurement
Has the project procured goods and services from project country sources during the reporting period? If “Yes”, please provide the average annual amount of operational procurement (excluding utilities, rent, tax payments and labor) from project country sources during the reporting period. Please also briefly describe the goods and/or services that have been procured by OPIC support.	If the response is “Yes”, please provide the average annual amount of operational procurement in U.S. dollars. The reported amount should exclude payments of utilities, rent, taxes and labor expenses. Please provide a description of the goods and/or services the project procured.
Question 12: Project Payments to Host Government
Please provide all taxes or transfers to the host government made by the project during the reporting period.				Please provide the amount in U.S. dollars.
If the project is eligible for a tax holiday, indicate the duration of the tax holiday.				Please provide the tax holiday in a number of years.
If duties and/or tax payments to project country government have been reduced as a result of the project, please estimate the amount lost during the reporting period.				Please provide the amount in U.S. dollars.
Part II B – Project Country Effects (For Financial Services Projects)
Question 1: Financial Intermediary – Current Total Portfolio
Please provide the following portfolio information on the financial intermediary’s total portfolio during the reporting period: Number of transactions Number of clients Value of outstanding portfolio Average transaction amount per client Maximum transaction amount per client Minimum transaction amount to single client Average tenor (in months) % of the portfolio (based on number of clients) that targets rural clients. % of the portfolio (based on number of clients) that are women or women-owned businesses.		Please provide responses for the financials of the entire financial institution in the appropriate category: i.e. number, U.S. dollar value or percentage.
Question 2: Portfolio – Transaction Type
Please identify the type of project transactions supported by the OPIC-supported investment. Check all that apply.
MICROFINANCE LOANS ONLY The series of questions in section Q2A pertain to microfinance loans only. How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Responses for this question are for MICROFINANCE LOANS ONLY Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
SME LOANS ONLY The series of questions in section Q2A pertain to SME loans only. How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Responses for this question are for SME LOANS ONLY Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
MICROFINANCE OR SME LOAN PORTFOLIO INFORMATION If the OPIC investment supports Microfinance or SME loans, please provide the following total portfolio information for the reporting period: Number of project transactions Number of project clients Value of project outstanding portfolio Average transaction amount per client Maximum transaction amount to a single client Minimum transaction amount to a single client Average tenor (in months) Purpose of the transactions as a percentage of the outstanding value of portfolio reported in question 1A: Start-up Capital Working Capital Expansion Capital Equipment Capital Other (please specify) Business activities/sectors of clients of as a percentage of the outstanding value of portfolio reporting in question 1A: Manufacturing Agriculture Construction Transportation Communication Tourism Trade/Retail Energy Services (please specify) Other (please specify) Demographic distribution of clients as a percentage of the outstanding value of portfolio in question 1A: Women (or women-managed businesses) Rural Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in the appropriate category: i.e. number, U.S. dollar value or number of months. Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages. Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages. Please check the appropriate box that best describes each demographic. “Yes”, No or “Not Applicable” if the project does not or is not able to track such information.
EQUITY INVESTMENTS The series of questions in section Q2C pertain to Equity Investments only. How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
SME LOANS AND MICROFINANCE COMBINED The series of questions in section Q2C pertain to SME AND MICROFINANCE COMBINED LOANS only. How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
EQUITY INVESTMENT OR OTHER PORTFOLIO INFORMATION If the OPIC investment supports Equity Investments, please provide the following portfolio information for the reporting period. Number of project transactions Number of project clients Value of project outstanding portfolio Average transaction amount per client Maximum transaction amount to a single client Minimum transaction amount to a single client Average tenor (in months)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in the appropriate category: i.e. number, U.S. dollar value or number of months.
Economic segments of clients as a percentage of the outstanding value of portfolio in question 1A: Microenterprises Small & Medium Enterprises Large Corporations Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Purpose of the transactions as a percentage of the outstanding value of portfolio in question 1A: Start-Up Capital Working Expansion Expansion Capital Equipment Purchase Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Business activities/sectors of clients as a percentage of the outstanding value of portfolio in question 1A: Manufacturing Agriculture Construction Transportation Communication Tourism Trade/Retail Energy Services (please specify) Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Demographic distribution of clients as a percentage of the outstanding value of portfolio in question 1A: Women (or women-managed businesses) Rural Other (please specify)	Please check the appropriate box that best describes each demographic. “Yes”, No or “Not Applicable” if the project does not or is not able to track such information.
LEASING CONTRACTS How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
LEASING PORTFOLIO INFORMATION If the OPIC investment will support Leasing, please provide the following total portfolio information and projections for the reporting period. Number of project transactions Number of project clients Value of project outstanding portfolio Average transaction amount per client Maximum transaction amount to a single client Minimum transaction amount to a single client Average tenor (in months)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in the appropriate category: i.e. number, U.S. dollar value or number of months.
Please provide the economic segments of clients as a percentage of the outstanding total value of portfolio in question 1A. Microenterprises Small & Medium Enterprises Large Corporations Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Please provide the business activities/sectors of clients as a percentage of the total outstanding value of portfolio in question 1A. Manufacturing Agriculture Construction Transportation Communication Tourism Trade/Retail Energy Services (please specify) Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Demographic distribution of clients as a percentage of the outstanding value of portfolio in question 1A: Women (or women-managed businesses) Rural Other (please specify)	Please check the appropriate box that best describes each demographic. “Yes”, No or “Not Applicable” if the project does not or is not able to track such information.
CONSUMER LOANS How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
CONSUMER LOAN PORTFOLIO INFORMATION If the OPIC investment supports Consumer Loans, please provide the following portfolio information for the reporting period. Number of project transactions Number of project clients Value of project outstanding portfolio Average transaction amount per client Maximum transaction amount to a single client Minimum transaction amount to a single client Average tenor (months)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in the appropriate category: i.e. number, U.S. dollar value or number of months.
Demographic distribution of clients as a percentage of the outstanding value of portfolio in question 1A: Women (or women-managed businesses) Rural Other (please specify)	Please check the appropriate box that best describes each demographic. “Yes”, No or “Not Applicable” if the project does not or is not able to track such information.
INSURANCE CONTRACTS How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
INSURANCE CONTRACTS PORTFOLIO INFORMATION If the OPIC investment supports Insurance Contracts, please provide the following total portfolio information and projections for the reporting period. Number of project transactions Number of project clients Value of project outstanding portfolio Average transaction amount per client Maximum transaction amount to a single client Minimum transaction amount to a single client Average tenor (months)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in the appropriate category: i.e. number, U.S. dollar value or number of months.
Please provide the economic segments of clients as a percentage of the outstanding total value of portfolio in question 1A. Microenterprises Small & Medium Enterprises Large Corporations Other (Please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Please provide the business activities/sectors of clients as a percentage of the total outstanding value of portfolio in question 1A. Manufacturing Agriculture Construction Transportation Communication Tourism Trade/Retail Energy Services (please specify) Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Demographic distribution of clients as a percentage of the outstanding value of portfolio in question 1A: Women (or women-managed businesses) Rural Other (please specify)	Please check the appropriate box that best describes each demographic. “Yes”, No or “Not Applicable” if the project does not or is not able to track such information.
MORTGAGES How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
MORTGAGE PORTFOLIO INFORMATION If the OPIC investment supports Mortgages, please provide the following portfolio information and projections for the reporting period. Number of project transactions Number of project clients Value of project outstanding portfolio Average transaction amount per client Maximum transaction amount to a single client Minimum transaction amount to a single client Average tenor (months)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in the appropriate category: i.e. number, U.S. dollar value or number of months. (Intentionally Blank)
How much capital has been invested in the project as of the end of the reporting period? Has the project received additional financing (public and/or private) during the reporting period? If “Yes”, how much additional financing did the project receive during the reporting period?	Please respond in U.S. dollars for the Total Portfolio and the OPIC-supported portfolio. This question requires a “Yes” or “No” response. Please respond in U.S. dollars.
Please provide the purpose of the mortgages as a percentage of the outstanding value of portfolio in question 1A. Mortgages for new homeowners Home improvement loans Productive loan (e.g. home equity, loan/line of credit) Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Please provide the target market of mortgages as a percentage of the outstanding value of portfolio in question 1A. Low-income homes Middle-income homes High-income homes Residential rental properties Commercial properties Other (please specify)	Please provide responses for the financials of both the total portfolio of the FI and the OPIC-supported portfolio in percentages.
Demographic distribution of clients as a percentage of the outstanding value of portfolio in question 1A: Women (or women-managed businesses) Rural Other (please specify)	Please check the appropriate box that best describes each demographic. “Yes”, No or “Not Applicable” if the project does not or is not able to track such information.
Question 3: Project Employment
Please provide the current total number of project direct employees for operations & management
Total Current Direct Employment (Operations and Management) Local Male Female Managerial Professional/Technical Unskilled Labor Foreign Nationals Managerial Professional/Technical Unskilled Labor			This question is asking for total current direct employees in the following categories: male, female, local, foreign national, managerial, professional/technical and unskilled labor. In the electronic form the total will automatically calculate. To avoid error messages at submission, please place zeros in any columns that do not apply. (Include a definition for foreign national?)
Has the project utilized workers employed by third parties (i.e. through contractors/subcontractors) during the reporting period?			Please select all that apply or leave blank if none apply.

Question 4: Project Human Resource Management
Does the project have written human resource policies? Have there been any significant changes to the human resources policies during the reporting period? If “Yes”, please describe.			This question requires a “Yes” or “No” response by checking the appropriate box. If there have been significant changes in the HR policies please describe in detail in the space provided. Please provide an explanation if the response is “Yes”.
Please indicate the areas covered by the human resources policies: (Examples of Benefits: healthcare, life insurance, pension plan, vacation, maternity/paternity leave, childcare, etc.) Is/are mechanism(s) in place for workers to express grievances (e.g., direct access to supervisors and/or the human resources department, workers’ committees, and/or trade union reps, or an anonymous hotline)? Do general conditions of work at the minimum, comply with local applicable labor laws (e.g., limits on hours of work, wages (including premium or overtime pay), sick leave, collective bargaining agreements)? Are disciplinary procedures in place?			Please describe in detail the benefits provided to employees by the human resources policies. Requires a “Yes” or “No” response. Requires a “Yes” or “No” response. Requires a “Yes” or “No” response.
Are terms of employment clearly communicated to each worker? If “Yes” please describe how employment terms are communicated to each worker and attach verifying documentation, such as a sample employment contract.			Requires a “Yes” or “No” response. Please describe terms and how they are communicated to employees.
Does the project management have experience in applying international labor standards, such as those in the IFC Performance standards? If “Yes”, please specify.			This question requires a “Yes” or “No” response. Please refer to the IFC’s Performance Standards, found on the IFC website www.ifc.org A link to the English version is below. It is available in several languages: CLICK HERE Link to PDF document of IFC Standards http://www.ifc.org/wps/wcm/connect/115482804a0255db96fbffd1a5d13d27/PS_English_2012_Full-Document.pdf?MOD=AJPERES
Question 5: Project Labor-Related Issues
Has there been a significant change since the beginning of the reporting period in the number of employees, composition of employees, demographics (gender, skill level, nationality/place of origin, etc.) of the workforce? If “Yes”, please explain.			This question requires a “Yes” or “No” response. If response is “Yes” please describe those changes in the space provided.
Did the project involve any of the following during the reporting period?
Workers under the age of 18 (directly or indirectly employed by the project) If “Yes”, please briefly describe the general duties of these workers and include the age of the youngest worker.	This question requires a “Yes” or “No” response. Please provide as much detail as possible about any duties being performed by workers under the age of 18 and the ages of the workers.
Restructuring which results in a major retrenchment (i.e. lays off significant numbers of workers) If “Yes”, please describe the positions, skill level, gender, and the national origin of the workers who were dismissed. If “Yes”, did the organization develop and implement a retrenchment plan? If “Yes”, please describe and/or attach this plan. Is there any foreseen possibility of a major retrenchment in the next reporting year?	If response is “Yes”, please describe the positions, skill levels, gender and the national origins of the workers who were dismissed. If a retrenchment plan has been developed, please describe and/or attach a copy. A typical retrenchment plan addresses issues such as consideration of alternatives to retrenchment; schedule of dismissals; retrenchment methods and procedures; selection criteria; severance payments; offers of alternative employment or assistance in retraining efforts; job placement.
Known non-compliance with local laws, OPIC labor-related requirements, or other applicable labor standards (self-diagnosed, or as a result of official inspections or other audits) If “Yes”, please describe	If response is “Yes”, please describe the non-compliance in as much detail as possible what is being done to remedy the situation.
Labor-related lawsuits against the project If “Yes”, please describe	If response is “Yes”, please describe in as much detail as possible the lawsuits against the project.
Labor unrest during the reporting period in the form of strikes or other general industrial disputes If “Yes”, please describe	If response is “Yes”, please describe in as much detail as possible the strikes or other general industrial disputes.
Ongoing or unresolved issues/disputes with a project trade union If “Yes”, please describe	If response is “Yes”, please explain the unresolved issues or disputes.
Was the project or project organization required to submit to OPIC any reports on employment or labor practices or systems during the reporting period? If “Yes”, please list reports and dates of transmission of the reports. If a required report has not yet been submitted, please leave the date field blank and specify in the comments section why it has not been submitted and when it is expected to be submitted.	If “Yes”, please list reports and dates of transmission of the reports. If a required report has not yet been submitted, please leave the date field blank and specify in the comments section why it has not been submitted and when it is expected to be submitted.
Question 6: Project Business Innovation
Please indicate if the project operationalized a product, process, and/or technology that is new or not widely used in the domestic sector during the reporting period as a result of the OPIC-supported investment. Where applicable, please indicate whether any of these factors are new or uncommon in the project country and provide details.
New Financial Products and/or Services If “New” or “Uncommon”, please describe		These have changed from last time and I am not sure what I should put here.
Business Processes If “New” or “Uncommon”, please describe		These have changed from last time and I am not sure what I should put here.
Innovative Financing Structures If “New” or “Uncommon”, please describe		These have changed from last time and I am not sure what I should put here.
Has the project provided technical assistance (e.g., training of customers, industry counterparts, suppliers, technical expertise from fund manager) during the reporting period? If “Yes”, please describe		Technical assistance may include training of customers, of industry counterparts, of suppliers, etc.
Has the project secured voluntary sustainability certification from an internationally-recognized certifying authority during the reporting period? If “Yes”, please identify.		These may include certifications such as ISO 14000, 18001, and/or other voluntary certifications.
Question 7: Project Environmental and Community Benefits
As a result of the OPIC-supported investment, has the project implemented new initiatives (either corporate or transactional) which are directed at restoring and/or preserving the environment during the reporting period? If “Yes”, please describe (e.g. paperless banking, favorable financing terms for project clients engaging in activities which preserve the environment)
Did the project contribute money towards activities that benefit local communities (e.g. recreational facilities, schools, medical clinics, scholarship programs, other charitable activities) during the reporting period? If “Yes”, please provide the actual value of these expenditures during the reporting period and describe these activities.		Please provide the expenditures amount in U.S. dollars and provide a detailed description of the expenditures.
Does the project have an Environmental and Social Management System (ESMS)? If “Yes” please explain or attach a copy of the ESMS (in English)

Question 8: Project Environmental Impact
Is the project currently in compliance with all conditions in the OPIC contract or consent with respect to environment, health and safety? If “No”, please describe the areas of non-compliance.				This question requires a “Yes” or “No” response. If the project is non-compliant with any conditions of the contract or consent, please describe in detail in the box provided. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Has the project been cited or fined for any violation of local or host country environmental, health or safety laws during the reporting period? If “Yes”, please explain briefly below.				This question requires a “Yes” or “No” response. If the project has been cited or fined for any violations as described, please explain briefly in the box provided. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Has the project submitted all OPIC-required reports on environment, health and safety during the reporting period? If “Yes”, please list reports and dates of transmission of the reports. If a required report has not yet been submitted, please leave the date field blank and specify in the comments section why it has not been submitted and when it is expected to be submitted.				This question requires a “Yes”, “No” or “Not Applicable” response. (Typically Financial Projects are not required to submit such reports) Please check your project documents or with the project sponsor to determine if such reports are required. If reports have been submitted, please specify name and date of transmission to OPIC. Dates should be listed in the order of Day, Month, Year format (dd/mm/yyyy). If a report is due, but has not yet been transmitted, please list the name of the report, but leave the date blank. Please also explain reason for lateness of submission and expected date of transmission.
Have there been any changes in the design or capacity of the project that result in increased hazards to workers, area residents, or the environment during the reporting period? If “Yes”, please describe briefly below.				This question requires a “Yes” or “No” response. If the project has experienced changes in design or capacity that result in increased hazards, please explain. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Have any accidents occurred that resulted in loss of human life or material impacts on the environment during the reporting period? If so, describe briefly below.				This question requires a “Yes” or “No” response. If the project has experienced accidents resulting in loss of life, please explain. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms.
Question 9: Project Country Regulatory Environment
Has the project resulted from or caused any project country reforms, new legislation, or new regulations during the reporting period? If “Yes”, please explain.		This question requires a “Yes” or “No” response. Please explain any “Yes” responses. Additional documents can be attached in the Supporting Documentation section of the SMQ in OPIC Forms if necessary.
Has the project partnered with or received support from a public entity (i.e. a local development bank/federal or local government/NGO) during the reporting period? If “Yes”, please indicate the type of party involved and describe their involvement. Project country government entity Local non-governmental organization International non-governmental organization U.S. entity Other		This question requires a “Yes” or “No” response. If the response is “Yes”, please select the appropriate box(es) and describe their involvement. Examples include: The host country government institutions may include ministries, state/regional organizations, or local government offices. Government support can be contributed in various ways but should be direct and measurable. For example, a local government that donates city-owned property for a housing project, a national government agency offering technical assistance, or a state agency providing construction support. The criterion for this question is additional support for the project from a host country government entity or a local non-governmental organization. The fact that OPIC, as a U.S. public sector entity, is involved in the project, is not sufficient to receive credit for this indicator.
Question 10: Project Payments to Host Government
Please provide all taxes or transfers to the host government made by the project during the reporting period.			Please provide the tax amount in U.S. dollars. Link provided below to XE currency converter website. http://www.xe.com/currencyconverter/
If the project is eligible for a tax holiday, indicate the duration of the tax holiday.			Please provide this information in years.
If duties and/or tax payments to project country government have been reduced as a result of the project, please estimate the amount lost during the reporting period.			Please Provide the estimation in U.S. dollars. http://www.xe.com/currencyconverter/
Part III – U.S. Supplier and Procurement Information
Did the project procure any products and/or services from the United States during the reporting period?	This question requires a “Yes” or “No” response and if the response is “Yes”, please provide the following information about each U.S. supplier: Name of U.S. Supplier City State Zip code U S Zip Code Look Up Tool Minority-owned Business (check box if applicable) Woman-owned Business (check box if applicable) U.S. small business (check box if applicable) Type of Good or Service U.S. Dollar Value of amount procured in reporting period.
Supporting Documentation Section
Prior to submission any documents you need to add can be attached in this section. Please provide a question number if applicable and a title, description or comment about the attached document. Documents can also be removed. The system accepts the following document formats: .doc, docx, .docm, .jpg, .msg., .ppt, .rtf, .tif, .tiff, .txt, .zip, .pdf, .xls, .xlsx, .xlsm
Part IV – Investor/Representative Certification All fields of this section must be completed before submission.

revised smq guidelines	0