Form 248 Office of Investment Policy Questionnaire

Office of Investment Policy Questionnaire

OPIC 248 OIP Questionnaire

Office of Investment Policy Questionnaire

OMB: 3420-0032

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OVERSEAS 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-investment-policies.







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

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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.



Shape2 I have read and agree to the terms and conditions listed above.




GETTING STARTED


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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.



PART I – PROJECT SUMMARY

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INVESTMENT

FUNDS

REINSURANCE

INSURANCE

FINANCE


Please click on the appropriate OPIC product line:


  1. PROJECT INFORMATION

A

Applicant (or Financial Intermediary) Name:

B

Project Name:

C

Target percentage ownership of Applicant (or Financial Intermediary) in the Project.

____%

D

Please provide the estimated percentage of local ownership of the Project, if any.

____%


E

Is any of the local ownership comprised of Small & Medium Enterprises (SMEs)?

Yes

No

If Yes, please provide what percentage of local ownership is accounted for by Small & Medium Enterprises.

____%


F

Is there or will there be any female ownership of the Project?

Yes

No

If Yes, please provide the percentage of the Project that is or will be female-owned.

____%

G

Please provide the current or projected number of members of the Project’s Board of Directors or other governing body, if applicable.


Male


Female

H

Please provide the number of current or projected number of women in executive management positions

____#


I

Do any of the U.S. investors in the Project (or one of its subsidiaries or affiliates) currently produce the same product(s) as the one to be produced by this Project?

Yes

No

If Yes, will the number of employees engaged in the U.S. production of this product be reduced as a result of this OPIC-supported investment?

Yes

No

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

________





  1. PROJECT DESCRIPTION

A

Please check appropriate box:

Financial Services

Non-Financial Services

B

Please check appropriate box:

New Enterprise

(no existing facilities and/or operations)

Existing Enterprise

C

Project City and Country:


D

Describe the use of proceeds of this OPIC-supported investment:



E





Description of the Project and its operations:




If Financial Services, please proceed to Part II (B)


F

If Non-Financial Services, please check the appropriate Project sector classification:


Agriculture/Agribusiness


If Agriculture/Agribusiness, please answer the following questions:

Current

Projected by 5th year

Average agricultural yield (tonne/hectare)

# (tonne per hectare)

# (tonne per hectare)

Number of farmers that are linked to the Project as:




Employees

#

#


Suppliers

#

#


Buyers


#

#


Contractors


#

#


Education


If Education, please answer the following questions:

Current

Projected by 5th year

Number of students enrolled

#

#

Number of female students enrolled



Number of local students enrolled (excluding children of expatriates)

#

#

Number of needs-based scholarships for local students (per year)

#

#


Energy

If Energy, please answer the following question:

Current

Projected by 5th year

Energy delivered to offtaker(s) per year (GWh)

#GWh

#GWh



Health

If Health, please answer the following question:

Current

Projected by 5th year

Number of patient consultations provided per year

#

#


Number of patient consultations provided per year to women

#

#

Housing

If Housing, please answer the following questions:

Current

Projected by 5th year

Number of new residential dwellings

#

#

Number of refurbished residential dwellings

#

#


Information & Communications Technologies

If Information & Communications Technologies, please answer the following questions:

Current

Projected by 5th year

Number of mobile subscriptions, including voice and/or data

#

#

Number of fixed data subscriptions

#

#

Number of fixed voice (telephone) subscriptions

#

#


Transportation

If Transportation, please answer the following questions:

Current

Projected by 5th year

Units of cargo containers transported through the road/railway/port/airport per year (twenty foot equivalent units)

# TEUs

# TEUs

Tons of bulk cargo transported through the road/railway/port/airport per year

# tons

# tons

Passengers using transportation service per year

#

#


Waste & Sanitation

If Waste & Sanitation, please answer the following questions:

Current

Projected by 5th year

Amount of waste disposed per year (tons)

# tons

# tons

Volume of wastewater treated per year (m³)

# m³

# m³


Water

If Water, please answer the following question:

Current

Projected by 5th year

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)

_________#



  1. PROJECT SITING



A


Project Site Location (please include GPS coordinates and, if available, a map of site location):



B

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




  1. 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












PART IIA – PROJECT COUNTRY EFFECTS

(For Non-Financial Services Projects)



1.    PROJECT OPERATIONS AND MANAGEMENT EMPLOYMENT

A

Please provide the current and projected number of Project employees for operations & management (not including employment during the construction phase) by the 5th year of operations.


Current Employment

(Operations and Management)

Projected Employment

(Operations & Management)

by year five of operations as a result of this OPIC-Supported Investment  

Total Projected Employment (Operations & Management)

by the 5th year of operations

Local

Foreign Nationals

Male

Female



Local

Foreign Nationals

Local

Foreign Nationals

Managerial











Professional/











Technical








Unskilled Labor











TOTAL











B

Will the Project utilize workers employed by third parties (i.e., through contractors/subcontractors) once the Project is operational?

Yes

No

For physical construction

For administrative needs

For other operational needs



2. PROJECT CONSTRUCTION LABOR



A

If physical construction is involved, has construction already begun?

Yes

No


If Yes, approximately how much has been completed (estimate in % completed terms)?


Estimated start-up/construction period (if applicable):

MM/YYYY – MM/YYYY

Estimated operational start date (if applicable):

MM/YYYY



B

Please provide the current and projected number of Project employees during the construction phase.


Employment

(Construction Phase )

Local

Foreign nationals

Managerial



Professional/Technical




Unskilled Labor



TOTAL





C

Will the Project utilize workers employed by third parties (i.e., through contractors/subcontractors) during Project start-up or construction phase?

Yes

No


For physical construction

For administrative needs

For other operational needs



D

Will the Project require the establishment of temporary worker housing facilities?

Yes

No


If Yes, how many workers are expected to be housed at these facilities? ____________


3. JOB QUALITY

A

Does or will the Project (or Project Company) offer employee development programs, such as tuition reimbursement or formal mentorships to both current and new non-management employees identified above in Question 1A above?


Yes


No

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

B

Does or will the Project (or Project Company) offer other employee benefits that exceed local legal requirements to both current and new non-management employees identified above in Question 1A above?

Yes

No

If Yes, please provide a list of employee benefits that exceed local law that are or will be available to non-management personnel:

C

Please provide the average monthly wage (in local currency) that is or will be paid to full-time equivalent unskilled employees identified in Question 1A above.

____local currency/month

D

Please provide the average monthly wage (in local currency) that is or will be paid to full-time equivalent professional/technical employees identified in Question 1A above.

__ local currency/

month


4. PROJECT BENEFITS TO WOMEN, ENVIRONMENT, AND COMMUNITY

A

Does (or will) the Project (1) have any direct or ancillary benefits for women, (2) consider gender issues in the project design and/or implementation, or (3) include specific actions to address gender-related vulnerabilities?

Yes

No


If Yes, please describe.

B

Does the Project specifically serve female clients or customers?

Yes

No


If Yes, please provide the number of female clients that are currently served per year and projected to be served by the 5th year of operations.

Current:

# per year


Projected by 5th year:

# per year

C

As a result of this OPIC-supported investment, will the Project implement initiatives (either corporate or transactional) which are directed at restoring and/or preserving the environment?

Yes

No

If Yes, please explain (e.g., paperless banking, favorable financing terms for Project clients engaging in activities which preserve the environment).


D

Does (or will) the Project contribute money towards activities that benefit local communities (e.g., recreational facilities, schools, medical clinics, scholarship programs, other charitable activities)?

Yes

No


If Yes, please provide the actual or expected annual budget for these activities and describe these activities.

_____$/year

E

Does the Project have an Environmental and Social Management System (ESMS)?

Yes

No


If Yes, please attach a copy of the ESMS (in English).


5. PROJECT HUMAN RESOURCE MANAGEMENT

A

Does (or will) the Project have written human resources policies?


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).

Yes

No

Disciplinary procedures.

Yes

No



C

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

D

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 specify.





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

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).

Yes

No

If Yes, please describe.

E

Is there an onsite trade union?

Yes

No

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

If Yes, please describe.


G

Labor unrest in the last three years in the form of strikes or other general industrial disputes.

Yes

No

If Yes, please describe.


H

Ongoing or unresolved issues/disputes with a Project trade union.

Yes

No

I

Is there onsite security?

Yes

No

If Yes, are security guards armed?

Yes

No

Is security publically or privately contracted?

Publicly Contracted

Privately Contracted




7. BUSINESS INNOVATION

Please indicate if the Project will operationalize a product, process, and/or technology that is new or not widely used in the domestic sector 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.

A

Products and/or services

New

Uncommon

No

If New or Uncommon, please describe.

B

Business Processes

New

Uncommon

No

If New or Uncommon, please describe.

C

Production and/or processing technologies (if New or Uncommon, please describe).

New

Uncommon

No

If New or Uncommon, please describe.

D

Will there be any technical assistance provided by the Project?

Yes

No

If Yes, please describe.

E

Has (or will) the Project secure(d) voluntary sustainability certification from an internationally-recognized certifying authority?

Yes

No

If Yes, please identify.


PART IIB – PROJECT COUNTRY EFFECTS

(For Financial Services Projects)



  1. FINANCIAL INTERMEDIARY– CURRENT TOTAL PORTFOLIO



A

Please provide the following portfolio information on the Financial Intermediary’s current total portfolio.

Current Total Portfolio

Number of transactions per year

#

Number of clients

#

Value of outstanding portfolio ($US)

$

Average transaction amount per client ($US)

$

Maximum transaction amount to a single client ($US)

$

Minimum transaction amount to a single client ($US)

$

Average tenor (in months)

(months)

% of the portfolio that are rural clients (based on number of clients)

%

# of clients that are women or women-owned businesses

%





  1. PROJECT PORTFOLIO – TRANSACTION TYPE & PORTFOLIO INFORMATION

Please identify the type of Project transactions supported by the OPIC-supported investment. Check all that apply.

Microfinance loans

Yes

No

If Yes, please provide the following portfolio information and projections on the OPIC-supported Microfinance portfolio:

A

Current portfolio information and projections for OPIC-supported Microfinance portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over next five years)

Number of Project clients

#

# (total over next five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months

B

Purpose of the transactions as a percentage of the outstanding value of the Microfinance portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Start-Up Capital

%

%

Working Capital

%

%



Expansion Capital

%

%


Equipment Purchase

%

%

Other (please specify):      

%

%

C


Business activities/sectors of clients as a percentage of the outstanding value of the applicable portfolio in A above

Current Portfolio

Projected OPIC-supported portfolio

Manufacturing

%

%

Agriculture

%

%

Construction

%

%

Transportation

%

%

Communication

%

%

Tourism

%

%

Trade/Retail

%

%

Energy

%

%

Services (please specify):      

%

%

Other (please specify):      

%

%

D

Project’s impact on Female Borrowers


Does (or will) the Financial Intermediary serve female borrowers?

Yes

No


If Yes, number of female clients

Current Portfolio

#

5-year Projections

#


If Yes, value of portfolio to female clients

Current Portfolio

US$

5-year Projections

US$


Will the OPIC-supported investment increase lending to female clients?

Yes

No


If Yes, please indicate the US$ value of the OPIC-supported investment that will be specifically earmarked for lending to female borrowers (if applicable).

US$


If Yes, how many new female borrowers are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to female borrowers (i.e., tailored financial products/services, trainings, seminars, outreach to women entrepreneur associations).

E

Demographic distribution of clients as a percentage of the number of clients in the applicable portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio




Rural

%

%

Other (please specify):      

%

%


SME Loans

Yes

No


If Yes, please provide the following portfolio information and projections on the OPIC-supported SME portfolio:

A

Current portfolio information and projections for OPIC-supported SME portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over next five years)

Number of Project clients

#

# (total over next five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months


Purpose of the transactions as a percentage of the outstanding value of the SME portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

B

Start-Up Capital

%

%

Working Capital

%

%

Expansion Capital

%

%



Equipment Purchase

%

%

Other (please specify):      

%

%

C


Business activities/sectors of clients as a percentage of the outstanding value of the SME portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Manufacturing

%

%

Agriculture

%

%

Construction

%

%

Transportation

%

%

Communication

%

%

Tourism

%

%

Trade/Retail

%

%


Energy

%

%

Services (please specify):      

%

%

Other (please specify):      

%

%

D

Project’s impact on women-owned and/or led SMEs


Does (or will) the Financial Intermediary serve women-owned and/or managed SMEs?

Yes

No


If Yes, number of women-owned and/or led SMEs

Current Portfolio

#

5-year Projections

#


If Yes, value of SME portfolio to women-owned and/or led enterprises

Current Portfolio

US$

5-year Projections

US$


Will the OPIC-supported investment increase lending to women-owned and/or led SMEs?

Yes

No


If Yes, please indicate the US$ value of the OPIC-supported investment that will be specifically earmarked for investment to women-owned and/or led SMEs (if applicable).

US$


If Yes, how many new women-owned and/or led SMEs are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to women-owned and/or led enterprises (i.e., tailored financial products/services, trainings, seminars, outreach to women entrepreneur associations.)


E

Demographic distribution of clients as a percentage of the number of clients in the SME portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio




Rural

%

%

Other (please specify):      

%

%


Consumer Loans

Yes

No

If Yes, please provide the following portfolio information and projections on the OPIC-supported Consumer lending portfolio:

A

Current portfolio information and projections for OPIC-supported Consumer loan portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over next five years)

Number of Project clients

#

# (total over next five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months

B

Project’s impact on Female Borrowers


Does (or will) the Financial Intermediary serve female borrowers?

Yes

No


If Yes, number of female clients

Current Portfolio

#

5-year Projections

#


If Yes, value of portfolio to female clients

Current Portfolio

US$

5-year Projections

US$


Will the OPIC-supported investment increase lending to female clients?

Yes

No


If Yes, please indicate the US$ value of the OPIC-supported investment that will be specifically earmarked for lending to female borrowers (if applicable).

US$


If Yes, how many new female borrowers are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to female borrowers (i.e., tailored financial products/services, trainings, seminars, outreach to women entrepreneur associations).

D

Demographic distribution of clients as a percentage of the number of clients in the Consumer Lending portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio




Rural

%

%

Other (please specify):      

%

%


Mortgages

Yes

No

If Yes, please provide the following portfolio information and projections on the OPIC-supported Mortgage portfolio:

A

Current portfolio information and projections for OPIC-supported Mortgage portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over next five years)

Number of Project clients

#

# (total over next five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months

B

Please provide the purpose of the mortgages as a percentage of the outstanding value of the Mortgage portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio


Mortgages for new homeowners

%

%

Home Improvement loans

%

%

Productive loan (e.g. home equity loan or line of credit)

%

%

Other (please specify):      

%

%


C

Please provide the target market of mortgages as a percentage of the outstanding value of the Mortgage portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Low-income homes

%

%

Middle-income homes

%

%

High-income homes

%

%

Residential rental properties

%

%

Commercial properties

%

%

Other (please specify):      

%

%

D

Project’s impact on Female Homeowners


Does (or will) the Financial Intermediary serve female homeowners?

Yes

No


If Yes, number of female homeowners

Current Portfolio

#

5-year Projections

#


If Yes, value of portfolio to female homeowners

Current Portfolio

US$

5-year Projections

US$


Will the OPIC-supported investment increase lending to female homebuyers?

Yes

No


If Yes, please indicate the US$ value of the OPIC-supported investment that will be specifically earmarked for lending to female homebuyers (if applicable).

US$


If Yes, how many new female homebuyers are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to female homebuyers (i.e., tailored financial products/services, trainings, seminars, outreach to women).

E

Please provide the demographic distribution of clients as a percentage of the number of clients in the Mortgage portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio





Rural

%

%


Other (please specify):      

%

%



Equity Investments

Yes

No


If Yes, please provide the following portfolio information and projections on the OPIC-supported Equity portfolio:

A

Current portfolio information and projections for OPIC-supported Equity portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over next five years)

Number of Project clients

#

# (total over next five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months

B

Economic segments of clients as a percentage of the outstanding value of the Equity portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Microenterprises

%

%

Small & Medium Enterprises

%

%

Large Corporations

%

%

Other (please specify):      

%

%



C

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):      

%

%

D


Business activities/sectors of clients as a percentage of the outstanding value of the Equity portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Manufacturing

%

%

Agriculture

%

%

Construction

%

%

Transportation

%

%

Communication

%

%

Tourism

%

%

Trade/Retail

%

%

Energy

%

%

Services (please specify):      

%

%

Other (please specify):      

%

%


E

Project’s impact on women-owned and/or led enterprises


Does (or will) the Financial Intermediary invest in women-owned and/or led enterprises?

Yes

No


If Yes, number of women-owned and/or led enterprises

Current Portfolio

#

5-year Projections

#


If Yes, value of portfolio to women-owned and/or managed enterprises

Current Portfolio

US$

Current Portfolio

US$


Will the OPIC-supported investment increase investment in women-owned and/or led enterprises?

Yes

No


If Yes, please indicate the $US value of the OPIC-supported investment that will be specifically earmarked for investment to women-owned and/or led enterprises (if applicable).

US$


If Yes, how many new women-owned and/or led enterprises are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to women-owned and/or led enterprises (i.e., tailored financial products/services, trainings, seminars, outreach to women entrepreneur associations).

F

Demographic distribution of clients as a percentage of the number of clients in the Equity portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio




Rural

%

%

Other (please specify):      

%

%



Leasing contracts

Yes

No

If Yes, please provide the following portfolio information and projections on the OPIC-supported Leasing portfolio:

A

Current portfolio information and projections for the OPIC-supported Leasing portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over next five years)

Number of Project clients

#

# (total over next five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months

B

Please provide the economic segments of clients as a percentage of the outstanding value of the Leasing portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Microenterprises

%

%

Small & Medium Enterprises

%

%

Large Corporations

%

%

Other (please specify):      

%

%


C


Please provide the business activities/sectors of clients as a percentage of the outstanding value of the Leasing portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Manufacturing

%

%

Agriculture

%

%

Construction

%

%

Transportation

%

%

Communication

%

%

Tourism

%

%

Trade/Retail

%

%

Energy

%

%

Services (please specify):      

%

%

Other (please specify):      

%

%

D

Project’s impact on women-owned and/or led enterprises


Does (or will) the Financial Intermediary serve women-owned and/or led enterprises?

Yes

No


If Yes, number of women-owned and/or led enterprises

Current Portfolio

#

5-year Projections

#


If Yes, value of portfolio to women-owned and/or led enterprises

Current Portfolio

US$

Current Portfolio

US$


Will the OPIC-supported investment increase leasing to women-owned and/or led enterprises?

Yes

No


If Yes, please indicate the $US value of the OPIC-supported investment that will be specifically earmarked for leasing to women-owned and/or led enterprises (if applicable).

US$


If Yes, how many new women-owned and/or led enterprises are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to women-owned and/or led enterprises (i.e., tailored financial products/services, trainings, seminars, outreach to women entrepreneur associations).

E

Please provide the demographic distribution of clients as a percentage of the number of clients in the Leasing portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio




Rural

%

%

Other (please specify):      

%

%




Insurance contracts

Yes

No

If Yes, please provide the following portfolio information and projections on the OPIC-supported Insurance portfolio:

A

Current portfolio information and projections for the OPIC-supported Insurance portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over next five years)

Number of Project clients

#

# (total over next five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months

B

Please provide the economic segments of clients as a percentage of the outstanding value of the Insurance portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Microenterprises

%

%

Small & Medium Enterprises

%

%

Large Corporations

%

%

Other (please specify):      

%

%

C


Please provide the business activities/sectors of clients as a percentage of the outstanding value of the Insurance portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Manufacturing

%

%

Agriculture

%

%

Construction

%

%

Transportation

%

%

Communication

%

%

Tourism

%

%

Trade/Retail

%

%

Energy

%

%

Services (please specify):      

%

%

Other (please specify):      

%

%

D

Project’s impact on women-owned and/or led enterprises


Does (or will) the Financial Intermediary serve women-owned and/or led enterprises?

Yes

No


If Yes, number of women-owned and/or led enterprises

Current Portfolio

#

5-year Projections

#


Value of portfolio to women-owned and/or led enterprises

Current Portfolio

US$

Current Portfolio

US$


Will the OPIC-supported investment increase insurance to women-owned and/or led enterprises?

Yes

No


If Yes, please indicate the US$ value of the OPIC-supported investment that will be specifically earmarked for insurance to women-owned and/or led enterprises (if applicable).

US$


If Yes, how many new women-owned and/or led enterprises are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to women-owned and/or led enterprises (i.e., tailored financial products/services, trainings, seminars, outreach to women entrepreneur associations).

E

Please provide the demographic distribution of clients as a percentage of the number of clients in the Insurance portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio




Rural

%

%

Other (please specify):      

%

%




Other (please specify):

Yes

No

If Yes, please provide the following portfolio information and projections on the OPIC-supported portfolio:

A

Current portfolio information and projections for OPIC-supported portfolio:

Current Portfolio

Projected OPIC-supported portfolio

Number of Project transactions

# (per year)

# (total over first five years)

Number of Project clients

#

# (total over first five years)

Value of Project outstanding portfolio ($US)

$

$

Average transaction amount per client ($US)

$

$

Maximum transaction amount to a single client ($US)

$

$

Minimum transaction amount to a single client ($US)

$

$

Average tenor (in months)

# months

# months

B

Economic segments of clients as a percentage of the outstanding value of the portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Microenterprises

%

%

Small & Medium Enterprises

%

%

Large Corporations

%

%

Other (please specify):      

%

%




C

Purpose of the transactions as a percentage of the outstanding value of the portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Start-Up Capital

%

%

Working Capital

%

%

Expansion Capital

%

%

Equipment Purchase

%

%

Other (please specify):      

%

%

D


Business activities/sectors of clients as a percentage of the outstanding value of the portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio

Manufacturing

%

%

Agriculture

%

%

Construction

%

%

Transportation

%

%

Communication

%

%

Tourism

%

%

Trade/Retail

%

%

Energy

%

%

Services (please specify):      

%

%

Other (please specify):      

%

%

E

Project’s impact on Female Borrowers


Does (or will) the Financial Intermediary serve female borrowers?

Yes

No


If Yes, number of female clients

Current Portfolio

#

5-year Projections

#


If Yes, value of portfolio to female clients

Current Portfolio

US$

5-year Projections

US$


Will the OPIC-supported investment increase lending to female clients?

Yes

No


If Yes, please indicate the US$ value of the OPIC-supported investment that will be specifically earmarked for lending to female borrowers (if applicable).

US$


If Yes, how many new female borrowers are projected to be served by the OPIC-supported investment (total over next five years)?

#


Please describe current and/or future initiatives that will increase the Financial Intermediary’s outreach and/or service to female borrowers (i.e., tailored financial products/services, trainings, seminars, outreach to women entrepreneur associations).

F

Demographic distribution of clients as a percentage of the number of clients in the portfolio in A above.

Current Portfolio

Projected OPIC-supported portfolio


#


Rural

%

%

Other (please specify):      

%

%




3.    PROJECT FINANCIAL INTERMEDIARY EMPLOYMENT


A

Please provide the current and projected number of Project employees for operations & management of the Financial Intermediary.


Current Employment

(Operations and Management)

Projected Employment

(Operations & Management)

by 5th year of operations as a result of this OPIC-Supported Investment  

Total Projected Employment (Operations & Management)

by the 5th year of operations

Local

Foreign Nationals

Male

Female



Local

Foreign Nationals

Local

Foreign Nationals

Managerial












Professional/












Technical









Unskilled Labor












TOTAL












B

Will the Project utilize workers employed by third parties (i.e., through contractors/subcontractors) once the Project is operational?


For physical construction

For administrative needs

For other operational needs




4. JOB QUALITY


A

Does or will the Financial Intermediary offer employee development programs, such as tuition reimbursement or formal mentorships to both current and new non-management employees identified above in Question 1A above?


Yes


No

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


B

Does or will the Financial Intermediary offer other employee benefits that exceed local legal requirements to both current and new non-management employees identified above in Question 1A above?

Yes

No

If Yes, please provide a list of employee benefits that exceed local law that are or will be available to non-management personnel:

C

Please provide the average monthly wage (in local currency) that is or will be paid to full-time equivalent unskilled employees identified in Question 1A above.

____local currency/month

D

Please provide the average monthly wage (in local currency) that is or will be paid to full-time equivalent professional/technical employees identified in Question 1A above.

__ local currency/

month


5. PROJECT BENEFITS TO WOMEN, ENVIRONMENT, AND COMMUNITY

A

Does (or will) the Project (1) have any direct or ancillary benefits for women, (2) consider gender issues in the project design and/or implementation, or (3) include specific actions to address gender-related vulnerabilities?

Yes

No


If Yes, please describe.

B

As a result of this OPIC-supported investment, will the Project implement initiatives (either corporate or transactional) which are directed at restoring and/or preserving the environment?

Yes

No

If Yes, please explain (e.g. paperless banking, favorable financing terms for Project clients engaging in activities which preserve the environment).

C


Does (or will) the Project contribute money towards activities that benefit local communities (e.g., recreational facilities, schools, medical clinics, scholarship programs, other charitable activities)?

Yes

No

If Yes, please provide the actual or expected annual budget for these activities and describe these activities.

_________$/year

D

Does the Project have an Environmental and Social Management System (ESMS)?

Yes

No

If Yes, please attach a copy of the ESMS (in English).









6. PROJECT HUMAN RESOURCE MANAGEMENT

A

Does (or will) the Project have written human resources policies?

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).

Yes

No

Disciplinary procedures.

Yes

No



C

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

D

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 specify.
















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

If Yes, please describe.

B

Restructuring which results in a major retrenchment (i.e., lays off significant numbers of workers).

Yes

No

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).

Yes

No

If Yes, please describe.



D

Labor-related lawsuits against the Project.

Yes

No

If Yes, please describe.



E

Labor unrest in the last three years in the form of strikes or other general industrial disputes.

Yes

No

If Yes, please describe.



F

Ongoing or unresolved issues/disputes with a Project trade union.

Yes

No

If Yes, please describe.




8. BUSINESS INNOVATION

Please indicate if the Project will operationalize a product, process, and/or technology that is new or not widely used in the domestic sector 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.

A

Financial Products and/or services

New

Uncommon

No

If New or Uncommon, please describe.

B

Business Processes

New

Uncommon

No

If New or Uncommon, please describe.

C

Innovative Financing Structures

New

Uncommon

No

If New or Uncommon, please describe.

D

Will there be any technical assistance provided by the Project?


Yes

No

If Yes, please describe.

E

Has (or will) the Project secure(d) voluntary sustainability certification from an internationally-recognized certifying authority?

Yes

No

If Yes, please describe.


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

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?

Yes

No

If Yes, please explain.


D

Does (or will) the Project result from or cause any Project Country reforms, new legislation, or new regulations?

Yes

No

If Yes, please explain.





  1. INITIAL SOURCES OF PROJECT FUNDING



Debt

Equity

Other

TOTAL

A

OPIC

$

$ N/A

$

$


B

Applicant (or Financial Intermediary):

$

$

$

$

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

$

$

$



C

U.S. sources other than Applicant (or Financial Intermediary) (please specify source and amounts per source):

$

$

$

$

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

$

$

$


What amount, if any, is from a U.S. public source (e.g., USAID grants, Export-Import Bank financing, U.S. Trade and Development Agency grants)? (please specify)

$

$

$



D

Project Country sources (please specify source and amounts per source):

$

$

$

$


E

Non-U.S. and non-Project Country sources (please specify sources, countries, and amounts per country):

$

$

$

$


F

Development Finance Institutions (e.g. International Finance Corporation, Inter-American Development Bank, etc.) (please specify):

$

$

$

$

G

Other sources (please specify):

$

$

$

$

H

INITIAL PROJECT FUNDING TOTAL :

$

$

$

$





  1. INITIAL USES OF PROJECT FUNDING

Refers to expenditures financed by the Project Funding Total included in Question 2H above.


A

Purchased or spent in the Project Country:

$

Of the amount in 3A above, how much will be spent on the procurement of goods and services from domestic suppliers?

$

B

Purchased from the U.S.:

$

C

Purchased from countries other than the Project Country or the U.S. (please specify countries and amounts per country):

$

D

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):

$

E

TOTAL INITIAL PROJECT FUNDING USES:

$




  1. INITIAL PROJECT U.S. PROCUREMENT

Please list items to be procured from the U.S. from Question 3B, above. Also, please ensure that the total below is equal to the total in Question 3B above.

Supplier

City, State

ZIP Code

Enterprise Characteristics

Product

Product Description

Procurement Amount ($)




Small Enterprise?

Minority Owned?

Women Owned?

Yes No Don’t Know Yes No Don’t Know

Yes No Don’t Know

New Used

Don’t Know



TOTAL

$





  1. OPERATIONAL PROJECT PROCUREMENT


A

Will the Project procure goods and services from the U.S on an on-going basis after the Project is fully operational?

Yes

No


B

Will the Project procure goods and services from Project Country sources on an on-going basis after the Project is fully operational?

Yes

No

If Yes, please provide the average annual value of the Project’s purchases of goods and services (excluding internal labor and utility costs) from domestic suppliers as a result of this OPIC-supported investment. Projections should be annual averages over a five year time horizon after the Project is fully operational.

$

Please briefly describe the goods and/or services that will be procured by these funds.



  1. OPERATIONAL PROJECT U.S. PROCUREMENT

Please list items to be procured from the U.S. once the Project is fully operational. Figures provided below should be annual averages over a five year time horizon after the Project becomes fully operational.

Supplier

City, State

ZIP Code

Enterprise Characteristics

Product

Product Description

Procurement Amount ($)




Small Enterprise?

Minority Owned?

Women Owned?

Yes No Don’t Know Yes No Don’t Know

Yes No Don’t Know


New Used




TOTAL

$







7. PROJECT SALES/PRODUCTION or INTEREST/FEE REVENUE (FOR FINANCIAL INTERMEDIARIES)

A

Please provide current annual sales (or interest and fee revenue if a financial intermediary) and projected increases in annual sales (or interest and fee revenue) as a result of this OPIC-supported investment by the 5th year of operations.


Product

Current Annual Production Capacity

Projected Increase in Annual Production Capacity as a result of this OPIC-Supported Investment

Total Projected Annual Production Capacity

Current Annual Gross Sales Value/Revenue

($US)

Current Annual Volume (Units)

Increase in Gross Annual Sales Value/Revenue

($US)

Increase in Annual Volume

(Units)

Total Annual Gross

Sales Value/ Revenue

($US)

Total Annual Volume (Units)








TOTAL







B

Does the Project currently export or plan to export any of its production?

Yes

No

C

If Yes, please provide current annual exports and the projected increase in annual exports expected as a result of this OPIC-supported investment by the 5th year of full operations.

Exported Product

Export Country

Current Annual Export Sales

Projected Increase in Annual Export Sales as a result of this OPIC-Supported Investment

Total Projected Annual Exports

by 5th year of operations

$US

Volume

(Units)

$US

Volume

(Units)

$US

Volume (Units)









TOTAL

$


$


$


D

Will the Project reduce dependency on imports?

Yes

No

If Yes, please explain.


8. PROJECT PAYMENTS TO HOST GOVERNMENT

A

Please provide all transfers to the host government made by the Project.

Project Country

Current Annual Payment Figure ($US)

Projected Increase in Annual Payment Figure as a result of this OPIC-Supported Investment ($US)

Total Projected Annual Payments

($US)





TOTAL




B

If the Project is eligible for a tax holiday, indicate the duration of the tax holiday.

___ year(s)

C

If duties and/or tax payments to Project Country government will be reduced as a result of the Project, please estimate the amount lost.

$____



9. FINANCIAL OUTFLOW FROM PROJECT COUNTRY

In each column, estimate the Project average annual financial outflow from the Project Country over a five year time horizon. Please only report those outflows related to this OPIC-supported investment.

Remittance to the U.S.

Remittance to Other Countries (please specify countries)

A

OPIC Payments ($US)

$

$

B

Other Loan Principal and Interest (from U.S. or other lenders) ($US)

$

$

C

Lease Payments ($US)

$

$

D

Return on Initial Capital Investment ($US)

$

$

E

Annual Fees (other than OPIC fees, please specify) ($US)

$

$



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:

Telephone:      

Name and Title:      

Email address:      






3/30/2018 43

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