Form OPIC-129 Personal Information Form

Personal Identification Form (“PIF”)

Overseas Private Investment Corporation

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

An Agency of the United States of America

INSTRUCTIONS

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

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

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

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

“Name” means:

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

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

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

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

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

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

“Project Company” means the entity identified as such in the Summary Information section of this form. In the case of an investment fund transaction, the “Project Company” is the investment fund. In the case of a political risk insurance transaction, the “Project Company” is the entity into which the investment is being made, commonly referred to as the “foreign enterprise.”

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

“PIF Party” means:

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

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

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

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

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

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

2. the Fund Borrower’s investment manager;

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

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

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

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

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

3. in the case of a Project where OPIC insurance support will be provided for an equity, loan, or other type of investment:

1. the proposed insured party;

2. the proposed reinsurer or reinsured party, if any;

3. if the proposed insured party is seeking coverage for an equity investment, any person (physical or legal) that beneficially owns, directly or indirectly, at least 10% of the Project Company; and

4. if the proposed insured party is seeking coverage for a loan investment, any person (physical or legal) that beneficially owns, directly or indirectly, at least 10% of such proposed lender.

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

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

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

(ii) the United Nations or agencies thereof;

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

(iv) state-owned enterprises; and

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

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

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

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

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

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

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

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

OVERSEAS PRIVATE INVESTMENT CORPORATION

PERSONAL IDENTIFICATION FORM

OPIC Form 129

OMB 3420-0018

Expiration: [ ]

This form requests information from potential OPIC clients that is required by OPIC’s governing legislation - the Foreign Assistance Act (FAA) of 1961, Title IV, as amended - to assist OPIC in determining whether a project and certain parties associated with it meet eligibility criteria for OPIC support. Complete responses to the questions are required on this form to apply for OPIC support per the FAA.

Statements of fact provided to OPIC in this document must be accurate as of the date of submission of this document. Anyone who knowingly makes a false statement with the intent to influence OPIC’s insurance, reinsurance, guarantees, loans, or other investments may be criminally prosecuted pursuant to 22 U.S.C. § 2197(n).  Such false statements are also grounds for OPIC to terminate a commitment and declare a contract default.  These rights are in addition to any other rights or remedies available to OPIC. Neither submission nor acceptance of this form implies that the project is eligible for OPIC support or that support will be provided.

Information provided in this form will be deemed designated as “confidential commercial information” in accordance with OPIC's Freedom of Information Act (FOIA) regulations at 22 C.F.R. Part 706, and will be treated as such to the extent permitted by applicable law.

Paperwork Reduction Act Notice: This information is required to obtain benefits. As a federal agency, OPIC may not collect information unless it displays a valid OMB Control Number with an expiration date that has not expired. The public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to Agency Clearance Officer, Records Management, Overseas Private Investment Corporation, 1100 New York Ave., NW, Washington, DC 20527 and to the OPIC Desk Officer at the Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.

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

CANCEL

START

Note: Some of the questions in the Form 129 refer to specific defined terms that the user should understand before answering the question. To read and print the form instructions and defined terms, please click here. Please note that if you would like to provide additional/explanatory information on any item, you may attach supporting documentation at any time by clicking on the “Supporting Documentation” link at the bottom of each screen.

1. PIF SUBMITTING PARTY SUMMARY INFORMATION

Full Legal Name of the PIF Submitting Party:

What type of entity is the PIF Submitting Party? (check only one)

Individual

Corporation, Limited Liability Company, or Company

Partnership

Trust, Business Association or other entity

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

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

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

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

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

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

Project Company/Project itself

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

Will provide credit support to the Project

Bears a significant managerial relationship to the Project

General partner (or managing member) of the Project Company

Investment fund manager of the Project Company

Will provide insurance support to the Project

Direct or indirect, beneficial owner of 10% or more of the proposed insured lender

2. PIF SUBMITTING PARTY IDENTIFICATION INFORMATION

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

Identification Information for Individuals

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

Nicknames or Aliases (if applicable):

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

Date of Birth; Place of Birth

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

Choose one of the following with respect to this individual:

Never resided in the United States.

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

Last resided in the United States at the following Address:

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

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

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

Please complete all of the following that apply. U.S. Citizens are required to provide driver’s license information and social security number; non-U.S. citizens are required to provide passport number and any other information that may be applicable.

US Driver’s License Number:

US Driver’s License State of Issuance:

US Social Security Number:

Passport Number:

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

IDENTIFICATION INFORMATION FOR CORPORATIONS, LLCS AND COMPANIES

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

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

Address of the PIF Submitting Party:

Is the PIF Submitting Party a Reporting Company? Yes No

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

IDENTIFICATION INFORMATION FOR PARTNERSHIPS

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

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

Address of the PIF Submitting Party:

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

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

Is the PIF Submitting Party a Reporting Company? Yes No

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

IDENTIFICATION INFORMATION FOR TRUSTS, BUSINESS ASSOCIATIONS OR OTHER ENTITIES

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

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

Address of the PIF Submitting Party:

Is the PIF Submitting Party a trust? Yes No

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

Name of the trustee:

Is the PIF Submitting Party a Reporting Company? Yes No

Unless the PIF Submitting Party is submitting this form in conjunction with the processing of a Project under OPIC’s Insurance Program or if the user has chosen the entity type of “Individual” on the first screen, then the following questions should also come up:

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

Full Name:

Previous Names or Aliases (if applicable):

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

Address:

Date of Birth

Country of Citizenship – Have a drop-down box.

Fields asking for 1) SSN, 2) U.S. driver’s license number, 3) jurisdiction of U.S. driver’s license, and 4) passport should come up. U.S. citizens are required to enter #1-3. Non-U.S. citizens are required to enter #4 and any others that apply.

Has the individual ever resided in the US? Yes No

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

Full Name:

Previous Names or Aliases (if applicable):

Title (e.g. CEO, Director)

Name of the Subsidiary of the PIF Submitting Party

Address:

Date of Birth

Country of Citizenship – Have a drop-down box.

Fields asking for 1) SSN, 2) U.S. driver’s license number, 3) jurisdiction of U.S. driver’s license, and 4) passport should come up. U.S. citizens are required to enter #1-3. Non-U.S. citizens are required to enter #4 and any others that apply.

Has the individual ever resided in the US? Yes No

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

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

Full Name of Affiliate of the PIF Submitting Party:

Principal Address of Affiliate of the PIF Submitting Party:

Jurisdiction of Incorporation/Formation?

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

Submission Page

All required fields in the Personal Identification Form have been completed. [Please read the Notification of Credit Investigation below before submitting this form.] You may submit the form for OPIC review by clicking the “Sign and Submit” button below. The Personal Identification Form review and finalization process is as follows:

• Once you click the “Sign and Submit” button, your Personal Identification Form will be in a “read-only” format.

• An OPIC officer/attorney will review your Personal Identification Form for completeness.

• If the officer/attorney determines that the information is incomplete or that additional information is required, the form will be “unlocked” and returned to you for editing.

• If the officer/attorney determines that the form is complete, they will change the status to “Final Signed.”

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

The undersigned, as either the PIF Submitting Party (in the case of an individual) or as the duly authorized representative of the PIF Submitting Party (in the case of Persons other than an individual), including the other Review Parties, as the case may be, certifies on behalf of the PIF Submitting Party and the other Review Parties that the information provided in response to the questions herein, under penalty of law (pursuant to 22 USC Section 2197(n)), is true and correct to the best of such Person’s knowledge.

Full Name of PIF Submitting Party (pre-populated)

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

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

Sign and Submit