Form DFC‐007 Impact Assessment Questionnaire

IMPACT ASSESSMENT QUESTIONNAIRE (DFC-007)
OMB No. [
]
Expiration Date: [

]

United States Development Finance Corporation
1100 New York Avenue, NW Washington, DC 20527-0001
An Agency of the United States Government
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 in this document must be accurate as of the date of submission. Anyone who knowingly makes a false statement with the intent
to influence DFC’s guarantees, loans, or other investments may be criminally prosecuted.  Such false statements are also grounds for DFC to terminate a
commitment or declare a contract default.  These rights are in addition to any other rights or remedies available to United States government. Neither submission
nor acceptance of this application implies that the proposed transaction is eligible for support or that support will be provided.

When trade secrets or confidential commercial or financial information are submitted to the agency in this collection, they will be held in confidence to the extent
permitted by applicable law including the Freedom of Information Act (“FOIA”) at 5 U.S.C. § 552(b)(4) and the agency’s implementing regulations at 22 C.F.R. Part
706.
Paperwork Reduction Act Notice: This information is required to obtain benefits. Federal agencies may not collect information unless a valid OMB Control Number
with an expiration date that has not expired is displayed. 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 or any other aspects of this collection of information, including suggestions for
reducing this burden, to Agency Clearance Officer, Records Management, United States International Development Corporation, 1100 New York Avenue,
NW, Washington, DC, 20527 and to the DFC Desk Officer at the Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive
Office Building, Room 10202, Washington, DC 20503.

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

Questions Common to All Project Types
1
A.
B.
C.
D.
E.
F.
G.
H.
I.
2

PROJECT DESCRIPTION AND OWNERSHIP PROFILE
Project Name
Project City and Country
Is the Project a new/greenfield enterprise or expansion
New Enterprise
of an existing operation?
(no existing facilities and/or operations)
Describe the Project, particularly the use of proceeds of the DFC-supported investment:
[text box]
Current/projected percentage of local ownership of the Project (if there is/will be none, enter "0").
Current/projected percentage of female ownership of the Project (if there is/will be none, enter "0").
Current/projected gender breakdown of the Project's Board of Directors or other governing body (if applicable)
Current/projected number of women in executive management positions (if there are/will be none, enter "0").
Is the Project a local Small and Medium Enterprise (SME)?

Existing Enterprise

# male
Yes

%
%
# female
#
No

PROJECT SOCIAL CHARACTERISTICS
A. Does the Project have an Environmental and Social Management System (ESMS)? 
Yes
No
Please attach a copy of the ESMS (in English).
Button to attach a copy of ESMS
B. Does (or will) the Project have or involve the following:
Migrant or foreign workers (excluding foreign nationals in management or highly-skilled non-manual workers).
Yes
No
Workers under the age of 18 (directly or indirectly employed by the Project).
Yes
No
Restructuring that results in a major retrenchment (i.e., lays off significant numbers of workers).
Yes
No
Please describe
Known non-compliance with local laws or other applicable labor standards (self-diagnosed, or as a result of official inspections or other
Yes
No
audits).
Please describe
Onsite trade union
Yes
No
What percentage of workers are covered by a collective bargaining agreement?
%
Please attach a copy of the collective bargaining agreement in English, if applicable.
Button to attach copy of agreement
Labor-related lawsuits, labor unrest in last 3 years, or ongoing/unresolved disputes with Project trade union.
Yes
No
Please describe
Onsite security
Yes
No
Are security guards armed?
Yes
No
Is security publicly or privately contracted?
Public
Private

Common Questions: 2 of 23

Questions Common to All Project Types
3
A.
B.
C.

D.

PROJECT HUMAN RESOURCES MANAGEMENT AND JOB QUALITY
Does (or will) the entity undertaking the Project have written human resources policies?
Yes
No
Please attach a copy of the human resources policies (in English).
Button to attach copy of policies.
How are the terms of employment communicated to each worker? (check all that apply)
Verbally
Written
Please attach a copy of a sample employment contract (in English).
Button to attach copy of contract.
Does (or will) the Project management have experience in applying international labor standards, such as those addressed in the IFC
Yes
No
Performance Standards?
Please specify the standards and describe the experience.
Does (or will) the entity undertaking the Project offer employee development programs, such as tuition reimbursement or formal
mentorships to both current and new non-management employees?
Yes
No

Please describe what type of employee development programs will be available to non-management personnel
Does (or will) the entity undertaking the Project offer other employee benefits that exceed local legal requirements to both current and
E. new non-management employees
Please provide a list of employee benefits that exceed local law that are or will be available to non-management personnel 
4

Yes

PROJECT BENEFITS TO WOMEN, ENVIRONMENT, AND COMMUNITY
Does (or will) the Project have any direct or ancillary benefits to women that exceed what is required by law or permit or will the Project
A. consider gender issues in the project design and/or implementation )?
Yes
Please Describe
As a result of this DFC-supported investment, will the Project implement initiatives (either corporate or transactional) which are directed
B. at restoring and/or preserving the environment that exceed what is required by law or permit?
Yes
Please Explain
Does (or will) the Project contribute money towards activities that benefit local communities (e.g., recreational facilities, schools, medical
C. clinics, scholarship programs, other charitable activities ) that exceed what is required by law or permit?
Yes
Actual/Expected annual budget
Please Describe

Common Questions: 3 of 23

No

No

No

No
$/Year

Questions Common to All Project Types
5
A.
B.

C.

D.
6

BUSINESS INNOVATION
Does the Project involve an innovative financial structure that will mobilize private capital in a way that has not been done previously in
this market?
Yes
Please describe
Please indicate if the Project will operationalize a product, process, and/or technology that is new as a result of the DFC-supported investment.
Products and/or services
Yes
Please describe
Business Processes
Yes
Please describe
Production and/or processing technologies
Yes
Please describe
Will there be any technical assistance provided by the Project to either customers or suppliers?
Yes
Please describe
Has (or will) the Project secure(d) voluntary sustainability certification from an internationally-recognized certifying authority?  
Yes
Please identify

PROJECT COMPETITIVE POSITION
A. Does (or will) the Project occupy a monopoly position in any of its markets?
Please explain
Please estimate how many firms currently provide the same or similar products and/or services in the local market?

What is the project's market share?
B. Does (or will) the Project Country government have majority ownership or effective management control of the Project?
Please explain
C. Does (or will) the Project result from or cause any Project Country reforms, new legislation, or new regulations?
Please explain

Common Questions: 4 of 23

Yes

No

No
No
No
No

No

No
#

Current
Yes

Projected
by 5th year
No

Yes

No

Questions Common to All Project Types
7

PROJECT OPERATIONAL EMPLOYMENT
Please provide the current and projected number of Project employees for operations only. (Do not include construction/buildout/startup employees. If this is
A. the type of project that has a construction/buildout/startup phase, that information will be provided in a separate question.)
Additional Employment by 5th year of
operations as a result of the DFC-supported
investment

Current Employment

Local
Female

Foreign
Nationals

Local

Foreign Nationals

Male
Youth
Managerial
Professional/
Technical
Unskilled Labor
TOTAL
B. Will the Project utilize workers employed by third parties (i.e. contractors/sub-contractors) for operations?
For what type(s) of tasks will these workers be employed?

DFC will total this data, but the client will not
see or be asked to enter totals.

Yes
Administrative

Common Questions: 5 of 23

No
Other

Questions Common to All Project Types
8

MACROECONOMIC IMPACTS ON THE US, LOCAL AND THIRD COUNTRY ECONOMIES
Please describe how the Project will benefit U.S. businesses or the U.S. economy (e.g., opens new markets, enables efficiencies through vertical integration,
A. reduces costs, increases sales from U.S. businesses (offshore or U.S.-based), support U.S. small business).
[text box]
B. Please provide an estimated breakdown of where the initial Project Funding will come from ("Sources"). To see an example, please click [here].
Public
Private
Not for Profit
DFC
United States
Other USG Agencies
Private/Non-Profit
Host Country
Non-U.S./Non-Host Country(ies)
Multicountry/Multilateral
Please provide an estimated breakdown of where initial Project funding will be spent ("Uses"). To see an example, please click [here]. Note: the total Uses must
C. equal the total Sources above.
Goods and Services
Fees/Transaction Costs
Contingency/Other
United States

DFC
Other USG Agencies
Private/Non-Profit

Host Country
Non-U.S./Non-Host Country(ies)
Multicountry/Multilateral
You estimated that $( ) of initial project funding would be spent on goods/services from U.S. private companies. Please provide detail on the potential suppliers:
Small?
New/
Minority?
Used
Company Name
Women?
Description of Goods/Services
Amount ($US)
City
State
Total
You estimated that $( ) of initial project funding would be spent on goods/services from private companies in the Host Country. Please provide a description of
the goods/services that will be procured.
[text field]

Common Questions: 6 of 23

Questions Common to All Project Types
D. Please provide an estimated breakdown of the Project's revenues by market/source by the 5th year of operation:

United States

Host Country

Revenues ($US)
Will the Project reduce the Host Country's need to import certain goods?

Non U.S./Non-Host Country

Estimated % of Total Revenues
due to DFC-supported investment
Yes

No

Please provide an estimated breakdown of the Project's 1) operating expenditures on goods/services and 2) taxes/fees paid to governments by the 5th year of
E. operation:
Estimated % of Total Operating
Expenditures or Taxes due to DFCUnited States
Host Country
Non U.S./Non-Host Country
supported investment
Operating Expenditures on
goods/services ($US)
Taxes/Fees ($US)
You estimated that $( ) would be spent annually on goods/services from the United States. Please provide detail on the potential suppliers:
Small?
New/
Minority?
Used
City
State
Company Name
Women?
Description of Goods/Services
Amount ($US)
Total
You estimated that $( ) would be spent annually on goods/services in the Host Country. Please provide a description of the goods/services that will be procured.
[text field]
9

FINANCIAL OR NON-FINANCIAL SECTOR PROJECT
Will the Project's primary business be to provide:
Financial Products/Services

Non-Financial Products/Services

Common Questions: 7 of 23

Questions Common to All Project Types
Cell: B14
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Comment:
An ESMS typically includes the components listed below:
•
An overarching policy that defines the environmental and social objectives and principles that will guide the project.
•
A process for identifying the environmental and social risks and impacts of the project.
•
Management plans and programs that describe mitigation and performance improvement measures that address environmental and social risks of the project.
•
An organizational structure that defines roles, responsibilities to implement the management system.
•
Emergency preparedness and response plans that will enable the project to respond to accidents and emergency situations.
•
Procedures to monitor and measure the effectiveness of the management system.
•
A plan for building and maintaining strong, constructive and responsive relationships with communities affected by the project, including mechanisms to respond to
complaints, consultation and reporting.
Cell: B42
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Comment:
Please include “family-friendly” benefits, such as flexible work schedules, extended paid maternity/paternity leave, child care.
Cell: B45
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Comment:
E.g., project provides safer cooking appliances, convenience of clean water close to the household, ample lighting and presence of cameras in parking lots to
increase safety.
Cell: B49
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Common Questions: 8 of 23

Questions Common to All Project Types
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Comment:
Philanthropic and/or charitable initiatives not directly related to the business operations of the Project, required by the host country government, or implemented
for impact mitigation.
Cell: B59
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Comment:
Examples may include, but are not limited to: methods used to deliver products or services; methods used to improve the company’s supply chain; managerial
practices to improve transparency or employee productivity. Expertise provided by Investment Funds to portfolio companies should be included.
Cell: B61
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Comment:
Examples may include, but are not limited to: equipment upgrades, creation of manufacturing technology efficiencies, IT enhancements.
Cell: B65
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Comment:
Examples may include, but are not limited to: Fairtrade International, International Sustainability and Carbon Certification, International Standards Organization
certificates.
Cell: B79
Common Questions: 9 of 23

Questions Common to All Project Types
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Comment:
Number of full-time equivalent employees as per local definition working for the Project. This includes directly hired individuals and individuals hired through third
party agencies as long as those individuals provide on-site services related to the operations of the Project. Also, this includes full-time equivalent worked by
seasonal, contractual and part time employees. Part-time jobs are converted to full-time equivalent jobs on a pro rata basis, based on local definition (e.g., if working
week equals 40 hours, a 24 hr/week job would be equal to 0.6 FTE job). Seasonal or short-term jobs are prorated on the basis of the portion of the year that was
worked (e.g., a full-time position for three months would be equal to a 0.25 FTE job). If the information is not available, the rule-of-thumb is two part-time jobs equal
one full-time job.
Cell: F82
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Comment:
Those of legal working age 15-24
Cell: B100
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Comment:
Some funding entities such as multilateral development banks may fit into this category.
Cell: B121
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Comment:
Common Questions: 10 of 23

Questions Common to All Project Types
For operating expenditures, exclude utility costs, rent and internal labor costs.
Cell: B122
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Comment:
Includes payments to the government in the form of corporate income or profit taxes. Additional forms of transfer to be reported as appropriate include (i) sales
taxes, (ii) net VAT, (iii) royalties, (iv) dividends and related taxes, (v) management and/or concession fees, (vi) license fees, (vii) tax on payment of interest, and (viii)
other material payments net of any direct subsidies received.
Cell: B131
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Comment:
Including but not limited to commercial banks, non-bank financial institutions, insurance companies, re-insurance companies, investment funds (e.g., microfinance,
SME, venture capital, private equity), lending facilities, and financial intermediaries engaged in specialized financial transactions

Common Questions: 11 of 23

Questions for Financial Services Projects Only
FINANCIAL INTERMEDIARY OPERATIONAL METRICS

1

Current
A.
B.
C.
D.

5th Year Projection

Number of active clients
Number of transactions
Total value of financial assets portfolio ($US)
Number of branches
NATURE OF DFC SUPPORT
What percentage of the DFC-supported investment will be used to expand one or more of the Financial Intermediary's financial product
portfolios?

2

%

For the portion of the DFC-supported investment that will not be used to expand financial product portfolios, please describe in detail how it will be used:
[text field]
CLASSIFICATION OF FINANCIAL ASSET PORTFOLIO BY PRODUCT TYPE
For each product type offered by the Financial Intermediary undertaking this Project, indicate what percentage of the portfolio it equals when measured by #
of clients, # of transactions and total value. In addition, please provide the average tenor/holding period of the transactions in each product type offered and
indicate whether the DFC-supported investment will be for expansion of this product type. For examples, please click [here].

3

A.

Product Type
Microfinance
SME Loans
Corporate Loans
Consumer Loans
Mortgages
Equity Investments
Leasing Contracts
Insurance Contracts
Other (provide)

By # clients
Current 5th Year

By # of transactions
Current
5th Year

By Value ($US)
Current
5th Year

Average Tenor/Holding
Period (months)

Current

DFC-Supported?

5th Year
[Checkbox]
[Checkbox]
[Checkbox]
[Checkbox]
[Checkbox]
[Checkbox]
[Checkbox]
[Checkbox]
[Checkbox]

100%

100%

100%

100%

100%

100%

B. Does the Financial Intermediary intend to provide any of the potentially DFC-supported products to clients that are larger than SMEs?
Please describe the relevant client base and the products that would be provided to them.

Yes

No

C. For your Equity Investments portfolio, do you invest in SMEs?

Yes

No

Financial Services: 12 of 23

Questions for Financial Services Projects Only
4

CLASSIFICATION OF DFC-SUPPORTED BUSINESS LOANS BY SECTOR AND USE
Since you indicated above that the DFC-Supported investment would be used for business loans (i.e. not consumer loans or mortgages), please provide the
A. percentage of such loans expected to be in each sector.
Sector

Manufacturing

Agriculture

Housing
Construction

Transportati Communicat
on
ions/ITC
Tourism

Energy

Trade/ Retail Services

Health

Education

Product Type
[Programming Note:
Show only the
product types that
were chosen as "DFCSupported" above]

100%
100%
100%
100%
100%
100%
Since you indicated above that the DFC-Supported investment would be used for business loans (i.e. not consumer loans or mortgages), please provide the
B. percentage of such loans expected to be used for the following purposes.
Purpose

Start-up Capital

Working Capital

Expansion Capital

Product Type
[Programming Note:
Show only the
product types that
were chosen as "DFCSupported" above]

Equipment Purchase

Other (please specify):

100%
100%
100%
100%
100%
100%

Financial Services: 13 of 23

Questions for Financial Services Projects Only
5

DEVELOPMENTAL IMPACTS OF DFC-SUPPORTED FINANCIAL ASSET PORTFOLIO
Of the product types that will benefit from the DFC-supported investment, please indicate the approximate percentage of those portfolios taken up by the
following
Product Type
Rural
Women
Other Underserved Populations
By # clients
By Value ($US)
By # clients
By Value ($US)
By # clients
By Value ($)
[Programming Note:
Current 5th Year Current
5th Year Current
5th Year Current
5th Year Current
5th Year Current
5th Year
Show only the
product types that
were chosen as "DFCSupported" above]
Please describe current and/or future initiatives that will increase the Financial Intermediary's outreach and/or service to rural borrowers (tailored financial
products/services, training, mobile technology, new branches, etc.). If the initiatives are specific to particular product lines, please include that in the
explanation.
[text field]
Please describe current and/or future initiatives that will increase the Financial Intermediary's outreach and/or service to female borrowers (tailored financial
products/services, training, mobile technology, new branches, etc.). If the initiatives are specific to particular product lines, please include that in the
explanation.
[text field]
Please describe current and/or future initiatives that will increase the Financial Intermediary's outreach and/or service to other underserved borrowers
(tailored financial products/services, training, mobile technology, new branches, etc.). If the initiatives are specific to particular product lines, please include
that in the explanation.
[text field]

Financial Services: 14 of 23

Questions for Financial Services Projects Only
Cell: B20
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Comment:
Defined as a borrower of consumer, non-mortgage loan product, such as a car loan, credit card, signature loan, signature line of credit, or Certificate of Deposit
loan.
Cell: B23
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Comment:
The Financial Intermediary will be required to receive DFC approval prior to issuing leases to companies that export products in the following sectors:
•
Steel, aluminum and forged metal goods (including automotive parts)
•
Textile mills, textile products and apparel
•
Chemical products
•
Paper and plastic products
•
Lumber and furniture production/manufacture
•
Agriculture, forestry, fishing and hunting (with the exception of agriculture products not currently commercially grown in the U.S.)
Cell: B27
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Comment:
DFC may need to provide prior approval for support of financial products to companies that meet at least two of the following three criteria: >$15 million
assets, >$15 million in annual revenue, >300 employees.
Cell: H53
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Financial
Services:
15 ofto23

Questions for Financial Services Projects Only
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Comment:
“Female Borrowers” means the loan will be solely held by a women and not jointly held by her husband or other male person. A “women-owned enterprise” is
one in which women own at least fifty one percent (51%) of the company, or where the company was founded by a woman who continues to play an active role
in running the company. A “women-led enterprise” is one in which the share of women in senior management is at least 30% or women comprise 30% or more
of the board, investment committee or equivalent governing and/or investment decision-making bodies.
Cell: L53
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Comment:
Examples include but are not limited to: ethnic minorities, youth, handicapped individuals.

Financial Services: 16 of 23

Questions for Non-Financial Services Projects Only
1

IMPACT ON CURRENT U.S. EMPLOYMENT
Do any of the investors in the Project (or any of their subsidiaries or affiliates) currently produce in the United States the same
A. product(s) as those produced by this Project?
How many U.S. employees are currently employed by such company, subsidiary, or affiliate that produce the product(s)?
Has the number of U.S. employees engaged in the U.S. production of the product(s) declined or will it decline as a result of this DFCsupported investment?
B. Does the Project involve business process outsourcing for companies operating in the U.S.?

2
A.
B.
C.
D.

PROJECT ENVIRONMENTAL AND SOCIAL CHARACTERISTICS
Project Site Location (please include GPS coordinates and, if available, a map of site location):
Has the Project conducted or will the Project conduct consultations with Project-affected communities (including disadvantaged and
vulnerable groups)?
Please describe the scope and results (if applicable) of these consultations.
Has the Project been involved in any past or ongoing community dispute or complaint resolution processes?
Please describe the nature of the dispute/complaint and steps being taken to resolve (if applicable).
Please indicate whether the Project is (or 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
#

Yes
Yes

No
No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

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

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.)
Sensitive locations of national or regional importance including wetlands, floodplains, coral reefs, mangrove swamps or areas prone to
erosion, desertification or seismic activity.
E. Please indicate whether the Project involves any of the following:

If Yes, please estimate the number of people affected.

[insert number]

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

Non-Financial: 17 of 23

Questions for Non-Financial Services Projects Only
3

SECTOR-SPECIFIC METRICS
Please select the sector(s) that best describe(s) the Project's purpose/operations:
Agriculture/Agribusiness

Average agricultural yield (tonnes/hectare)

Current
# (tonnes per

Projected
by 5th year
# (tonnes per

hectare)

hectare)

Number of smallholder farmers linked to the Project as:
Suppliers
Buyers
Contractors

#
#
#

#
#
#

Education

Number of students enrolled
Number of local students enrolled (excluding children of expatriates)
Number of local female students enrolled (excluding children of expatriates)
Number of needs-based scholarships for local students (per year)

Current
#
#
#
#

Projected
by 5th year
#
#
#
#

Current

Projected
by 5th year

Energy

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

#GWh

#GWh

Energy Access
Current
#
#
#
#

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

Non-Financial: 18 of 23

Projected
by 5th year
#
#
#
#

Questions for Non-Financial Services Projects Only
Health
Current
#
#

Number of patient beds
Number of patient consultations provided per year
Number of low-income patient consultations provided per year

#

Projected
by 5th year
#
#
#

Housing

Number of new residential dwellings
Number of new residential dwellings eligible for government housing assistance program for low-income homebuyers
Number of new residential dwellings eligible for government housing assistance program for middle-income homebuyers
Number of refurbished residential dwellings
Number of refurbished residential dwellings eligible for government housing assistance program for low-income homebuyers
Number of refurbished residential dwellings eligible for government housing assistance program for middle-income homebuyers

Current
#
#
#
#

Projected
by 5th year
#
#
#
#

#

#

#

#

Please specify the low- and/or middle-income government housing assistance programs for which the homebuyers are eligible.
Information and Communications Technologies
Current
#
#
#
#

Number of cell towers
Number of mobile subscriptions, including voice and/or data
Number of fixed data subscriptions
Number of fixed voice (telephone) subscriptions

Non-Financial: 19 of 23

Projected
by 5th year
#
#
#
#

Questions for Non-Financial Services Projects Only
Transportation

New road construction
Improved road construction
Units of cargo containers transported through the road/railway/port/airport per year (twenty foot equivalent units)
Tonnes of bulk cargo transported through the road/railway/port/airport per year
Passengers using transportation service per year

Current
# km
# km
# TEUs
# tonnes
#

Projected
by 5th year
# km
# km
# TEUs
# tonnes
#

Current
# tonnes
#m3

Projected
by 5th year
# tonnes
#m3

Current
#m3

Projected
by 5th year
#m3

Current

Projected
by 5th year

Waste and Sanitation

Amount of waste disposed per year (tonnes)
Volume of wastewater treated per year (m3)
Water

3

Volume of potable water produced per year (m )
Other
Please describe in detail the specific product and/or service that the Project provides: [space for text input]

Number of clients or customers per year

#

#

Number of low-income clients or customers per year

#

#

Number of female clients or customers per year

#

#

Non-Financial: 20 of 23

Questions for Non-Financial Services Projects Only
4

PROJECT CONSTRUCTION/BUILDOUT/STARTUP
Estimated Construction/Buildout/Start-up Period (if applicable)

MM/YYYY

TO

MM/YYYY

Estimated Operational Start Date (if applicable)

MM/YYYY

Does the Project involve physical construction?

Yes

Approximately what percentage of the construction has been completed to date?

No
%

Please provide a breakdown of the estimated number of Project employees that are/will be directly involved in the construction/buildout/startup:
Employment
Local
Foreign Nationals
Managerial
Professional/Technical
Unskilled Labor
Total
Will the Project utilize workers employed by third parties (i.e. contractors/subcontractors) for the construction/buildout/ startup?
physical construction

For what type(s) of tasks will these workers be employed?

Will the Project require the establishment of temporary construction worker housing facilities?
How many workers are expected to be housed at these facilities?

Yes

No
Other

administrative
Yes

No
#

Non-Financial: 21 of 23

Questions for Non-Financial Services Projects Only
Cell: B32
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Comment:
Smallholder farmers are defined as those farmers owning small plots of land on which they grow subsistence crops and up to two cash crops, relying almost
exclusively on family labor.
Cell: B39
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Comment:
Include both full-time and part-time, where each discrete student is counted regardless of number of courses.
Cell: B59
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Comment:
Low income means subsidized or eligible for subsidized healthcare.
Cell: B74
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Comment:
Including but not limited to GSM, CDMA, BGAN, VSAT, EDGE, UMTS, WiMax, 3G, 4G, LTE. Include both post-pay and pre-pay subscriptions
Cell: B75
Comment: [Threaded comment]

Non-Financial: 22 of 23

Questions for Non-Financial Services Projects Only
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Comment:
Including but not limited to ADSL, Broadband, Fibre. Include both post-pay and pre-pay subscriptions.
Cell: B76
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Comment:
Include both post-pay and pre-pay subscriptions
Cell: B99
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Comment:
Clients/customers who cannot afford the local market cost of basic goods/services, and thus would do without such goods/services if they were not made
available at a reduced cost.
Cell: B107
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Comment:
Number of full-time equivalent construction workers employed for the construction of the Project’s hard assets. Part-time jobs for construction are converted
to full-time equivalent jobs on a pro rata basis, based on local definition (e.g., if working week equals 40 hours, a 24 hr/week job would be equal to 0.6 FTE job).
Seasonal or short-term jobs are prorated on the basis of the portion of the year that was worked (e.g., a full-time position for three months would be equal to a
0.25 FTE job). If the information is not available, the rule-of-thumb is two part-time jobs equal one full-time job.
Non-Financial: 23 of 23