Form DFC‐010 Aligned Capital Investee Opt‐In

Aligned Capital Investee Opt-In (DFC010)
OMB No. [
]
Expiration Date: _______

United States International Development Finance Corporation
1100 New York Avenue, NW Washington, DC 20527-0001
An Agency of the United States Government

Paperwork Reduction Act Notice: This information is voluntary. 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 30 minutes 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 Finance 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.

Instructions
The information in this form is used by companies that are interested in connecting with potential
investors through DFC’s Aligned Capital Program. The Aligned Capital Program is designed to align
development finance and investment with other capital, including philanthropic, socially responsible and
impact investment, to enable effective deployment of that capital towards projects in the countries and
sectors in which DFC works. This program is independent of DFC’s other programs. Participation or
non-participation will have no bearing on existing or pending applications with DFC.
Information provided on this form will be automatically shared with any potential investors that have
completed an Aligned Capital Investor Screener indicating that their interests are a match with your
proposed project. These potential investors may choose to contact you, but are not obliged to do so.
To begin, click the “Start” button below.

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Part A—Identifying Information

1. INVESTEE COMPANY
Name:
Address (including city and country):
Phone Number(s):

2. AUTHORIZED REPRESENTATIVE
Name of Representative:
Relationship to the Company:
Address (including city and country):
Phone Number(s):
E-mails(s):
3. DESCRIPTION OF THE PROJECT
• Write a brief description of the Company’s operations or the project for which the Company is
seeking an investment. Include any details of particular interest, such as development goals or
targeted populations.
• If you are already working with DFC to arrange financing for this project, you may include relevant
information about the status of your discussions and update this information as often as warranted.
• If you would like to attach a presentation or other materials, please click the “Supporting
Documentation” hyperlink at the bottom of the screen.
• Do not include any confidential commercial information as this will be shared directly with
potential investors.

Part B—Matching Questions
The information requested in this section will be used to identify potential investors that may be
interested in the Company.
Please select one or more applicable responses for each question:
1. Asset Classes/Types of Investments and Sizes of Investment (Select each type of investment and
the size per type of investment the Company would be interested in discussing with potential
investors.)
(a) ____ Equity
[Drop down with dollar ranges]
(b) ____ Convertible Debt
[Drop down with dollar ranges]
(c) ____ Subordinated/Mezzanine Debt
[Drop down with dollar ranges]
(d) ____ Senior Debt
[Drop down with dollar ranges]
(e) ____ Grants/Technical Assistance
[Drop down with dollar ranges]
2. Total Project Size (Select the total target size of investment/project, including debt. If size has
not been finalized, select the current best estimate.)
[Drop down with dollar ranges]

3. Type of Investment Vehicle (Select the most accurate description of the Company.)
____ The Company is the entity that is building/operating a project—Operating
Company/Project Company/Special Purpose Vehicle
____ The Company is an entity that invests (usually via equity) in other companies—
Investment Vehicle/Fund/Holding Company
____ The Company is an entity that invests (usually via debt) in other companies—Financial
Intermediary/Bank/Non-Bank Financial Institution
____ The Company is an entity that invests in other companies in one or more ways—Hybrid
Vehicles

4. Sector (Identify the relevant sector for the business of the Company or the proposed project.)
[Drop down list of DFC Sectors]
5. Regions and Countries (Identify the countries or geographic region where the Company
operates or the proposed project will be conducted.)
[Drop down list of DFC Regions and Countries]

6. Does the Company have, or intend to have, a performance metric or other system for measuring
social impact and/or environmental impact?
____ Yes

____ No

7. Is the Company a women-owned enterprise or a women-led enterprise?
____ Yes

____ No

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.

Part C —Disclaimers and Certifications
The person completing this form represents and warrants that you are authorized to register on behalf
of the Company described in this Aligned Capital Investee Opt-In and that all information provided is
accurate and truthful.
DFC does not control, is not responsible for, has not reviewed and does not endorse any investor that is
participating in the Aligned Capital Program. In order for investors to participate in the Aligned Capital
Program, they must certify that they are an “accredited investor” within the meaning of Rule 501 of
Regulation D under the U.S. Securities Act of 1933, as amended, but DFC has not verified the accuracy of
their statements. DFC does not warrant the accuracy, completeness or usefulness of the information
provided by third parties. DFC’s creation of this program does not constitute investment advice. Users
need to consult with their own investment, accounting, legal and tax advisers to evaluate independently
the risks, consequences and suitability of their participation in this program.
This form shall be used only for the Aligned Capital Program, as described herein and on DFC’s website.
DFC may remove any profile that may, in DFC’s sole discretion, be offensive, illegal or include
inappropriate content.
DFC may terminate the program at any time, with or without notice.

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