Form DFC-007 Impact Assessment Questionnaire

Impact Assessment Questionnaire

DFC-007 OMB Final

Impact Assessment Questionnaire

OMB: 3015-0009

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3015-0009 can be found here:

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IMPACT ASSESSMENT QUESTIONNAIRE (DFC-007)

OMB [ 3015-0009 ]

Expiration Date: [ ]

United States International 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 project officer’s knowledge and belief. Statements of fact provided to DFC 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.

Information contained in this form will be deemed designated as “confidential commercial information” in accordance with 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. 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 2.5 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 Finance Corporation 1100 New York Ave., 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, D.C. 20503.

Rights Under the Privacy Act of 1974

The Privacy Act of 1974, as amended (5 U.S.C. § 552a), prohibits the disclosure without consent of information about individuals that the federal government maintains in a system of records. Agencies are required to give the public notice of their systems of records by publication in the Federal Register. The Act also provides individuals with a means by which to seek access to and amendment of their records, although such requests are subject to exemptions as set forth in the Privacy Act. In addition, the Act allows individuals to bring suit against an agency for violating the Privacy Act.

The Development Outcomes Survey (DOS) Form 008 is the principal document used by the DFC to review and update a client’s developmental impact profile and determine the project’s compliance with environmental, labor, and economic policies, as consistent with DFC’s authorizing legislation. As part of the DOS we are required to collect privacy information related to U.S. Citizens, lawful permanent resident, or a non-U.S. Citizens. If we store information about you in a system of records from which we retrieve that information by personal identifier (e.g., name, personal email address, home mailing address, personal or mobile phone number, etc.), we will safeguard your information in accordance with the Privacy Act. DFC adheres to Privacy Act requirements with respect to all information about individuals that it collects, maintains, uses, or disseminates in a System of Records, regardless of whether the information pertains to a U.S. Citizen, lawful permanent resident, or a non-U.S. Citizen. However, the rights to seek access to and amendment of covered records, and to bring suit for alleged violations of the Privacy Act, only extend to U.S. citizens and legal permanent residents (as defined in 5 U.S.C. § 552a(a)(2)) and citizens of designated foreign countries or regional economic organizations (as defined under the Judicial Redress Act of 2015, 5 U.S.C. § 552a note). Nonetheless, because we have an interest in maintaining records that are accurate and complete, non-U.S. citizens may seek amendment of records under the procedures described in the DFC’s Privacy Act Regulation.

DFC’s Privacy Act regulations can be found at 22 C.F.R. Part 706. Instructions on submitting a Privacy Act request are located at 22 C.F.R. § 707.21.

Personally identifiable information not contained in a system of records is protected under the Federal Information Security Modernization Act of 2014. 44 U.S.C. §§ 3554(a)(1)(A)(i), 3552(b)(3)(B).

For the general contact information that may be submitted through www.dfc.gov, we have completed a System of Records Notice (SORN) providing details about the privacy protections and redress options for information we collect from the public. For further information, please reference the documentation below.

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

PROJECT DESCRIPTION AND OWNERSHIP PROFILE [Q101 – Q110 TO BE COMPLETED BY PROJECT OFFICER]

The information in this section will ask for background and descriptive information about the Project. This section is to be completed by the APPLICANT based on information received from the PROJECT OFFICERS. For this section, “applicant” can refer to investors, lenders, insurers, reinsurers, Project sponsors, financial intermediaries, or fund managers who seek DFC support. “Project” refers to direct investments subprojects, or investment funds who use DFC-supported financial intermediaries that will benefit from this DFC support.

Q101 Applicant Name:

Q102 Project Name:

Q103 Will this Project operate in a single country, in multiple countries, throughout a region, or will it be global?

Single Country
Multiple Countries
Regional
Global

Q104 [IF Q103=1, ASK]: A. In what country will the project operate? _________

[IF Q103=1, ASK]: B. What is the total amount the Project will spend or invest in this country? _____$ (In US Dollars)

Q105 [IF Q103=2, ASK]: A. In what country will the project operate? _____________

[IF Q103=2, ASK]: B. What is the total amount the Project will spend or invest in this country?________$ (In US Dollars)

(PROGRAMMING NOTE: Repeat A and B when respondent clicks on “Add More” button)

Q106 [IF Q103=3, ASK]: In what region will the project operate? _________

[IF Q103=3, ASK]: What country will be considered the primary host country for this regional project? _________

[IF Q103=3, ASK]: What is the total amount the Project will spend or invest in this region? _____$ (In US Dollars)

[IF Q103=4, ASK]: What country will be considered the primary host country for this global project? _________

Q107 In what city will the Project’s headquarters or main office be located in? ___________________

Q108 Project Site Location (please include GPS coordinates of the site location, if available):

Q109 Will this project operate or invest in any of the following sectors? (Multiple Responses Allowed, Select All That Apply)

Agriculture, Forestry, Fishing and Hunting
Mining, Quarrying, and Oil and Gas Extraction
Utilities
Construction
Manufacturing
Wholesale Trade
Retail Trade
Transportation and Warehousing
Information
Finance and Insurance
Real Estate and Rental and Leasing
Professional, Scientific, and Technical Services
Management of Companies and Enterprises
Administrative and Support and Waste Management and Remediation Services
Educational Services
Health Care and Social Assistance
Arts, Entertainment, and Recreation
Accommodation and Food Services
Other Services (except Public Administration)
Public Administration

Q110A Please specify the DFC product(s) being requested for this Project: (Multiple Responses Allowed, Select All That Apply)

Debt – direct loan
Debt – investment guarantee
Equity
Political risk insurance
Technical Development
MTU Loan Guarantees

[IF Q110A=5, ASK]: Q110B Is this technical development a Grant, Technical Assistance, or a Feasibility Study?

Q110C Is this project considered a Financial Intermediary? Yes / No

[IF Q110C=YES, ASK]: Q110D Is this project an investment fund? Yes / No

[IF Q110D=YES, Q111 AUTOFILL = 1 NEW PROJECT AND DISPLAY NOTE: “For an investment fund, the term Project refers to the new fund being established and all activities and investments this fund plans to make.”]

Q111 Is this a new Project or an expansion of an existing Project?

New Project
Expansion of existing Project

Q111A Please provide a short description of the Project, including how DFC support will be used:

Q111B What are the main development impacts you expect from this Project? Please explain how these impacts will help solve a development challenge in the host country.

Q112 Will this Project be owned or managed (either completely or partially) by any individuals or enterprises located in the host country? Yes / No

[IF YES TO Q112, ASK]: Q112 A. How many host country owners are men?

[IF YES TO Q112, ASK]: Q112 B. How many host country owners are women?

[IF YES TO Q112, ASK]: Q112 C. How many host country executive level managers are men?

[IF YES TO Q112, ASK]: Q112 D. How many host country executive level managers are women?

[IF Q110D=YES, SKIP Q113] Q113 Will this Project be overseen by a Board of Directors in the host country? Yes / No

[IF Q113=YES, ASK]: A. How many host country board of directors members are men?

[IF Q113=YES, ASK]: B. How many host country board of directors members are women?

Q114 [IF Q110B = YES] A. How many of the Project’s Investment Committee members will be male?

[IF Q110B = YES] B. How many of the Project’s Investment Committee members will be female?

Q115 Will the Project be able to measure the total number of clients served in any of the following groups? (Multiple Responses Allowed, Select All That Apply)

Women
Youth
Low Income
Poor
Ethnic Minorities
Disabled
Smallholder farmers
Other marginalized or disadvantaged groups

[IF Other marginalized or disadvantaged groups is Selected]: Please specify what other group(s) can be measured: _____________

[IF Q110D=YES, SKIP Q115A1, Q115A2, and Q115A3]

[IF Q115A=YES, ASK]: Q115A1 Will this project have a way receive input from female stakeholders on product or service design, development, and delivery? Yes / No

[IF Q115A=YES, ASK]: Q115A2 Will this project offer price savings to female customers compared to similar products? Yes / No

[IF Q115A=YES, ASK]: Q115A3 Will this project allow new female customers access products and services that were previously unavailable to them? Yes / No

[IF Q110D=YES, SKIP Q116]

Q116 Is the Project considered a local Small and Medium Enterprise (SME) by the host country? Yes / No

Q117 Will the project serve SMEs in the host country? Yes / No

[IF Q110D=YES, SKIP Q118A-Q118D]

[IF YES TO Q116 OR Q117, ASK 118A – 118D]: We would like to know how the local host country defines small and medium enterprises (SMEs). First…

118A What is the host country’s limit for the number of employees an SME can have? _______

118B What is the host country’s limit for the total asset value an SME can have? _____

118C What is the host country’s limit for the total annual sales an SME can have? ____

118D What other standards, if any, are used locally when determining SME classification (Enter None if no other standards are known):_________

PROJECT ENVIRONMENTAL AND SOCIAL CHARACTERISTICS [TO BE COMPLETED BY APPLICANT]

The information in this section will ask about programs and management characteristics for the project. Questions will cover your Environment and Social Management System (ESMS), trade unions, collective bargaining agreements, and onsite security.

Q201 Does your project currently have: Yes / No

An Environmental and Social Policy Document
An organizational structure showing who is responsible for each part of your Environmental and Social Policy
An Occupational Health and Safety Plan
An Environmental and Social Management Plan
An Emergency Preparedness and Response Plan
A Stakeholder Engagement Plan
A formal Grievance Mechanism for Communities with concerns about the project

[IF YES TO ANY Q201A – Q201G, ASK]: Q202A – Q202G Please click Choose File to upload this document.

Q204 Does the project have onsite security? Yes / No

[IF Q204 = YES, ASK]: Q204A Are security guards armed? Yes / No

[IF Q204 = YES, ASK]: Q204B Is security publicly or privately contracted? Yes (Publicly) / Yes (Privately) / No, not contracted

Q205 Please attach documentation detailing the Project’s plans for environmental, social, and human rights due diligence processes that will be used to assess, avoid, mitigate, and monitor project risks.

3. PROJECT HUMAN RESOURCES MANAGEMENT AND JOB QUALITY [TO BE COMPLETED BY APPLICANT]

The information in this section will ask about human resource policies, labor standards, and employee benefits.

Q301 Does the Project (or the organization running the Project) have a written human resources policy? Yes / No

[IF Q301 = YES, ASK]: Q301a In which languages are the human resources policies available?

[IF Q301 = YES, ASK]: Q302 Does the Project’s human resources policy include any of the following: Yes / No

Policies prohibiting child labor
Policies prohibiting forced labor
Non-discrimination and Equal Opportunity policies
Sexual Harassment policies
Collective Bargaining/workers organizations policies
Disciplinary procedures
Policies for Hours of Work
Overtime arrangements and overtime compensation
Wages and benefits
Wage deductions
Breaks, Rest days, Leave for illness, maternity, vacation, or holiday policies
Established process for workers’ to express grievances (grievance mechanisms)
Dedicated staff member who is the point of contact for these policies

[IF Q301 = YES, ASK]: Q303 Please click here to upload a copy of the human resources policies (in English).

Q304 Are terms of employment communicated to workers verbally, in writing, or both?

Verbally
In writing
Both

Q305 [IF Q304 = 2 or 3, ASK] Please click here to upload a copy of a sample employment contract (in English).

Q306 Does the Project currently meet any international labor standards or certifications? Yes / No

[IF Q306 = YES, ASK]: Q306A Please specify the standard or certification ______

[IF Q306 = YES, ASK]: Q306B Please describe how it will be applied on this project _______

[PROGRAMMING NOTE: Repeat Q306A and Q306B if the respondent clicks on “Add More”]

Q307 Does the project plan to meet [any/additional] international labor standards or gain certifications in the future? Yes / No

[IF Q307 = YES, ASK]: Q307A Please specify the standard or certification ______

[IF Q307 = YES, ASK]: Q307B Please describe how it will be applied on this project _______

[Repeat Q307A and Q307B if respondent clicks on “Add More”]

Q308 Will the Project offer employee career development programs, such as tuition reimbursement or mentorships to any NEW NON-MANAGEMENT employees in the host country? Yes / No

[IF Q308 = YES, ASK]: Q308A Will the project offer education stipends to NEW NON-MANAGEMENT employees? Yes / No

[IF Q308 = YES, ASK]: Q308B Will the project offer any other education opportunities to NEW NON-MANAGEMENT employees? Yes/No

[IF Q308B = YES, ASK]: Q308C Please describe the opportunities offered:

[IF Q110D=YES, SHOW: “For these next questions, we want to know about policies in the host country where the fund headquarters are located. You do not need to take into consideration all of the other countries where the fund may be investing.]

Q309 Will the Project offer non-management employees benefits that go beyond the host country’s legal requirements? Yes / No

[IF Q309 = YES, ASK]: Q309A Which benefits for non-management employees go beyond what is legally required by the host country?

Q310 Will the Project offer employees any Family Friendly Benefits that go beyond what is legally required by the host country? Please check all that apply:

Flexible work schedules
Extended paid maternity leave
Paid paternity leave
Access to child care or child care stipends through the project
Family healthcare

Q311 Will the project include any initiatives to advance women in their workforce beyond what is legally required by the host country? Yes / No

[IF Q311=YES, ASK] Q311A Do these initiatives include any of the following: [SELECT ALL THAT APPLY]

A written policy on diverse representation and a system to monitor compliance
Flexible work arrangements for female employees
A written policy to combat and prevent sexual harassment and a system to monitor compliance
A written policy to compensate employees fairly and equitably and a system to monitor compliance
A written policy to support progression/promotion of employees fairly and a system to monitor compliance
A written anti-discrimination policy for its employees and a system to monitor compliance
Employment benefits
Employee training program(s)
Other [PLEASE SPECIFY]:

Q312 Is the Project expected to cause layoffs of workers? Yes / No

[IF YES TO Q312, ASK]: Q312A How many layoffs are expected? ______#

[IF YES TO Q312, ASK]: Q312B Please describe what will cause these layoffs.

Q313 Will the Project work with an onsite trade union? Yes / No

[IF YES TO Q313, ASK]: Q314 What percentage of Project workers will be covered by a collective bargaining agreement? ______ %

[IF Q314 > 0, ASK]: Q314A Please click here to upload a copy of the collective bargaining agreement.

Q315 To the best of your knowledge, has the project experienced any of the following? Yes / No

Violation of host country (local) laws or other labor standards

[IF Q315A=YES, ASK]: Q315A1 Please describe the violation of host country (local) laws or other labor standards:

Labor-related lawsuits against the project

[IF Q315B=YES, ASK]: Q315B1 Please describe the labor-related lawsuits against the project:

Strikes or other labor disputes in the last 3 years

[IF Q315C=YES, ASK]: Q315C1 Please describe the strikes or other labor disputes in the last 3 years:

Ongoing or unresolved disputes with a trade union

[IF Q315D=YES, ASK]: Q315D1 Please describe any ongoing or unresolved disputes with a trade union:

PROJECT BENEFITS TO THE ENVIRONMENT AND THE COMMUNITY [TO BE COMPLETED BY APPLICANT.]

This section will ask about the Project’s efforts to help the environment and local communities.

[IF Q110D=YES, SKIP Q401 – Q405 AND ONLY ASK Q406]

Q401 Will the Project take any actions to help restore or preserve the environment? (Do NOT include actions required by law or permit in the host country)? Yes / No

[IF Q401 = YES, ASK]: These next questions will ask about specific actions related to the environment the project plans to take. If the Project will take more than one action to help restore of preserve the environment, list each action separately.

Q401A What action will be taken to help restore or preserve the environment?

Q401B How will this action help restore or preserve the environment?

Q401C How will the Project measure the impact this action will have on the environment?

(PROGRAMMING NOTE: Repeat Q401A – Q401C if respondent clicks on “Add More”.)

Q402 Does the Project currently meet any international environmental standards or certifications? Yes / No

[IF Q402 = YES, ASK]: These next questions will ask about international environmental standards or certifications the Project currently meets. If the Project meets more than one standard, list each separately.

Q402A Please specify the standard or certification ______

Q402B Please describe how it is applied on this project _______

(PROGRAMMING NOTE: Repeat Q402A – Q402B if respondent clicks on “Add More”.)

Q403 Does the project plan to meet [any/additional] international environmental standards or gain certifications in the future? Yes/No

[IF Q403 = YES, ASK]: These next questions will ask about international environmental standards or certifications the Project plans to meet in the future. If the Project plans to meet more than one standard, list each separately.

Q403A Please specify the standard or certification ______

Q403B Please describe how it will be applied on this project _______

(PROGRAMMING NOTE: Repeat Q403A – Q403B if respondent clicks on “Add More”.)

Q404 Does the Project currently have a voluntary sustainability certification from an internationally-recognized authority? Yes / No

[IF Q404 = YES, ASK]: These next questions will ask about voluntary sustainability certifications the Project currently has. If the Project currently meets more than one standard, list each separately.

Q404A Please specify the standard or certification ______

Q404B Please describe how it is applied on this project _______

(PROGRAMMING NOTE: Repeat Q404A – Q404B if respondent clicks on “Add More”.)

Q405 Does the project plan to meet [any/additional] voluntary sustainability certifications in the future? Yes / No

[IF Q405 = YES, ASK]: These next questions will ask about sustainability certifications the Project plans to meet in the future. If the Project plans to receive more than one certification, list each separately.

Q405A Please specify the certification ______

Q405B Please describe how it will be applied on this project _______

(PROGRAMMING NOTE: Repeat Q405A – Q405B if respondent clicks on “Add More”.)

Q406 Will the Project support any charitable activities to benefit the local community in which they operate? (Do NOT include the goods and/services the Project will produce for customers in the local community.) Yes / No

[IF Q406 = YES, ASK]:

Q406A How much money will be spent on these charitable activities each year?( $/year) _____

Q406B Please describe the charitable activities the Project will support:

Q406C Will these charitable activities be developed or administered in collaboration with local stakeholders in the host country? Yes/No

[IF Q406C = YES, ASK]: Q406D Please describe who the Project will collaborate with and what this collaboration involves:

5. BUSINESS INNOVATION AND TECHNICAL ASSISTANCE [TO BE COMPLETED BY APPLICANT.]

The information in this section will ask about innovative aspects of the Project, including financial structures, new products or services, and/or operational/production processes that create efficiencies.

[IF Q110D=YES, SHOW: “For investment funds answering the following questions, please think about investments into portfolio companies you expect the fund will make and the impacts of those investments. Please think of portfolio companies as the fund’s customers for this section.”]

Q501 Will the Project use a new or uncommon financial structure or business model that has not been used in this market before and is intended to mobilize private capital or increase competition in the market? Yes / No

[IF Q501 = YES, ASK]: Q501A Please describe the new or uncommon financial structure being used.

Q502 Will the Project use DFC support to offer a new product that is not currently produced or available in the host country, a new process that increases distribution or efficiency, or introduce any new technology into the host country? Yes / No

[IF Q502 = YES, ASK Q503 – Q505]: Will the Project introduce any of the following to the host country for the first time:

Q503 New products or services Yes / No

[IF Q503 = YES, ASK]: Q503A Please describe how the Project’s product or service is different from what is currently available:

Q504 New business processes Yes / No

[IF Q504 = YES, ASK]: Q504A Please describe how this business process will impact Project operations, customers, or the overall market:

Q505 New production or processing technology Yes / No

[IF Q505 = YES, ASK]: Please describe how this technology will impact Project operations, customers, or the overall market:

Q506 Will the project provide technical assistance to customers? Yes / No

[IF Q506 = YES] Q506A Please describe this technical assistance including how it is funded and how its effectiveness is measured:

[IF Q506 = YES] Q506B How many customers will the project provide technical assistance to? _______#

[IF Q506 = YES] Q506C How much money will be spent on technical assistance for customers?

[IF Q110D=YES, SKIP Q507]

Q507 Will the project provide technical assistance to suppliers? Yes / No

[IF Q507 = YES] Q507A Please describe this technical assistance including how it is funded and how its effectiveness is measured:

[IF Q507 = YES] Q507B How many suppliers will the project provide technical assistance to? _______#

[IF Q507 = YES] Q507C How much money will be spent on technical assistance for suppliers?

6. PROJECT COMPETITIVE POSITION [TO BE COMPLETED BY APPLICANT]

The information in this section will ask about project market share and new legislation or regulations resulting from the project.

Q601 Please estimate how many firms currently provide the same or similar products or services in the host country? _______#

[IF Q111=2, ASK]: Q602 What is the Project’s estimated current market share? ________%

Q603 Did recent host country reforms, new legislation, or new regulations make this Project possible? Yes / No

[IF Q603 = YES, ASK]: Q603A Please explain those changes in the host country and how they impact the Project.

Q604 Do you expect the Project to lead to new host country reforms, new legislation, or new regulations? Yes / No

[IF Q604 = YES, ASK]: Q604A Please explain what changes are expected and how the project will lead to these changes.

7. PROJECT OPERATIONAL EMPLOYMENT [TO BE COMPLETED BY APPLICANT]

This section will ask about current and future Project employees for operations only. Do not include construction, buildout, or startup employees; those employees will be asked about later. We will ask about different types of employees including MANAGERS, PROFESSIONAL/TECHNICAL, ENTRY LEVEL STAFF, and UNSKILLED LABOR. We will ask about FULL-TIME, PART-TIME, SEASONAL, and CONTRACT employees separately.

For Investment Funds, we are asking for the number of new employees at the Fund level who will be working at the fund’s offices.
For other Financial Intermediaries, we are asking for the number of current and new employees that will service the DFC-supported portfolio(s).

We will ask several detailed questions about the operations staff you currently employ and plan to hire so you may need to refer to your employment records to answer questions in this section.

For this first section, please think about FULL-TIME MANAGERS for this Project.

[IF Q111=2, ASK]: Q701 How many FULL-TIME MANAGERS from the host country does the Project currently employ? _____

[IF Q111=2 AND Q701>0, ASK]: Q701A Of these FULL-TIME MANAGERS in the host country, how many are FEMALE? _________

[IF Q111=2 AND Q701>0, ASK]: Q701B Of these FULL-TIME MANAGERS in the host country, how many are YOUTH (15-24 years old)?

[IF Q111=2, ASK]: Q701C How many current FULL-TIME MANAGERS are foreign nationals (not from the host country)? ___________

Q702A Thinking about the next five years, how many FULL-TIME MANAGERS from the host country do you expect to hire? _______

Q702B Still thinking about the next five years, how many FULL-TIME MANAGERS who are foreign nationals do you expect to hire?_____

For the next set of questions, please think about FULL-TIME PROFESSIONAL/TECHNICAL employees for this Project.

[IF Q111=2, ASK]: Q703 How many FULL-TIME PROFESSIONAL/TECHNICAL employees from the host country does the Project currently employ? ___

[IF Q111=2 AND Q703>0, ASK]: Q703A Of these FULL-TIME PROFESSIONAL/TECHNICAL employees in the host country, how many are FEMALE?

[IF Q111=2 AND Q703>0, ASK]: Q703B Of these FULL-TIME PROFESSIONAL/TECHNICAL employees in the host country, how many are YOUTH (15-24 years old)? _____

[IF Q111=2, ASK]: Q703C How many current FULL-TIME PROFESSIONAL/TECHNICAL employees are foreign nationals? _____

Q704A Thinking about the next five years, how many FULL-TIME PROFESSIONAL/TECHNICAL employees from the host country do you expect to hire? __________

Q704B Still thinking about the next five years, how many FULL-TIME PROFESSIONAL/TECHNICAL employees who are foreign nationals do you expect to hire?________

For the next set of questions, please think about FULL-TIME UNSKILLED LABORERS for this Project.

[IF Q111=2, ASK]: Q707 How many FULL-TIME UNSKLLED LABORERS from the host country does the Project currently employ? __

[IF Q111=2 AND Q707>0, ASK]: Q707A Of these FULL-TIME UNSKLLED LABORERS in the host country, how many are FEMALE?

[IF Q111=2 AND Q707>0, ASK]: Q707B Of these FULL-TIME UNSKLLED LABORERS in the host country, how many are YOUTH (15-24 years old)? ____

[IF Q111=2, ASK]: Q707C How many current FULL-TIME UNSKLLED LABORERS are foreign nationals? ____________

Q708A Thinking about the next five years, how many FULL-TIME UNSKLLED LABORERS from the host country do you expect to hire? __________

Q708B Still thinking about the next five years, how many FULL-TIME UNSKLLED LABORERS who are foreign nationals do you expect to hire?________

For this next section, we will ask you about any PART-TIME EMPLOYEES for this project.

[ASK ALL]: Q709 Will the project be employing any PART-TIME workers? Yes / No

For the next set of questions, please think about PART-TIME MANAGERS for this Project.

[IF Q111=2 AND Q709=YES, ASK]: Q710 How many PART-TIME MANAGERS from the host country does the Project currently employ? ____________

[IF Q111=2 AND Q709=YES AND Q710>0, ASK]: Q710A Of these PART-TIME MANAGERS in the host country, how many are FEMALE? ____________

[IF Q111=2 AND Q709=YES AND Q710>0, ASK]: Q710B Of these PART-TIME MANAGERS in the host country, how many are YOUTH (15-24 years old)? ____________

[IF Q111=2 AND Q709=YES, ASK]: Q710C How many current PART-TIME MANAGERS are foreign nationals? ____________

[IF Q709=YES, ASK]: Q711A Thinking about the next five years, how many PART-TIME MANAGERS from the host country do you expect to hire? _____

[IF Q709=YES, ASK]: Q711B Still thinking about the next five years, how many PART-TIME MANAGERS who are foreign nationals do you expect to hire?____

For this next set of questions, please think about PART-TIME PROFESSIONAL/TECHNICAL employees for this Project.

[IF Q111=2 AND Q709=YES, ASK]: Q712 How many PART-TIME PROFESSIONAL/TECHNICAL employees from the host country does the Project currently employ? ____

[IF Q111=2 AND Q709=YES AND Q712>0, ASK]: Q712A Of these PART-TIME PROFESSIONAL/TECHNICAL employees in the host country, how many are FEMALE?

[IF Q111=2 AND Q709=YES AND Q712>0, ASK]: Q712B Of these PART-TIME PROFESSIONAL/TECHNICAL employees in the host country, how many are YOUTH (15-24 years old)? ____________

[IF Q111=2 AND Q709=YES, ASK]: Q712C How many current PART-TIME PROFESSIONAL/TECHNICAL employees are foreign nationals? ____________

[IF Q709=YES, ASK]: Q713A Thinking about the next five years, how many PART-TIME PROFESSIONAL/TECHNICAL employees from the host country do you expect to hire? __________

[IF Q709=YES, ASK]: Q713B Still thinking about the next five years, how many PART-TIME PROFESSIONAL/TECHNICAL employees who are foreign nationals do you expect to hire?________

For the next set of questions, please think about PART-TIME UNSKILLED LABORERS for this Project.

[IF Q111=2 AND Q709=YES, ASK]: Q716 How many PART-TIME UNSKLLED LABORERS from the host country does the Project currently employ? ____________

[IF Q111=2 AND Q709=YES AND Q716>0, ASK]: Q716A Of these PART-TIME UNSKLLED LABORERS in the host country, how many are FEMALE? ____________

[IF Q111=2 AND Q709=YES AND Q716>0, ASK]: Q716B Of these PART-TIME UNSKLLED LABORERS in the host country, how many are YOUTH (15-24 years old)? ____________

[IF Q111=2 AND Q709=YES, ASK]: Q716C How many current PART-TIME UNSKLLED LABORERS are foreign nationals? _______

[IF Q709=YES, ASK]: Q717A Thinking about the next five years, how many PART-TIME UNSKLLED LABORERS from the host country do you expect to hire? __________

[IF Q709=YES, ASK]: Q717B Still thinking about the next five years, how many PART-TIME UNSKLLED LABORERS who are foreign nationals do you expect to hire?________

[IF Q110D=YES, SKIP Q718 and GOTO Q728]

For this next section, we will ask you about any SEASONAL EMPLOYEES for this project.

Q718 Will the project be employing any SEASONAL workers? Yes / No

For the next set of questions, please think about SEASONAL MANAGERS for this Project.

[IF Q718=YES, ASK]: Q719 On average, how many months per year do the Project’s seasonal employees work? _____

[IF Q111=2 AND Q718=YES, ASK]: Q720 How many SEASONAL MANAGERS from the host country does the Project currently employ? ____________

[IF Q111=2 AND Q718=YES AND Q720>0, ASK]: Q720A Of these SEASONAL MANAGERS in the host country, how many are FEMALE? ____________

[IF Q111=2 AND Q718=YES AND Q720>0, ASK]: Q720B Of these SEASONAL MANAGERS in the host country, how many are YOUTH (15-24 years old)? ____________

[IF Q111=2 AND Q718=YES, ASK]: Q720C How many current SEASONAL MANAGERS are foreign nationals? ____________

[IF Q718=YES, ASK]: Q721A Thinking about the next five years, how many SEASONAL MANAGERS from the host country do you expect to hire? ______

[IF Q718=YES, ASK]: Q721B Still thinking about the next five years, how many SEASONAL MANAGERS who are foreign nationals do you expect to hire?________

For the next set of questions, please think about SEASONAL PROFESSIONAL/TECHNICAL employees for this Project.

[IF Q111=2 AND Q718=YES, ASK]: Q722 How many SEASONAL PROFESSIONAL/TECHNICAL employees from the host country does the Project currently employ? ___

[IF Q111=2 AND Q718=YES AND Q722>0, ASK]: Q722A Of these SEASONAL PROFESSIONAL/TECHNICAL employees in the host country, how many are FEMALE?

[IF Q111=2 AND Q718=YES AND Q722>0, ASK]: Q722B Of these SEASONAL PROFESSIONAL/TECHNICAL employees in the host country, how many are YOUTH (15-24 years old)? _____

[IF Q111=2 AND Q718=YES, ASK]: Q722C How many current SEASONAL PROFESSIONAL/TECHNICAL employees are foreign nationals? ____________

[IF Q718=YES, ASK]: Q723A Thinking about the next five years, how many SEASONAL PROFESSIONAL/TECHNICAL employees from the host country do you expect to hire? __________

[IF Q718=YES, ASK]: Q723B Still thinking about the next five years, how many SEASONAL PROFESSIONAL/TECHNICAL employees who are foreign nationals do you expect to hire?________

For this next set of questions, please think about SEASONAL UNSKILLED LABORERS for this Project.

[IF Q111=2 AND Q718=YES, ASK]: Q726 How many SEASONAL UNSKLLED LABORERS from the host country does the Project currently employ? ____________

[IF Q111=2 AND Q718=YES AND Q726>0, ASK]: Q726A Of these SEASONAL UNSKLLED LABORERS in the host country, how many are FEMALE? ____________

[IF Q111=2 AND Q718=YES AND Q726>0, ASK]: Q726B Of these SEASONAL UNSKLLED LABORERS in the host country, how many are YOUTH (15-24 years old)? __

[IF Q111=2 AND Q718=YES, ASK]: Q726C How many current SEASONAL UNSKLLED LABORERS are foreign nationals? ________

[Q718=YES, ASK]: Q727A Thinking about the next five years, how many SEASONAL UNSKLLED LABORERS from the host country do you expect to hire? __________

[Q718=YES, ASK]: Q727B Still thinking about the next five years, how many SEASONAL UNSKLLED LABORERS who are foreign nationals do you expect to hire?________

Now we will ask about CONTRACTORS OR SUBCONTRACTORS employed by this Project.

[ASK ALL]: Q728 Will the Project use contract workers from third parties such as contractors or subcontractors? Yes / No

[IF Q728=YES, ASK]: Q728A What type(s) of jobs will these contract workers complete? Please select all that apply.

Physical construction
Administrative work
Custodial work
Security services
Other operational needs

[IF Q728A = 1, ASK]: Physical construction[IF Q728A = 1, ASK]: How many contracts for physical construction will the project issue? _______#

[IF Q728A = 1, ASK]: How many contract workers in total will be employed through these contracts? _______#

[IF Q728A = 1, ASK]: Of these contracted workers how many will be unskilled laborers? _______#

[IF Q728A = 1, ASK]: Of these contracted workers how many will be foreign nationals? _______#

[IF Q728A = 2, ASK]: Administrative work

[IF Q728A = 2, ASK]: How many contracts for administrative work will the project issue? _______#

[IF Q728A = 2, ASK]: How many contract workers in total will be employed through these contracts? _______#

[IF Q728A = 2, ASK]: Of these contracted workers how many will be unskilled laborers? _______#

[IF Q728A = 2, ASK]: Of these contracted workers how many will be foreign nationals? _______#

[IF Q728A = 3, ASK]: Custodial work

[IF Q728A = 3, ASK]: How many contracts for custodial work will the project issue? _______#

[IF Q728A = 3, ASK]: How many contract workers in total will be employed through these contracts? _______#

[IF Q728A = 3, ASK]: Of these contracted workers how many will be unskilled laborers? _______#

[IF Q728A = 3, ASK]: Of these contracted workers how many will be foreign nationals? _______#

[IF Q728A = 4, ASK]: Security services

[IF Q728A = 4, ASK]: How many contracts for security services will the project issue? _______#

[IF Q728A = 4, ASK]: How many contract workers in total will be employed through these contracts? _______#

[IF Q728A = 4, ASK]: Of these contracted workers how many will be unskilled laborers? _______#

[IF Q728A = 4, ASK]: Of these contracted workers how many will be foreign nationals? _______#

[IF Q728A = 5, SHOW]: Other operational needs

[IF Q728A = 5, ASK]: How many contracts for other operational needs will the project issue? _______#

[IF Q728A = 5, ASK]: Please describe these operations related contracted jobs:

[IF Q728A = 5, ASK]: How many contract workers in total will be employed through these contracts? _______#

[IF Q728A = 5, ASK]: Of these contracted workers how many will be unskilled laborers? _______#

[IF Q728A = 5, ASK]: Of these contracted workers how many will be foreign nationals? _______#

We will finish this section by asking about those employed by the project who are disabled and/or disadvantaged.

[ASK ALL]: Q739 Will the project employ any disabled people? Yes / No

[IF Q111=2 AND Q739=YES, ASK]: Q739A How many disabled employees from the host country does the project currently employ?

[IF Q111=2 AND Q739=YES, ASK]: Q739B How many disabled employees who are foreign nationals does the project currently employ? ________

[IF Q739=YES, ASK]: Q739C How many disabled employees from the host country will the project employ in five years? ________

[IF Q739=YES, ASK]: Q739D How many disabled employees who are foreign nationals will the project employ in five years? ________

[ASK ALL]: Q740 Will the project employ any disadvantaged people? Yes / No

[IF Q111=2 AND Q740=YES, ASK]: Q740A How many disadvantaged employees from the host country does the project currently employ? ________

[IF Q111=2 AND Q740=YES, ASK]: Q740B How many disadvantaged employees who are foreign nationals does the project currently employ? ________

[IF Q740=YES, ASK]: Q740C How many disadvantaged employees from the host country will the project employ in five years? _______

[IF Q740=YES, ASK]: Q740D How many disadvantaged employees who are foreign nationals will the project employ in five years? __

[IF Q111=2, ASK]: Q741 Please provide the total amount currently paid each year to Project employees in the host country (total annual local payroll). Do not include foreign nationals working on the project.

[ASK ALL]: Q742 Please provide the total amount expected to be paid annually by the FIFTH YEAR of operation, including all annual salaries for Project employees in the Host Country. Do not include foreign nationals working on the project.

[ASK ALL]: Q743 Next, thinking about all people directly employed by the Project, how many are US Citizens? _____

8. MACROECONOMIC IMPACTS ON US, LOCAL, AND THIRD COUNTRY ECONOMIES [TO BE COMPLETED BY APPLICANT]

The information in this section will ask about project benefits to the U.S. economy, project funding, and operating expenditures.

[ASK ALL]: Q801 Please describe how the Project will benefit U.S. businesses or the U.S. economy?

We would like to know more about initial funding for this Project. For these questions, please provide amounts in US Dollars.

[ASK ALL]: Q802 Will the Project receive funding from other US government agencies, not including potential DFC support? Yes/No

[IF Q802=YES, ASK]: Q802A What is the name of this funding source? [LIST OF USG AGENCIES ]

[IF Q802=YES, ASK]: Q802B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $________

[PROGRAMMING NOTE: Repeat Q802A-Q802B if respondent clicks on “Add More”]

[ASK ALL]: Q803 Will the Project receive private-sector funding from US sources, including the Applicant organization? Yes/No

[IF Q803=YES, ASK]: Q803A What is the name of this funding source? ________________

[IF Q803=YES, ASK]: Q803B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $________

[PROGRAMMING NOTE: Repeat Q803A-Q803B if respondent clicks on “Add More”]

[ASK ALL]: Q804 Will the Project receive public-sector funding from US sources? Yes/No

[IF Q804=YES, ASK]: Q804A What is the name of this funding source? ________________

[IF Q804=YES, ASK]: Q804B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $________

[PROGRAMMING NOTE: Repeat Q804A-Q804B if respondent clicks on “Add More”]

[ASK ALL]: Q805 Will the project receive funding from any other development finance or multilateral organizations? Yes/No

[IF Q805=YES, ASK]: Q805A What is the name of this funding source? [DROP DOWN LIST OF ORGANIZATIONS]

[IF Q805=YES, ASK]: Q805B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $____

[PROGRAMMING NOTE: Repeat Q805A-Q805B if respondent clicks on “Add More”]

[ASK ALL]: Q806 Will the Project receive funding from private-sector sources within the host country? Yes/No

[IF Q806=YES, ASK]: Q806A What is the name of this funding source? ________________

[IF Q806=YES, ASK]: Q806B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $_____

[PROGRAMMING NOTE: Repeat Q806A-Q806B if respondent clicks on “Add More”]

[ASK ALL]: Q807 Will the Project receive public-sector funding from sources within the host country? Yes/No

[IF Q807=YES, ASK]: Q807A What is the name of this funding source? ________________

[IF Q807=YES, ASK]: Q807B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $________

[PROGRAMMING NOTE: Repeat Q807A-Q807B if respondent clicks on “Add More”]

[ASK ALL]: Q808 Will the project receive funding from private-sector sources located outside the host country, not including the United States? Yes/No

[IF Q808=YES, ASK]: Q808A What is the name of this funding source? ________________

[IF Q808=YES, ASK]: Q808B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $______

[PROGRAMMING NOTE: Repeat Q808A-Q808B if respondent clicks on “Add More”]

[ASK ALL]: Q809 Will the Project receive public-sector funding from sources located outside the host country, not including the United States? YES/NO

[IF Q809=YES, ASK]: Q809A What is the name of this funding source? ________________

[IF Q809=YES, ASK]: Q809B How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $________

[PROGRAMMING NOTE: Repeat Q809A-Q809B if respondent clicks on “Add More”]

[ASK ALL]: Q810 Will the project receive initial funding from any other source not listed above? Yes / No

[IF Q810=YES, ASK]: Q810A What is the name of this funding source? ________________

[IF Q810=YES, ASK]: Q810B Is this a public source or private source of funding? Public / Private

[IF Q810=YES, ASK]: Q810C How much funding will the Project receive from {INSERT SOURCE NAME} in US Dollars? $________

[PROGRAMMING NOTE: Repeat Q810A-Q810C if respondent clicks on “Add More”]

9. IMPACT ON CURRENT U.S. EMPLOYMENT [TO BE COMPLETED BY APPLICANT FOR PROJECTS PROVIDING NON-FINANCIAL PRODUCTS/SERVICES]

The next few questions will ask about project business procedures such as outsourcing.

[IF Q110C=NO, ASK]: Q901 Do any U.S. investors in the Project currently produce the same product as this Project? Yes / No

[IF Q110C=NO AND Q901=YES, ASK]: Q902 How many people are currently employed by this U.S. company or subsidiaries that currently produces the product and are investing in this Project?

[IF Q110C=NO AND Q901=YES, ASK]: Q903 Will there be fewer employees of this U.S. company or subsidiaries making the product(s) in the U.S. as a result of this Project?

[IF Q110C=NO AND Q901=YES, ASK]: Q904 Will the Project allow this U.S. company or subsidiaries to outsource any business process that is currently done in the United States? Yes / No

[IF Q110C=NO, ASK]: Q905 Not including the U.S. investors to this Project we just asked about, do any other U.S. companies currently produce the same product as this Project? Yes / No

[IF Q110C=NO AND Q905=YES, ASK]: Q906 Which U.S. companies currently produce the same product as this Project?

[IF Q110C=NO AND Q905=YES, ASK]: Q907 How many people are currently employed by these other U.S. companies that currently produces the product?

[IF Q110C=NO AND Q905=YES, ASK]: Q908 Will there be fewer employees at these other companies making the product(s) in the U.S. as a result of this Project?

[IF Q110C=NO AND Q905=YES, ASK]: Q909 Will any of these other companies be likely to outsource any of these business processes that are currently done in the US? Yes / No

10. SPENDING ON PROCUREMENT OF GOODS AND SERVICES, TAXES [TO BE COMPLETED BY APPLICANT FOR PROJECTS THAT ARE NON-FINANCIAL INTERMEDIARY]

For this next section, we would like to know more about how and where project funds will be spent. First, we would like to know us how much will be spent on goods and services.

[IF Q110C=NO, ASK]: Q1001 How much will be spent on goods and services from companies in the United States? __________$

[IF Q110C=NO, ASK]: Q1002 How much will be spent on goods and services from companies in the host country? __________$

[IF Q110C=NO, ASK]: Q1003 How much will be spent on goods and services from companies not in the United States or host country?$

[IF Q110C=NO AND Q1001>0, ASK]: You estimated that ${FILL Q1001 RESPONSE} of the Project’s funding will be spent on goods or services from U.S. companies. For the next questions, please think only about NEW products -- do not include any USED products. Answer for one product at a time. If the Project will purchase more than one product from US companies, we will ask about each product separately.

[IF Q110C=NO AND Q1001>0, ASK]: Q1004 What is the name of the product or service that will be purchased from a US company?

[IF Q110C=NO AND Q1001>0, ASK]: Q1005 From what US company will this product or service be purchased? _________________

[IF Q110C=NO AND Q1001>0, ASK]: Q1006 Where is the US company that produces this product or service located?

A City:_________________ B State: (DROP DOWN LIST OF STATES)

[IF Q110C=NO AND Q1001>0, ASK]: Q1007 What is the total amount this Project will spend on this good or service? $_____

[IF Q110C=NO AND Q1001>0, ASK]: Q1007 Will the Project purchase any other goods or services from US companies? Yes / No

(PROGRAMMING NOTE: REPEAT Q1004 – Q1007 UNTIL RESPONDENT SAYS “NO” TO Q1007.)

[IF Q111=2 AND Q110C=NO AND Q1002>0]: You estimated that ${FILL Q1002 RESPONSE} of the Project’s funding will be spent on goods or services in the host country. We would like to know more about your current local suppliers.

[IF Q111=2 AND Q110C=NO AND Q1002>0, ASK]: Q1008 How many local suppliers do you purchase goods and services from?

[IF Q111=2 AND Q110C=NO AND Q1002>0, ASK]: Q1009 How many local suppliers are women-owned or led enterprises?

[IF Q111=2 AND Q110C=NO AND Q1002>0, ASK]: Q1010 How many local suppliers are classified as microenterprises (companies with fewer than 10 employees)?

[IF Q111=2 AND Q110C=NO AND Q1002>0, ASK]: Q1011 How many local suppliers are classified as SMEs by the local government?

[IF Q111=2 AND Q110C=NO AND Q1002>0, ASK]: Q1012 How many local suppliers are smallholder farmers?

[IF Q111=2 AND Q110C=NO AND Q1002>0, ASK]: Q1013 How many local suppliers are owned or led by disadvantaged populations?

[IF Q110C=NO, ASK]: Q1014 How much in total does the Project expect to pay the United States Government in taxes, royalties, concessions, or other fees over the next five years? $____

[IF Q111=2 AND Q110C=NO, ASK]: Q1015 How much in total does the Project currently pay the host country government in taxes, royalties, concessions, or other fees? $______

[IF Q110C=NO, ASK]: Q1016 How much in total does the Project expect to pay the host country government in taxes, royalties, concessions, or other fees over the next five years? $______

11. SALES AND REVENUE [TO BE COMPLETED BY NON-FINANAICIAL INTERMEDIARY PROJECT APPLICANTS]

Now we will ask a few questions about the project’s current and projected revenue.

[IF Q111=2 AND Q110C=NO, ASK]: Q1101 How much of the Project’s CURRENT revenue comes from exports to the United States? ______$

[IF Q111=2 AND Q110C=NO, ASK]: Q1102 How much of the Project’s CURRENT revenue comes from sales inside the host country? ______$

[IF Q111=2 AND Q110C=NO, ASK]: Q1103 How much of the Project’s CURRENT revenue comes from exports to countries other than the United States or the host country? $___________

[IF Q111=2 AND Q110C=NO, ASK]: Q1104 What is the Project’s CURRENT, annual gross revenue? $__________

[IF Q111=2 AND Q110C=NO, ASK]: Q1105 What is the Project’s CURRENT, annual net profit? $__________

[IF Q110C=NO, ASK]: Q1106 Please estimate the Project’s annual gross revenue by the fifth year of operation. $_______

[IF Q110C=NO, ASK]: Q1107 Please estimate the Project’s annual net profit by the fifth year of operation. $_______

[IF Q110C=NO, ASK]: Q1108 Will the Project increase Host Country exports? Yes / No

[IF Q110C=NO AND Q1108=YES, ASK]: Q1108A What goods will the Project export?

[IF Q110C=NO AND Q1108=YES, ASK]: Q1108B To which countries does the Project intend to export these goods? _________

[IF Q110C=NO AND Q1108=YES, ASK]: Q1108C How many units of the product will the project export? ________ [DROP DOWN UNITS]

[IF Q110C=NO AND Q1108=YES, ASK]: Q1108D In total, how much does the Project expect to export over the next five years? $____

[IF Q110C=NO, ASK]: Q1109 Will the Project reduce the Host Country’s need to import certain goods? Yes / No

[IF Q110C=NO AND Q1109=YES, ASK]: Q1109A What goods will the Project provide that are currently being imported?

[IF Q110C=NO AND Q1109=YES, ASK]: Q1109B Which countries are currently importing these goods to the host country?

[IF Q110C=NO AND Q1109=YES, ASK]: Q1109C In total, how much less is expected to be imported over the next five years? $______

12. ENVIRONMENTAL AND SOCIAL CHARACTERISTICS [TO BE COMPLETED BY ALL APPLICANTS]

The next few questions will ask about project impacts on the environment and regulatory agency auditing or monitoring of the project.

Q1201 Will the Project engage with communities impacted by the project throughout every stage of Project design and implementation (including disadvantaged and vulnerable groups)? Yes / No

[IF Q1201=YES, ASK] Q1201a If available, please upload documentation of these activities.

Q1202 Has the Project been involved in a community dispute or complaint resolution process, including at an Independent Accountability Mechanism of an International Finance Institution? Yes / No

[IF Q1202 =YES, ASK] Q1202a Please describe the dispute or complaint and list steps being taken to resolve it.

Q1202-1 Is the Project, applicant, any related party or affiliate of the applicant, or any supplier to the project currently or previously associated with an OECD National Contact Point complaint? Yes/No

Q1202-2 Does the Project have a protocol to prevent and address threats of or actual retaliation against grievance mechanism complainants and those associated with Project complaints or concerns? Yes/No

[IF Q1202-2= YES, ASK] Q1202-2a Please describe the Project’s protocol and attach supporting documentation.

Q1203 Will the Project be located in or with the potential to adversely impact:

Q1203a Natural forest areas Yes / No

Q1203b Areas on the United Nations List of Natural Parks, World Heritage Sites, or other protected areas Yes / No

Q1204c Sensitive locations of national or regional importance Yes / No

Q1204 Does the Project involve:

Q1204a Construction of a dam or weir Yes / No

Q1204b Production or trade of a product or activity that is illegal under the host country’s laws or international agreements (this includes international phase-outs or bans). Yes / No

Q1204c Land acquisition Yes / No

Q1204d Physical displacement and resettlement of people in the host country Yes / No

[IF Q1204d=YES, ASK] Q1204d1 How many households will be displaced? ____________

Q1204e Disruption of people’s livelihoods, jobs, or income in the host country Yes / No

[IF Q1204e=YES, ASK] Q1204e1 Please estimate the number of people whose livelihoods, jobs, or income will be affected: ________#

[IF Q1204e=YES, ASK] Q1204e2 Please describe the cause of these impacts:

Q1204f Use of previously contaminated sites Yes / No

Q1204g Production or trade in radioactive materials Yes / No

Q1204h Production, trade, or use of unbounded asbestos fibers Yes / No

Q1204i Fishing practices which may harm vulnerable or protected species or may damage biodiversity or habitats Yes / No

Q1205 Will any government regulatory agencies monitor or audit the Project’s impacts? These may include environmental, social, labor, performance, or construction impacts. Yes / No

[IF Q1205=YES, ASK] Q1205a What agency will perform this audit?

[IF Q1205=YES, ASK] Q1205b Describe how they will monitor or audit the Project?

[PROGRAMMING NOTE: Repeat Q1205a, Q1205b if respondent clicks on “Add More”].

Q1206 Will any Project suppliers have their environmental and social practices certified by a third party in the next five years? Yes/No

[IF Q1206=YES, ASK] Q1206a Which organization will certify the suppliers?

[IF Q1206=YES, ASK] Q1206b Which Project supplies will meet these certification standards?

[IF Q1206=YES, ASK] Q1206c Of all supplies used by the project, what percentage will come from suppliers who meet these standards? _____%

13. SECTOR-SPECIFIC METRICS

[START NEW SECTION. TO BE COMPLETED BY APPLICANT FOR PROJECTS PROVIDING NON-FINANCIAL PRODUCTS/SERVICES]

[IF Q110C=NO, ASK SECTION 13]:

The next few questions will ask about sector specific projects. For each sector, we will ask for detailed information about services provided and the number of people who benefit from these services.

PROJECTS IN AGRICULTURAL SECTOR [IF Q109A=YES, ASK Q1301-Q1302]

[IF Q111=2] Q1301 What is the current average annual yield from this project? ___________# of tons per hectare

Q1302 What is the expected average annual yield from this project by the fifth year of operation? ________# of tons per hectare

PROJECTS IN EDUCATION SECTOR [IF Q109O=YES, ASK Q1303-Q1310]

These next questions are about the enrollment of students and scholarships offered through the Project. For these questions, count ALL PART-TIME and FULL-TIME students, regardless of their course load.

	[IF Q111=2] Current	Total over next five years
Q1303 Total number of students enrolled	A	B
Q1304 Number of LOCAL students enrolled (excluding children of expatriates)	A	B
Q1305 Number of LOCAL FEMALE students enrolled (excluding children of expatriates)	A	B
Q1306 Number of LOCAL LOW INCOME students enrolled	A	B
Q1307 Number of LOCAL POOR students enrolled	A	B
Q1308 Number of LOCAL DISABLED students enrolled	A	B
Q1309 Number of LOCAL DISADVANTAGED students enrolled	A	B
Q1310 Number of needs-based scholarships for local students offered (per year)	A	B

PROJECTS IN ENERGY PROVISION SECTOR [IF Q109C=YES, ASK Q1311-Q1313]

The next questions are about the energy the Project is and will be delivering in Gigawatt hours (GWh) to energy offtakers. First provide the annual amount of non-renewable energy, renewable energy and the total energy the project currently delivers. Then provide the amount non-renewable energy, renewable energy, and total energy the Project expects to provide over the next five years combined.

	[IF Q111=2] Current Annual GWh	Total GWh over next five years
Q1311 Non-Renewable Energy	A	B
Q1312 Renewable Energy	A	B
Q1313 Total energy	A	B

PROJECTS IN ENERGY ACCESS SECTOR [IF Q109C=YES, ASK Q1314-Q1317]

The next questions are about increasing access to electricity and electrical devices. Please provide the number of on-grid connections, micro-grid connections, and household power systems the project currently has. Then provide the total number of new on-grid connections, micro-grid connections, and household power systems the Project expects to add over the next five years.

	[IF Q111=2] Current Number	Total NEW over next five years
Q1314 On-Grid connections	A	B
Q1315 Micro-grid connections	A	B
Q1316 Household power systems installed	A	B
Q1317 Modern lighting devices sold	A	B

PROJECTS IN ENERGY ACCESS SECTOR [IF Q109C=YES, ASK Q1317A-Q1317D]

Q1317A Please identify the type(s) of energy that will be generated. Please check all that apply.

Wind

Solar Geothermal Biofuels Thermal (coal)

Thermal (natural gas) Thermal (oil)

Hydro

Other (please specify):___________

PROJECTS IN HEALTH SECTOR [IF Q109P=YES, ASK Q1318-Q1323]

These next questions are about health services. For each service listed below, tell us how many the Project currently provides each year and the total number the Project expects to provide over the next five years.

	[IF Q111=2] Current Number per year	Total over next five years
Q1318 Number of patient beds	A	B
Q1319 Patient consultations provided	A	B
Q1320 Female patient consultations provided	A	B
Q1321 Low-income patient consultations	A	B
Q1322 Poor patient consultations	A	B
Q1323 Disadvantaged populations	A	B

PROJECTS IN HOUSING SECTOR [IF Q109K=YES, ASK Q1324-Q1331]

These next questions are about housing. For each type of dwelling listed below, tell us how many the Project currently builds each year and the total number the Project expects to provide over the next five years.

	[IF Q111=2] Current Number	Total over next five years
Q1324 Total new residential dwellings	A	B
Q1325 New residential dwellings eligible for government assistance for poor homebuyers	A	B
Q1326 New residential dwellings eligible for government assistance for low-income homebuyers	A	B
Q1327 New residential dwellings eligible for government assistance for middle-income homebuyers	A	B
Q1328 Refurbished residential dwellings	A	B
Q1329 Refurbished residential dwellings eligible for government assistance for poor homebuyers	A	B
Q1330 Refurbished residential dwellings eligible for government assistance for low-income homebuyers	A	B
Q1331 Refurbished residential dwellings eligible for government assistance for middle-income homebuyers	A	B

[IF ANY Q1325-1327 or Q1329-1331 >0, ASK]: Q1332 Please specify which poor, low-income, or middle-income government assistance programs the Project’s homebuyers are eligible for:

PROJECTS IN INFORMATION AND COMMUNICATIONS TECHNOLOGIES SECTOR [IF Q109I=YES, ASK Q1333-Q1338]

These next questions are about communications technology. For each item listed below, tell us how many the Project currently has and the total number the Project expects to have in five years. We will also ask about the number of poor and low income subscribers separately. Poor individuals make less than the host country’s poverty line. Low income individuals make less than the median income but more than the poverty line in the host country.

	[IF Q111=2] Current Number	Total over next five years
Q1333 Number of cell towers	A	B
Q1334 Number of mobile subscriptions (include both voice and data subscribers)	A	B
Q1335 Number of fixed data (wired connection) subscriptions	A	B
Q1336 Number of fixed voice (landline telephone) subscriptions	A	B
Q1337 Number of low-income subscribers	A	B
Q1338 Number of poor subscribers	A	B

PROJECTS IN TRANSPORTATION SECTOR [IF Q109H=YES, ASK Q1339-Q1344]

These next questions are about transportation and shipping improvements. For each item listed below, tell us how many the Project currently produces and the total number the Project expects to produce over the next five years.

	[IF Q111=2] Current Number per year	Total over next five years
Q1339 New road construction (a) current km per year and (b) total km over next five years	A # km	B # km
Q1340 Road improvement construction (a) current km per year and (b) total km over next five years	A # km	B # km
Q1341 Number of cargo containers transported through the road/railway/port/airport (a) per year (twenty foot equivalent units) and (b) total over next five years	A # TEU	B # TEU
Q1342 Tons of bulk cargo transported through the road/railway/port/airport (a) per year and (b) total over next five years	A tons	B tons
Q1343 Passengers using transportation service (a) currently per year and (b) total over next five years	A people	B people
Q1344 Number of warehouses or storage units (a) currently open and (b) to be constructed	A units	B units

PROJECTS IN WASTE AND SANITATION SECTOR [IF Q109N=YES, ASK Q1345-Q1347]

These next questions are about waste water and potable water. In the table below, tell us how much waste water the Project currently disposes of each year and how much will be disposed of in total over the next five years. Then tell us how many metric tonnes of wastewater the Project currently treats each year and how many metric tonnes will be treated in total over the next five years. Last, tell us how many metric tonnes of potable water are currently being produced and how many metric tonnes in total will be produced by the Project over the next five years.

	[IF Q111=2] Current Number per year	Total over next five years
Q1345 Amount of waste disposed per year	A MT	B MT
Q1346 Volume of wastewater treated per year	A MT	B MT
Q1347 Volume of potable water produced per year	A MT	B MT
Q1347A Volume of water delivered per year	A MT	B MT

[ASK FOR ALL PROJECTS]

Please tell us about any other products or services the Project will provide that were not asked about in the previous sections.

Q1348A First, will the project produce any products or provide any services that have not been counted in previous questions? Yes/No

[IF Q1348A=YES, ASK]: Q1348B Please describe the product or service the Project will produce:

[IF Q1348A=YES, ASK Q1349-1358]: Please tell us how many customers currently use the Project’s products or services. For each type of customer listed below, tell us how many the Project currently sells to or provide services to per year and how many from each category the Project expects to sell to or provide services to in total over the next five years:

	[IF Q111=2] Current Number per year	Total over next five years
Q1349 Number of clients or customers per year	A	B
Q1350 Poor clients or customers	A	B
Q1351 Low-income clients or customers	A	B
Q1352 Disabled clients or customers	A	B
Q1353 Small and Medium Enterprise (SME) clients or customers	A	B
Q1354 Rural clients or customers (not smallholder or microenterprises)	A	B
Q1355 Microenterprises	A	B
Q1356 Smallholder farmers	A	B
Q1357 Female clients or customers per year	A	B
Q1358 Other customers from marginalized populations	A	B

14. PROJECT CONSTRUCTION/BUILDOUT/STARTUP

[START NEW SECTION. TO BE COMPLETED BY STAFF FOR PROJECTS PROVIDING NON-FINANCIAL PRODUCTS/SERVICES]

The next few questions ask about project-related construction including timelines, the number of employees hired, and temporary housing for construction workers.

[IF Q109D=YES, ASK]: Q1401 What is the estimated construction/build-out/start-up period (if applicable): Start Date: MM/YYYY End Date: MM/YYYY

[IF Q109D=YES, ASK]: Q1402 Once construction/build-out/start-up is complete, when will the Project be operational (if applicable): Operational by: MM/YYYY

[IF Q109D=YES, ASK]: Q1403 Approximately what percentage of the construction/build-out/start-up has been completed as of today? ____%

[IF Q109D=YES, ASK]: Q1404 How many Project employees will be directly involved in construction, build-out, or startup? ___#

[IF Q109D=YES, ASK]: Thinking about all of the Project employees who will be involved in construction, buildout, or startup, how many are managerial, professional or technical, and unskilled labor? For each of these categories, please tell us how many are host country employees and how many are foreign nationals.

Employment	Local (Host Country)	Foreign Nationals
Q1405 Management	A	B
Q1406 Professional/Technical	A	B
Q1407 Unskilled Labor	A	B
Q1408 TOTAL	A	B

[IF Q109D=YES, ASK]: Q1409 Will the Project utilize workers employed by third parties (i.e., through contractors/subcontractors) for construction, build-out, and startup? Yes / No

[IF Q109D=YES, ASK]: Q1410 What jobs will third party employees complete for the Project? (Select all that apply)

Management

Professional / Technical

Unskilled labor including physical construction

Other (Please specify:____________________)

[IF Q109D=YES, ASK]: Q1411A Will the Project require the establishment of temporary construction worker housing facilities? Yes/No

[IF Q109D=YES, ASK AND Q1411A=YES, ASK]: Q1411B How many workers are expected to be housed at these facilities? #______

QUESTIONS ONLY FOR PROJECTS PROVIDING FINANCIAL PRODUCTS/SERVICES

15. FINANCIAL INTERMEDIARY– OPERATIONAL METRICS

[IF Q110C=YES, ASK THIS SECTION. TO BE COMPLETED BY APPLICANT FOR PROJECTS PROVIDING FINANCIAL PRODUCTS/SERVICES]

The next few questions will ask about project investments. [IF Q110D=YES, SHOW: “For investment funds, please answer based on the fund’s investment strategy and the types of projects you expect to invest in. Consider the host country to be any country you expect the fund to make investments in.”

[IF Q110C=YES, ASK]: Q1501 How much Project funding will be invested in the host country, not including fees, transaction costs, or contingency funds? $

[IF Q110C=YES, ASK]: Q1502 How much Project funding will be used for direct loans or investments in the host country to businesses or consumers? $

[IF Q110C=YES, ASK]: Q1503 How much Project funding will be used for improvements such as product development, building new branches, installing new ATMs, technology improvements or other uses other than direct loans or investments to businesses or consumers? $

[IF Q110C=YES, ASK]: Q1504 Will DFC funds be used for other activities to expand financial product portfolios? Please DO NOT include onlending, leasing, or investing equity in portfolio companies, such as branch expansion or establishing new distribution techniques? Yes / No

[IF Q110C=YES AND Q1504=NO, ASK] Q1504A For DFC funds NOT used to expand financial product portfolios, please describe in detail how those funds will be used:

16. CLASSIFICATION OF FINANCIAL ASSET PORTFOLIO BY PRODUCT TYPE

The next section will ask about current and projected financial transactions for the Project.

Please think about the number of clients, number of transactions, number of branches, and the number of portfolio investments the Project currently has and is expected to have in five years. Then think about the Project’s financial asset portfolio. Tell us the current size and expected size of the portfolio in five years and provide estimates for the amount of that portfolio lent to women and rural customers currently and in five years. Then tell us the current average transaction amount and the average transaction amount expected in five years. And last, tell us the current maximum transaction amount and the maximum transaction amount expected in five years.

	[IF Q111=2] Current	Total over next five years
Q1601 Number of active clients	#	#
Q1602 Number of transactions	#	#
[IF Q110D=YES, SKIP Q1603 through Q1604d] Q1603 Number of branches	#	#
Q1604 Total value of financial assets portfolio	$US	$US
Q1604a Amount of the portfolio lent to female clients	$US	$US
Q1604b Amount of the portfolio lent to rural clients	$US	$US
Q1604c Amount of the portfolio lent to low income clients	$US	$US
Q1604d Amount of the portfolio lent to disabled clients	$US	$US
Q1605 Average transaction amount per client	$US	$US
Q1606 Maximum transaction amount to a single client	$US	$US

17. LOAN TYPES OFFERED [START NEW SECTION. TO BE COMPLETED BY STAFF FOR PROJECTS PROVIDING FINANCIAL PRODUCTS/SERVICES]

[IF 110C=YES, ASK]: The next section will ask for information regarding different loans that may be offered by the Project. For each type of loan the Project offers, we will ask about the number of clients, number of loans, and values of the loans. If the Project acts as a financial intermediary, please only think about the final loan recipients for each loan type listed.

[IF Q110D=YES, SKIP TO Q1719]

Q1701Will the Project offer microfinance loans? Yes / No

[IF Q110C=YES AND Q111=2 AND Q1701=YES, ASK]: Q1701a How many microfinance clients does the project currently serve?___#

[IF Q110C=YES AND Q1701=YES, ASK]: Q1701b How many microfinance clients will the project serve in THE NEXT five years? ______#

[IF Q110C=YES AND Q111=2 AND Q1701=YES, ASK]: Q1701c How many microfinance transactions does the project currently administer each year? ______#

[IF Q110C=YES AND Q1701=YES, ASK]: Q1701d How many microfinance transactions will the project complete over the next five years? ____#

[IF Q110C=YES AND Q111=2 AND IF Q1701=YES, ASK]: Q1701e What is the current value of all microfinance loans under the project portfolio? ______$

[IF Q110C=YES AND Q1701=YES, ASK]: Q1701f What will be value of all microfinance loans under the project portfolio in THE NEXT five years? ____$

[IF Q110C=YES AND Q111=2 AND Q1701=YES, ASK]: Q1701g What is the current average loan size for microfinance loans? _____$

[IF Q110C=YES AND Q1701=YES, ASK]: Q1701h What will be the average loan size of microfinance loans in THE NEXT five years? ______$

[IF Q110C=YES AND Q111=2 AND Q1701=YES, ASK]: Q1701i What is the current average loan period for microfinance loans? ___months

[IF Q110C=YES AND Q1701=YES, ASK]: Q1701j What will be the expected average loan period for microfinance loans in THE NEXT five years? _____months

[IF Q110C=YES AND Q1701=YES, ASK]: Q1702 Will the Project offer microfinance loans to women-owned or led microenterprises? Yes/No

[Q110C=YES AND Q111=2 AND Q1702=YES, ASK]: Q1702a How many women microenterprise clients does the project currently serve? ______#

[IF Q110C=YES AND Q1702=YES, ASK]: Q1702b How many women microenterprise clients will the project serve in THE NEXT five years? ______#

[IF Q110C=YES AND Q111=2 AND Q1702=YES, ASK]: Q1702c How many transactions for women microenterprise clients does the project currently administer each year? ______#

[IF Q110C=YES AND Q1702=YES, ASK]: Q1702d How many transactions for women microenterprise clients will the project make over the next five years? __#

[IF Q110C=YES AND Q111=2 AND Q1702=YES, ASK]: Q1702e What is the current value of all for microenterprise loans to women under the project portfolio? ___$

[IF Q110C=YES AND Q1702=YES, ASK]: Q1702f What will be value of all microenterprise loans to women under the project portfolio in THE NEXT five years? ___$

[IF Q110C=YES AND Q111=2 AND Q1702=YES, ASK]: Q1702g What is the current average loan size for microenterprise loans to women? ______$

[IF Q110C=YES AND Q1702=YES, ASK]: Q1702h What will be the average loan size of for microenterprise loans to women in THE NEXT five years? ______$

[IF Q110C=YES AND Q111=2 AND Q1702=YES, ASK]: Q1702i What is the current average loan period for microenterprise loans to women? ______months

[IF Q110C=YES AND Q1702=YES, ASK]: Q1702j What will be the expected average loan period for microenterprise loans to women in THE NEXT five years? ______months

[IF Q110C=YES AND Q1701=YES, ASK]: Q1703 Will the Project offer rural (not smallholder) microfinance loans? Yes / No

[IF Q110C=YES AND Q111=2 AND Q1703=YES, ASK]: Q1703a How many rural microfinance clients does the project currently serve? _______#

[IF Q110C=YES AND Q1703=YES, ASK]: Q1703b How many rural microfinance clients will the project serve in THE NEXT five years?______#

[IF Q110C=YES AND Q111=2 AND Q1703=YES, ASK]: Q1703c How many rural microfinance transactions does the project currently administer each year? ______#

[IF Q110C=YES AND Q1703=YES, ASK]: Q1703d How many rural microfinance transactions will the project administer over the next five years? ______#

[IF Q110C=YES AND Q111=2 AND Q1703=YES, ASK]: Q1703e What is the current value of all rural microfinance loans under the project portfolio? ______$

[IF Q110C=YES AND Q1703=YES, ASK]: Q1703f What will be value of all rural microfinance loans under the project portfolio in THE NEXT five years? ______$

[IF Q110C=YES AND Q111=2 AND Q1703=YES, ASK]: Q1703g What is the current average loan size for rural microfinance loans?__$

[IF Q110C=YES AND Q1703=YES, ASK]: Q1703h What will be the average loan size of rural microfinance loans in THE NEXT five years?____$

[IF Q110C=YES AND Q111=2 AND Q1703=YES, ASK]: Q1703i What is the current average loan period for rural microfinance loans? ______months

[IF Q110C=YES AND Q1703=YES, ASK]: Q1703j What will be the expected average loan period for rural microfinance loans in THE NEXT five years? ______months

[IF Q110C=YES AND Q1701=YES, ASK]: Q1704 Will the Project offer smallholder microfinance loans? Yes / No

[IF Q110C=YES AND Q111=2 AND Q1704=YES, ASK]: Q1704a How many smallholder microfinance clients does the project currently serve? ______#

[IF Q110C=YES AND Q1704=YES, ASK]: Q1704b How many smallholder microfinance clients will the project serve in THE NEXT five years?___#

[IF Q110C=YES AND Q111=2 AND Q1704=YES, ASK]: Q1704c How many smallholder microfinance transactions does the project currently administer each year? ______#

[IF Q110C=YES AND Q1704=YES, ASK]: Q1704d How many smallholder microfinance transactions will the project administer over the next five years? ______#

[IF Q110C=YES AND Q111=2 AND Q1704=YES, ASK]: Q1704e What is the current value of all smallholder microfinance loans under the project portfolio? ______$

[IF Q110C=YES AND Q1704=YES, ASK]: Q1704f What will be value of all smallholder microfinance loans under the project portfolio in THE NEXT five years? ______$

[IF Q110C=YES AND Q111=2 AND Q1704=YES, ASK]: Q1704g What is the current average loan size for smallholder microfinance loans?______$

[IF Q110C=YES AND Q1704=YES, ASK]: Q1704h What will be the average loan size of smallholder microfinance loans in THE NEXT five years? ______$

[IF Q110C=YES AND Q111=2 AND Q1704=YES, ASK]: Q1704i What is the current average loan period for smallholder microfinance loans? ______months

[IF Q110C=YES AND Q1704=YES, ASK]: Q1704j What will be the expected average loan period for smallholder microfinance loans in THE NEXT five years? ______months

[IF Q110C=YES, ASK]: Q1705 Will the Project offer small and medium enterprise (SME) loans? Yes / No

[IF Q110C=YES AND Q111=2 AND Q1705=YES, ASK]: Q1705a How many SME clients does the project currently serve?______#

[IF Q110C=YES AND Q1705=YES, ASK]: Q1705b How many SME clients will the project serve in THE NEXT five years? ______#

[IF Q110C=YES AND Q111=2 AND Q1705=YES, ASK]: Q1705c How many SME transactions does the project currently administer each year? ______#

[IF Q110C=YES AND Q1705=YES, ASK]: Q1705d How many SME transactions will the project administer over the next five years? #

[IF Q110C=YES AND Q111=2 AND Q1705=YES, ASK]: Q1705e What is the current value of all SME loans under the project portfolio?$

[IF Q110C=YES AND Q1705=YES, ASK]: Q1705f What will be value of all SME loans under the project portfolio in THE NEXT five years?______$

[IF Q110C=YES AND Q111=2 AND Q1705=YES, ASK]: Q1705g What is the current average loan size for SME loans?______$

[IF Q110C=YES AND Q1705=YES, ASK]: Q1705h What will be the average loan size of SME loans in THE NEXT five years? ______$

[IF Q110C=YES AND Q111=2 AND Q1705=YES, ASK]: Q1705i What is the current average loan period for SME loans?______months

[IF Q110C=YES AND Q1705=YES, ASK]: Q1705j What will be the expected average loan period for SME loans in THE NEXT five years? _______months

[IF Q110C=YES AND Q1705=YES, ASK]:Q1706 Will the Project offer small and medium enterprise (SME) loans to women? Yes / No

[IF Q110C=YES AND Q111=2 AND Q1706=YES, ASK]: Q1706a How many women SME clients does the project currently serve? ______#

[IF Q110C=YES AND Q1706=YES, ASK]: Q1706b How many women SME clients will the project serve in THE NEXT five years?______#

[IF Q110C=YES AND Q111=2 AND Q1706=YES, ASK]: Q1706c How many SME transactions to women does the project currently administer each year? ______#

[IF Q110C=YES AND IF Q1706=YES, ASK]: Q1706d How many SME transactions to women will the project administer over the next five years? ______#

[IF Q111=2; IF Q1706=YES, ASK]: Q1706e What is the current value of all SME loans to women under the project portfolio? ______$

[IF Q1706=YES, ASK]: Q1706f What will be value of all SME loans to women under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1706=YES, ASK]: Q1706g What is the current average loan size for SME loans to women? ______$

[IF Q1706=YES, ASK]: Q1706h What will be the average loan size of SME loans to women in THE NEXT five years? ______$

[IF Q111=2; IF Q1706=YES, ASK]: Q1706i What is the current average loan period for SME loans to women ? ______months

[IF Q1706=YES, ASK]: Q1706j What will be the expected average loan period for SME loans to women in THE NEXT five years? ______months

[IF Q1706=YES, ASK]: Q1707 Will the Project offer rural (not including smallholder) small and medium enterprise (SME) loans? Yes/No

[IF Q111=2; IF Q1707=YES, ASK]: Q1707a How many rural SME clients does the project currently serve? ______#

[IF Q1707=YES, ASK]: Q1707b How many rural SME clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1707=YES, ASK]: Q1707c How many rural SME transactions does the project currently administer each year?______#

[IF Q1707=YES, ASK]: Q1707d How many rural SME transactions will the project administer over the next five years? ______#

[IF Q111=2; IF Q1707=YES, ASK]: Q1707e What is the current value of all rural SME loans under the project portfolio? ____$

[IF Q1707=YES, ASK]: Q1707f What will be value of all rural SME loans under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1707=YES, ASK]: Q1707g What is the current average loan size for rural SME loans? ______$

[IF Q1707=YES, ASK]: Q1707h What will be the average loan size of rural SME loans in THE NEXT five years? ______$

[IF Q111=2; IF Q1707=YES, ASK]: Q1707i What is the current average loan period for rural SME loans? _____months

[IF Q1707=YES, ASK]: Q1707j What will be the expected average loan period for rural SME loans in THE NEXT five years? _____months

[IF Q1706=YES, ASK]: Q1708 Will the Project offer smallholder small and medium enterprise (SME) loans? Yes / No

[IF Q111=2; IF Q1708=YES, ASK]: Q1708a How many smallholder SME clients does the project currently serve? _____#

[IF Q1708=YES, ASK]: Q1708b How many smallholder SME clients will the Project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1708=YES, ASK]: Q1708c How many smallholder SME transactions does the Project currently administer each year? ______#

[IF Q1708=YES, ASK]: Q1708d How many smallholder SME transactions will the Project administer over the next five years? ______#

[IF Q111=2; IF Q1708=YES, ASK]: Q1708e What is the current value of all smallholder SME loans under the Project portfolio?______$

[IF Q1708=YES, ASK]: Q1708f What will be value of all smallholder SME loans under the Project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1708=YES, ASK]: Q1708g What is the current average loan size for smallholder SME loans? ______$

[IF Q1708=YES, ASK]: Q1708h What will be the average loan size of smallholder SME loans in THE NEXT five years? ______$

[IF Q111=2; IF Q1708=YES, ASK]: Q1708i What is the current average loan period for smallholder SME loans? _____months

[IF Q1708=YES, ASK]: Q1708j What will be the expected average loan period for smallholder SME loans in THE NEXT five years? ______months

[IF Q110C=YES, ASK]: Q1709 Will the Project offer corporate loans? Yes / No

[IF Q111=2; IF Q1709=YES, ASK]: Q1709a How many corporate clients does the project currently serve? ______#

[IF Q1709=YES, ASK]: Q1709b How many corporate clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1709=YES, ASK]: Q1709c How many corporate transactions does the project currently administer each year? _____#

[IF Q1709=YES, ASK]: Q1709d How many corporate transactions will the project administer over the next five years? ____#

[IF Q111=2; IF Q1709=YES, ASK]: Q1709e What is the current value of all corporate loans under the project portfolio? ______$

[IF Q1709=YES, ASK]: Q1709f What will be value of all corporate loans under the project portfolio in THE NEXT five years? _____$

[IF Q111=2; IF Q1709=YES, ASK]: Q1709g What is the current average loan size for corporate loans? ______$

[IF Q1709=YES, ASK]: Q1709h What will be the average loan size of corporate loans in THE NEXT five years? ______$

[IF Q111=2; IF Q1709=YES, ASK]: Q1709i What is the current average loan period for corporate loans? ______months

[IF Q1709=YES, ASK]: Q1709j What will be the expected average loan period for corporate loans in THE NEXT five years? __months

[IF Q1709=YES, ASK]: Q1710 Will the Project offer rural (not including smallholder) corporate loans? Yes / No

[IF Q111=2; IF Q1710=YES, ASK]: Q1710a How many rural corporate clients does the project currently serve? ______#

[IF Q1710=YES, ASK]: Q1710b How many rural corporate clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1710=YES, ASK]: Q1710c How many rural corporate transactions does the project currently administer each year? ______#

[IF Q1710=YES, ASK]: Q1710d How many rural corporate transactions will the project administer over the next five years? ______#

[IF Q111=2; IF Q1710=YES, ASK]: Q1710e What is the current value of all rural corporate loans under the project portfolio?______$

[IF Q1710=YES, ASK]: Q1710f What will be value of all rural corporate loans under the project portfolio in THE NEXT five years? _____$

[IF Q111=2; IF Q1710=YES, ASK]: Q1710g What is the current average loan size for rural corporate loans? ______$

[IF Q1710=YES, ASK]: Q1710h What will be the average loan size of rural corporate loans in THE NEXT five years? ______$

[IF Q111=2; IF Q1710=YES, ASK]: Q1710i What is the current average loan period for rural corporate loans? _____months

[IF Q1710=YES, ASK]: Q1710j What will be the expected average loan period for rural corporate loans in THE NEXT five years? ____months

[IF Q1709=YES, ASK]: Q1710W Will the Project offer corporate loans to women-owned or led enterprises? Yes / No

[IF Q1710=YES, ASK]: Q1710Wa How many women-owned or led enterprise clients does the project currently serve? ______#

[IF Q1710=YES, ASK]: Q1710Wb How many women-owned or led enterprise clients will the project serve in THE NEXT five years? ______#

[IF Q1710=YES, ASK]: Q1710Wc How many corporate transactions for women-owned or led enterprises does the project currently administer each year? ______#

[IF Q1710=YES, ASK]: Q1710Wd How many corporate transactions for women-owned or led enterprises will the project administer over the next five years? ______#

[IF Q1710=YES, ASK]: Q1710We What is the current value of all corporate loans to women-owned or led enterprises under the project portfolio?______$

[IF Q1710=YES, ASK]: Q1710Wf What will the value of all corporate loans to women-owned or led enterprises under the project portfolio be in THE NEXT five years?______$

[IF Q1710=YES, ASK]: Q1710Wg What is the current average loan size for corporate loans to women-owned or led enterprises? ______$

[IF Q1710=YES, ASK]: Q1710Wh What will be the average loan size for corporate loans to women-owned or led enterprises in THE NEXT five years? ______$

[IF Q1710=YES, ASK]: Q1710Wi What is the current average loan period for corporate loans to women-owned or led enterprises? _____months

[IF Q1710=YES, ASK]: Q1710Wj What will be the average loan period for corporate loans to women-owned or led enterprises in THE NEXT five years? _____months

[IF Q110C=YES, ASK]: Q1711 Will the Project offer consumer loans? Yes / No

[IF Q111=2; IF Q1711=YES, ASK]: Q1711a How many consumer clients does the project currently serve? ______#

[IF Q1711=YES, ASK]: Q1711b How many consumer clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1711=YES, ASK]: Q1711c How many consumer transactions does the project currently administer each year? ______#

[IF Q1711=YES, ASK]: Q1711d How many consumer transactions will the project administer over the next five years? ______#

[IF Q111=2; IF Q1711=YES, ASK]: Q1711e What is the current value of all consumer loans under the project portfolio? _____$

[IF Q1711=YES, ASK]: Q1711f What will be value of all consumer loans under the project portfolio in THE NEXT five years? ____$

[IF Q111=2; IF Q1711=YES, ASK]: Q1711g What is the current average loan size for consumer loans? ______$

[IF Q1711=YES, ASK]: Q1711h What will be the average loan size of consumer loans in THE NEXT five years? ______$

[IF Q111=2; IF Q1711=YES, ASK]: Q1711i What is the current average loan period for consumer loans? ______months

[IF Q1711=YES, ASK]: Q1711j What will be the expected average loan period for consumer loans in THE NEXT five years? ___months

[IF Q1711=YES, ASK]: Q1712 Will the Project offer consumer loans for women? Yes / No

[IF Q111=2; IF Q1712=YES, ASK]: Q1712a How many consumer loans for women does the project currently serve? _____#

[IF Q1712=YES, ASK]: Q1712b How many consumer loans for women will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1712=YES, ASK]: Q1712c How many consumer loans for women does the project currently administer each year?______#

[IF Q1712=YES, ASK]: Q1712d How many consumer loans for women will the project administer over the next five years? ______#

[IF Q111=2; IF Q1712=YES, ASK]: Q1712e What is the current value of all consumer loans for women under the project portfolio? ______$

[IF Q1712=YES, ASK]: Q1712f What will be value of all consumer loans for women under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1712=YES, ASK]: Q1712g What is the current average loan size for consumer loans for women? _____$

[IF Q1712=YES, ASK]: Q1712h What will be the average loan size of consumer loans for women in THE NEXT five years? ______$

[IF Q111=2; IF Q1712=YES, ASK]: Q1712i What is the current average loan period for consumer loans for women? ______months

[IF Q1712=YES, ASK]: Q1712j What will be the expected average loan period for consumer loans for women in THE NEXT five years? ______months

[IF Q1711=YES, ASK]: Q1713 Will the Project offer consumer loans for low income borrowers? Yes / No

[IF Q111=2; IF Q1713=YES, ASK]: Q1713a How many consumer loans for low income borrowers does the project currently serve? ______#

[IF Q1713=YES, ASK]: Q1713b How many consumer loans for low income borrowers will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1713=YES, ASK]: Q1713c How many consumer loans for low income borrowers does the project currently administer each year? ______#

[IF Q1713=YES, ASK]: Q1713d How many consumer loans for low income borrowers will the project administer over the next five years? ____#

[IF Q111=2; IF Q1713=YES, ASK]: Q1713e What is the current value of all consumer loans for low income borrowers under the project portfolio? ______$

[IF Q1713=YES, ASK]: Q1713f What will be value of all consumer loans for low income borrowers under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1713=YES, ASK]: Q1713g What is the current average loan size for consumer loans for low income borrowers? ______$

[IF Q1713=YES, ASK]: Q1713h What will be the average loan size of consumer loans for low income borrowers in THE NEXT five years? ______$

[IF Q111=2; IF Q1713=YES, ASK]: Q1713i What is the current average loan period for consumer loans for low income borrowers? ______months

[IF Q1713=YES, ASK]: Q1713j What will be the expected average loan period for consumer loans for low income borrowers in THE NEXT five years? ___months

[IF Q1711=YES, ASK]: Q1714 Will the Project offer consumer loans for rural (not including smallholder) borrowers? Yes / No

[IF Q111=2; IF Q1714=YES, ASK]: Q1714a How many consumer loans for rural borrowers does the project currently serve? ______#

[IF Q1714=YES, ASK]: Q1714b How many consumer loans for rural borrowers will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1714=YES, ASK]: Q1714c How many consumer loans for rural borrowers does the project currently administer each year? ______#

[IF Q1714=YES, ASK]: Q1714d How many consumer loans for rural borrowers will the project administer over the next five years? ______#

[IF Q111=2; IF Q1714=YES, ASK]: Q1714e What is the current value of all consumer loans for rural borrowers under the project portfolio? ______$

[IF Q1714=YES, ASK]: Q1714f What will be value of all consumer loans for rural borrowers under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1714=YES, ASK]: Q1714g What is the current average loan size for consumer loans for rural borrowers? ______$

[IF Q1714=YES, ASK]: Q1714h What will be the average loan size of consumer loans for rural borrowers in THE NEXT five years? ______$

[IF Q111=2; IF Q1714=YES, ASK]: Q1714i What is the current average loan period for consumer loans for rural borrowers? ____months

[IF Q1714=YES, ASK]: Q1714j What will be the expected average loan period for consumer loans for rural borrowers in THE NEXT five years? _____months

[IF Q1711=YES, ASK]: Q1715 Will the Project offer consumer loans for smallholders? Yes / No

[IF Q111=2; IF Q1715=YES, ASK]: Q1715a How many consumer loans for smallholders does the project currently serve? ______#

[IF Q1715=YES, ASK]: Q1715b How many consumer loans for smallholders will the project serve in THE NEXT five years?______#

[IF Q111=2; IF Q1715=YES, ASK]: Q1715c How many consumer loans for smallholders does the project currently administer each year? ______#

[IF Q1715=YES, ASK]: Q1715d How many consumer loans for smallholders will the project administer over the next five years? ______#

[IF Q111=2; IF Q1715=YES, ASK]: Q1715e What is the current value of all consumer loans for smallholders under the project portfolio? ______$

[IF Q1715=YES, ASK]: Q1715f What will be value of all consumer loans for smallholders under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1715=YES, ASK]: Q1715g What is the current average loan size for consumer loans for smallholders? ______$

[IF Q1715=YES, ASK]: Q1715h What will be the average loan size of consumer loans for smallholders in THE NEXT five years? ______$

[IF Q111=2; IF Q1715=YES, ASK]: Q1715i What is the current average loan period for consumer loans for smallholders? ______months

[IF Q1715=YES, ASK]: Q1715j What will be the expected average loan period for consumer loans for smallholders in THE NEXT five years? ______months

[IF Q110C=YES, ASK]: Q1716 Will the Project offer mortgage loans? Yes / No

[IF Q111=2; IF Q1716=YES, ASK]: Q1716a How many mortgage clients does the project currently serve? ______#

[IF Q1716=YES, ASK]: Q1716b How many mortgage clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1716=YES, ASK]: Q1716c How many mortgage transactions does the project currently administer each year? ____#

[IF Q1716=YES, ASK]: Q1716d How many mortgage transactions will the project administer over the next five years? ______#

[IF Q111=2; IF Q1716=YES, ASK]: Q1716e What is the current value of all mortgage loans under the project portfolio? ______$

[IF Q1716=YES, ASK]: Q1716f What will be value of all mortgage loans under the project portfolio in THE NEXT five years? ____$

[IF Q111=2; IF Q1716=YES, ASK]: Q1716g What is the current average loan size for mortgage loans? ______$

[IF Q1716=YES, ASK]: Q1716h What will be the average loan size of mortgage loans in THE NEXT five years? ______$

[IF Q111=2; IF Q1716=YES, ASK]: Q1716i What is the current average loan period for mortgage loans? ______months

[IF Q1716=YES, ASK]: Q1716j What will be the expected average loan period for mortgage loans in THE NEXT five years? ___months

[IF Q1716=YES, ASK]: Q1717 Will the Project offer mortgage loans for women? Yes / No

[IF Q111=2; IF Q1717=YES, ASK]: Q1717a How many mortgage loans for women does the project currently serve? _____#

[IF Q1717=YES, ASK]: Q1717b How many mortgage loans for women will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1717=YES, ASK]: Q1717c How many mortgage loans for women does the project currently administer each year? _____#

[IF Q1717=YES, ASK]: Q1717d How many mortgage loans for women will the project administer over the next five years? ______#

[IF Q111=2; IF Q1717=YES, ASK]: Q1717e What is the current value of all mortgage loans for women under the project portfolio? ______$

[IF Q1717=YES, ASK]: Q1717f What will be value of all mortgage loans for women under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1717=YES, ASK]: Q1717g What is the current average loan size for mortgage loans for women? _____$

[IF Q1717=YES, ASK]: Q1717h What will be the average loan size of mortgage loans for women in THE NEXT five years? ______$

[IF Q111=2; IF Q1717=YES, ASK]: Q1717i What is the current average loan period for mortgage loans for women? ____months

[IF Q1717=YES, ASK]: Q1717j What will be the expected average loan period for mortgage loans for women in THE NEXT five years? ______months

[IF Q1716=YES, ASK]: Q1718 Will the Project offer mortgage loans for low income borrowers? Yes / No

[IF Q111=2; IF Q1718=YES, ASK]: Q1718a How many mortgage loans for low income borrowers does the project currently serve? _____#

[IF Q1718=YES, ASK]: Q1718b How many mortgage loans for low income borrowers will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1718=YES, ASK]: Q1718c How many mortgage loans for low income borrowers does the project currently administer each year? ______#

[IF Q1718=YES, ASK]: Q1718d How many mortgage loans for low income borrowers will the project administer over the next five years? ______#

[IF Q111=2; IF Q1718=YES, ASK]: Q1718e What is the current value of all mortgage loans for low income borrowers under the project portfolio? ______$

[IF Q1718=YES, ASK]: Q1718f What will be value of all mortgage loans for low income borrowers under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1718=YES, ASK]: Q1718g What is the current average loan size for mortgage loans for low income borrowers? ______$

[IF Q1718=YES, ASK]: Q1718h What will be the average loan size of mortgage loans for low income borrowers in THE NEXT five years? ______$

[IF Q111=2; IF Q1718=YES, ASK]: Q1718i What is the current average loan period for mortgage loans for low income borrowers? ___months

[IF Q1718=YES, ASK]: Q1718j What will be the expected average loan period for mortgage loans for low income borrowers in THE NEXT five years? ______months

[IF Q110C=YES, ASK]: Q1719 Will the Project offer equity investments? Yes / No

[IF Q111=2; IF Q1719=YES, ASK]: Q1719a How many equity investment clients or companies does the project currently serve? ____#

[IF Q1719=YES, ASK]: Q1719b How many equity investment clients or companies will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1719=YES, ASK]: Q1719c How many equity investment transactions does the project currently administer each year? ______#

[IF Q1719=YES, ASK]: Q1719d How many equity investment transactions will the project administer over the next five years? ______#

[IF Q111=2; IF Q1719=YES, ASK]: Q1719e What is the current value of all equity investments under the project portfolio? ___$

[IF Q1719=YES, ASK]: Q1719f What will be value of all equity investments under the project portfolio in THE NEXT five years? ____$

[IF Q111=2; IF Q1719=YES, ASK]: Q1719g What is the current average size for equity investments? ______$

[IF Q1719=YES, ASK]: Q1719h What will be the average size of equity investments in THE NEXT five years? ______$

[IF Q111=2; IF Q1719=YES, ASK]: Q1719i What is the current average period for equity investments? ______months

[IF Q1719=YES, ASK]: Q1719j What will be the expected average period for equity investments in THE NEXT five years? ___months

[IF Q1719=YES, ASK]: Q1720Will the Project offer equity investments for large corporations? Yes / No

[IF Q111=2; IF Q1720=YES, ASK]: Q1720a How many equity investments for large corporations does the project currently serve? ____#

[IF Q1720=YES, ASK]: Q1720b How many equity investments for large corporations will the project serve in THE NEXT five years? ____#

[IF Q111=2; IF Q1720=YES, ASK]: Q1720c How many equity investments for large corporations does the project currently administer each year? ______#

[IF Q1720=YES, ASK]: Q1720d How many equity investments for large corporations will the project administer over the next five years? ______#

[IF Q111=2; IF Q1720=YES, ASK]: Q1720e What is the current value of all equity investments for large corporations under the project portfolio? ______$

[IF Q1720=YES, ASK]: Q1720f What will be value of all equity investments for large corporations under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1720=YES, ASK]: Q1720g What is the current average size of equity investments for large corporations? ______$

[IF Q1720=YES, ASK]: Q1720h What will be the average size of equity investments for large corporations in THE NEXT five years? ______$

[IF Q111=2; IF Q1720=YES, ASK]: Q1720i What is the current average period for equity investments for large corporations? ______months

[IF Q1720=YES, ASK]: Q1720j What will be the expected average period for equity investments for large corporations in THE NEXT five years? ____months

[IF Q1719=YES, ASK]: Q1720W Does the Project offer equity investments for women-owned or led enterprises? Yes / No

[IF Q1720W=YES, ASK]: Q1720Wa How many equity investments for women-owned or led enterprises does the project currently serve? ____#

[IF Q1720W=YES, ASK]: Q1720Wb How many equity investments for women-owned or led enterprises will the project serve in THE NEXT five years? ____#

[IF Q1720W=YES, ASK]: Q1720Wc How many equity investments for women-owned or led enterprises does the project currently administer each year? ______#

[IF Q1720W=YES, ASK]: Q1720Wd How many equity investments for women-owned or led enterprises will the project administer over the next five years? ______#

[IF Q1720W=YES, ASK]: Q1720We What is the current value of all equity investments for women-owned or led enterprises under the project portfolio? ______$

[IF Q1720W=YES, ASK]: Q1720Wf What will the value of all equity investments for women-owned or led enterprises under the project portfolio be in THE NEXT five years? ______$

[IF Q1720W=YES, ASK]: Q1720Wg What is the current average size of equity investments for women-owned or led enterprises? ______$

[IF Q1720W=YES, ASK]: Q1720Wg What will be the average size of equity investments for women-owned or led enterprises in THE NEXT five years? ______$

[IF Q1720W=YES, ASK]: Q1720Wi What is the current average period for equity investments for women-owned or led enterprises? ______months

[IF Q1720W=YES, ASK]: Q1720Wj What will be the average period for equity investments for women-owned or led enterprises in THE NEXT five years? ______months

[IF Q1719=YES, ASK]: Q1721 Will the Project offer mid-cap equity investments? Yes / No

[IF Q111=2; IF Q1721=YES, ASK]: Q1721a How many mid-cap equity investment clients does the project currently serve? ____#

[IF Q1721=YES, ASK]: Q1721b How many mid-cap equity investment clients will the project serve in THE NEXT five years? _____#

[IF Q111=2; IF Q1721=YES, ASK]: Q1721c How many mid-cap equity investments does the project currently administer each year? _____#

[IF Q1721=YES, ASK]: Q1721d How many mid-cap equity investments will the project administer over the next five years? ______#

[IF Q111=2; IF Q1721=YES, ASK]: Q1721e What is the current value of all mid-cap equity investments under the project portfolio? ____$

[IF Q1721=YES, ASK]: Q1721f What will be value of all mid-cap equity investments under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1721=YES, ASK]: Q1721g What is the current average size of mid-cap equity investments? ______$

[IF Q1721=YES, ASK]: Q1721h What will be the average size of mid-cap equity investments in THE NEXT five years? ______$

[IF Q111=2; IF Q1721=YES, ASK]: Q1721i What is the current average period for mid-cap equity investments? ______months

[IF Q1721=YES, ASK]: Q1721j What will be the expected average period for mid-cap equity investments in THE NEXT five years? ______months

[IF Q1719=YES, ASK]: Q1722 Will the Project offer small and medium enterprise (SME) equity investments? Yes/ No

[IF Q111=2; IF Q1722=YES, ASK]: Q1722a How many SME equity investments does the project currently serve? ___#

[IF Q1722=YES, ASK]: Q1722b How many SME equity investments will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1722=YES, ASK]: Q1722c How many SME equity investments does the project currently administer each year? _____#

[IF Q1722=YES, ASK]: Q1722d How many SME equity investments will the project administer over the next five years? ______#

[IF Q111=2; IF Q1722=YES, ASK]: Q1722e What is the current value of all SME equity investments under the project portfolio? _____$

[IF Q1722=YES, ASK]: Q1722f What will be value of all SME equity investments under the project portfolio in THE NEXT five years?____$

[IF Q111=2; IF Q1722=YES, ASK]: Q1722g What is the current average size of SME equity investments? _____$

[IF Q1722=YES, ASK]: Q1722h What will be the average size of SME equity investments in THE NEXT five years? ______$

[IF Q111=2; IF Q1722=YES, ASK]: Q1722i What is the current average period for SME equity investments? ____months

[IF Q1722=YES, ASK]: Q1722j What will be the expected average period for SME equity investments in THE NEXT five years? ____months

[IF Q110C=YES, ASK]: Q1723 Will the Project offer Leasing Contracts? Yes / No

[IF Q111=2; IF Q1723=YES, ASK]: Q1723a How many leasing clients does the project currently serve? ____#

[IF Q1723=YES, ASK]: Q1723b How many leasing clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1723=YES, ASK]: Q1723c How many leasing contracts does the project currently administer each year? ______#

[IF Q1723=YES, ASK]: Q1723d How many leasing contracts will the project administer over the next five years? ____#

[IF Q111=2; IF Q1723=YES, ASK]: Q1723e What is the current value of leasing contracts under the project portfolio? ______$

[IF Q1723=YES, ASK]: Q1723f What will be value of all leasing contracts under the project portfolio in THE NEXT five years? ____$

[IF Q111=2; IF Q1723=YES, ASK]: Q1723g What is the current average size for leasing contracts? ______$

[IF Q1723=YES, ASK]: Q1723h What will be the average size of leasing contracts in THE NEXT five years? ______$

[IF Q111=2; IF Q1723=YES, ASK]: Q1723i What is the current average period for leasing contracts? ______months

[IF Q1723=YES, ASK]: Q1723j What will be the expected average period for leasing contracts in THE NEXT five years? ____months

[IF Q1723=YES, ASK]: Q1724 Will the Project offer leasing contracts to female clients? Yes/ No

[IF Q111=2; IF Q1724=YES, ASK]: Q1724a How many female clients does the project currently have leasing contracts with? ______#

[IF Q1724=YES, ASK]: Q1724b How many female clients will the project have leasing contracts with in THE NEXT five years? ______#

[IF Q111=2; IF Q1724=YES, ASK]: Q1724c How many leasing contracts to female clients does the project currently administer each year? ______#

[IF Q1724=YES, ASK]: Q1724d How many leasing contracts female clients will the project administer over the next five years? ______#

[IF Q111=2; IF Q1724=YES, ASK]: Q1724e What is the current value of all leasing contracts to female clients under the project portfolio? ______$

[IF Q1724=YES, ASK]: Q1724f What will be value of all leasing contracts to female clients under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1724=YES, ASK]: Q1724g What is the current average size of leasing contracts to female clients? ______$

[IF Q1724=YES, ASK]: Q1724h What will be the average size of leasing contracts to female clients in THE NEXT five years? ______$

[IF Q111=2; IF Q1724=YES, ASK]: Q1724i What is the current average period for leasing contracts to female clients? ______months

[IF Q1724=YES, ASK]: Q1724j What will be the expected average period for leasing contracts to female clients in THE NEXT five years? ______months

[IF Q1723=YES, ASK]: Q1725 Will the Project offer leasing contracts to small or medium enterprises (SMEs)? Yes/No

[IF Q111=2; IF Q1725=YES, ASK]: Q1725a How many SMEs does the project currently offer leasing contracts to? ____#

[IF Q1725=YES, ASK]: Q1725b How many SMEs will the project offer leasing contracts to in THE NEXT five years? ______#

[IF Q111=2; IF Q1725=YES, ASK]: Q1725c How many leasing contracts to SMEs does the project currently administer each year? _____#

[IF Q1725=YES, ASK]: Q1725d How many leasing contracts to SMEs will the project administer over the next five years? ______#

[IF Q111=2; IF Q1725=YES, ASK]: Q1725e What is the current value of all leasing contracts to SMEs under the project portfolio? ______$

[IF Q1725=YES, ASK]: Q1725f What will be value of all leasing contracts to SMEs under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1725=YES, ASK]: Q1725g What is the current average size of leasing contracts to SMEs? _____$

[IF Q1725=YES, ASK]: Q1725h What will be the average size of leasing contracts to SMEs in THE NEXT five years? ______$

[IF Q111=2; IF Q1725=YES, ASK]: Q1725i What is the current average period for leasing contracts to SMEs? ____months

[IF Q1725=YES, ASK]: Q1725j What will be the expected average period for leasing contracts to SMEs in THE NEXT five years? _____months

[IF Q1723=YES, ASK]: Q1726 Will the Project offer rural leasing contracts (not including smallholder)? Yes / No

[IF Q111=2; IF Q1726=YES, ASK]: Q1726a How many rural leasing clients does the project currently serve? ______#

[IF Q1726=YES, ASK]: Q1726b How many rural leasing clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1726=YES, ASK]: Q1726c How many rural leasing contracts does the project currently administer each year? ______#

[IF Q1726=YES, ASK]: Q1726d How many rural leasing contracts will the project administer over the next five years?______#

[IF Q111=2; IF Q1726=YES, ASK]: Q1726e What is the current value of all rural leasing contracts under the project portfolio? _____$

[IF Q1726=YES, ASK]: Q1726f What will be value of all rural leasing contracts under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1726=YES, ASK]: Q1726g What is the current average size of rural leasing contracts? ______$

[IF Q1726=YES, ASK]: Q1726h What will be the average size of rural leasing contracts in THE NEXT five years? ______$

[IF Q111=2; IF Q1726=YES, ASK]: Q1726i What is the current average period for rural leasing contracts? _____months

[IF Q1726=YES, ASK]: Q1726j What will be the expected average period for rural leasing contracts in THE NEXT five years? ______months

[IF Q1723=YES, ASK]: Q1727 Will the Project offer smallholder leasing contracts? Yes / No

[IF Q111=2; IF Q1727=YES, ASK]: Q1727a How many smallholder leasing clients does the project currently serve? _____#

[IF Q1727=YES, ASK]: Q1727b How many smallholder leasing clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1727=YES, ASK]: Q1727c How many smallholder leasing contracts does the project currently administer each year? ______#

[IF Q1727=YES, ASK]: Q1727d How many smallholder leasing contracts will the project administer over the next five years? ______#

[IF Q111=2; IF Q1727=YES, ASK]: Q1727e What is the current value of all smallholder leasing contracts under the project portfolio? ______$

[IF Q1727=YES, ASK]: Q1727f What will be value of all smallholder leasing contracts under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1727=YES, ASK]: Q1727g What is the current average size of smallholder leasing contracts? ______$

[IF Q1727=YES, ASK]: Q1727h What will be the average size of smallholder leasing contracts in THE NEXT five years? ______$

[IF Q111=2; IF Q1727=YES, ASK]: Q1727i What is the current average period for smallholder leasing contracts? ______months

[IF Q1727=YES, ASK]: Q1727j What will be the expected average period for smallholder leasing contracts in THE NEXT five years? ______months

[IF Q1723=YES, ASK]: Q1728 Will the Project offer low income leasing contracts? Yes / No

[IF Q111=2; IF Q1728=YES, ASK]: Q1728a How many low income leasing clients does the project currently serve? _____#

[IF Q1728=YES, ASK]: Q1728b How many low income leasing clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1728=YES, ASK]: Q1728c How many low income leasing contracts does the project currently administer each year? ______#

[IF Q1728=YES, ASK]: Q1728d How many low income leasing contracts will the project administer over the next five years? ______#

[IF Q111=2; IF Q1728=YES, ASK]: Q1728e What is the current value of all low income leasing contracts under the project portfolio? _____$

[IF Q1728=YES, ASK]: Q1728f What will be value of all low income leasing contracts under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1728=YES, ASK]: Q1728g What is the current average size of low income leasing contracts? ______$

[IF Q1728=YES, ASK]: Q1728h What will be the average size of low income leasing contracts in THE NEXT five years? ______$

[IF Q111=2; IF Q1728=YES, ASK]: Q1728i What is the current average period for low income leasing contracts? _____months

[IF Q1728=YES, ASK]: Q1728j What will be the expected average period for low income leasing contracts in THE NEXT five years? ______months

[IF Q110C=YES, ASK]: Q1729 Will the Project offer insurance contracts? Yes / No

[IF Q111=2; IF Q1729=YES, ASK]: Q1729a How many insurance contract clients does the project currently serve? ____#

[IF Q1729=YES, ASK]: Q1729b How many insurance contract clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1729=YES, ASK]: Q1729c How many insurance contracts does the project currently administer each year? ____#

[IF Q1729=YES, ASK]: Q1729d How many insurance contracts will the project administer over the next five years? ____#

[IF Q111=2; IF Q1729=YES, ASK]: Q1729e What is the current value of insurance contracts under the project portfolio? ____$

[IF Q1729=YES, ASK]: Q1729f What will be value of all insurance contracts under the project portfolio in THE NEXT five years? ____$

[IF Q111=2; IF Q1729=YES, ASK]: Q1729g What is the current average size for insurance contracts? _____$

[IF Q1729=YES, ASK]: Q1729h What will be the average size of insurance contracts in THE NEXT five years? ______$

[IF Q111=2; IF Q1729=YES, ASK]: Q1729i What is the current average period for insurance contracts? ____months

[IF Q1729=YES, ASK]: Q1729j What will be the expected average period for insurance contracts in THE NEXT five years? _____months

[IF Q1729=YES, ASK]: Q1730 Will the Project offer insurance contracts for female clients? Yes/ No

[IF Q111=2; IF Q1730=YES, ASK]: How many female insurance contract clients does the project currently serve? ______#

[IF Q1730=YES, ASK]: Q1730a How many female insurance contract clients will the project serve in THE NEXT five years? ______#

[IF Q111=2; IF Q1730=YES, ASK]: Q1730b How many female client insurance contracts does the project currently administer each year? ______#

[IF Q1730=YES, ASK]: Q1730c How many female client insurance contracts will the project administer over the next five years? ______#

[IF Q111=2; IF Q1730=YES, ASK]: Q1730d What is the current value of insurance contracts female clients under the project portfolio? ______$

[IF Q1730=YES, ASK]: Q1730e What will be value of all insurance contracts for female clients under the project portfolio in THE NEXT five years? ______$

[IF Q111=2; IF Q1730=YES, ASK]: Q1730f What is the current average size for insurance contracts for female clients? ______$

[IF Q1730=YES, ASK]: Q1730g What will be the average size of insurance contracts for female clients in THE NEXT five years? ______$

[IF Q111=2; IF Q1730=YES, ASK]: Q1730h What is the current average period for insurance contracts for female clients? ______months

[IF Q1730=YES, ASK]: Q1730i What will be the expected average period for insurance contracts for female clients in THE NEXT five years? ______months

18. CLASSIFICATION OF DFC-SUPPORTED BUSINESS LOANS BY SECTOR AND USE

[START NEW SECTION. TO BE COMPLETED BY APPLICANT FOR PROJECTS PROVIDING FINANCIAL PRODUCTS/SERVICES]

The next question will ask about business loans and the business sectors where the loans will be provided.

[IF Q110C=YES, ASK]: Q1801. Thinking about your total DFC-supported portfolio, please provide the percentage of these loans (or equity for investment funds) expected to be in each sector for the predicted lifecycle of the project.

____% -Primary Agriculture, Forestry, Fishing

____% -Food Processing

____% -Restaurants

____% -Mining, oil and gas

____% -Renewable Energy (including home energy systems)

____% -Energy efficiency

____% -Non-Renewable Energy

____% -Water, Sanitation (including WASH loans)

____% -Housing Construction, Rental and Leasing

____% -Commercial Real Estate, Rental and Leasing

____% -Wholesale and Retail Trade

____% -Ag-related transportation and warehousing

____% -Other transportation and warehousing

____% -ICT Services and Products

____% -Educational Services and Products

____% -Healthcare Services and Products

____% -Hospitality Services

____% -Other Manufacturing

____% -Other Services

19. DEVELOPMENTAL IMPACTS OF DFC-SUPPORTED FINANCIAL ASSET PORTFOLIO

[START NEW SECTION. TO BE COMPLETED BY STAFF FOR PROJECTS PROVIDING FINANCIAL PRODUCTS/SERVICES]

The next section will ask for specific information regarding the project portfolio including percentages for those in rural areas, for women, and for underserved populations. We will also ask about current and future initiatives for these groups.

[IF Q110C=YES AND Q110D=NO, ASK]: Q1901 Will the Project increase lending to rural borrowers? Yes / No

[IF Q1901=YES, ASK]: Q1901a Please describe how the Project will reach out to and improve products for rural borrowers. Include both current activities and activities planned for the future. If any activities directly relate to a specific product, please include that in your description.

[IF Q110C=YES AND Q110D=NO, ASK]: Q1902 Will the Project increase lending to female borrowers? Yes / No

[IF Q1902=YES, ASK]: Q1902a Please describe how the Project will reach out to and improve products for female borrowers. Include both current activities and activities planned for the future. If any activities directly relate to a specific product, please include that in your description.

[IF Q110C=YES AND Q110D=NO, ASK]: Q1903 Will the Project increase lending to underserved borrowers? Yes / No

[IF Q1903=YES, ASK]: Q1903a Please describe how the Project will reach out to and improve products for currently underserved borrowers. Include both current activities and activities planned for the future. If any activities directly relate to a specific product, please include that in your description.

[IF Q110C=YES AND Q110D=NO, ASK]:

Economic segments of clients as a percentage of the portfolio.	[IF Q111=2] Current	5^th year Projection
Q1904a Consumers (not including mortgages). A consumer loan such as a car loan, credit card, signature loan, signature line of credit, or Certificate of Deposit.	%	%
Q1904b Microenterprises. Businesses which meet at least two of the following three characteristics: (1) total employees of up to 10, (2) total assets of up to $100,000, and/or (3) total annual sales of up to $100,000.	%	%
Q1904c Small & Medium Enterprises. Businesses which meet two out of the following three characteristics: (1) total employees of up to 300, (2) total assets of up to $15 million, and/or (3) total annual sales of up to $15 million.	%	%
Q1904d Large Corporations	%	%
Q1904e Other (please specify):	%	%

[IF Q110C=YES AND Q110D=NO, ASK]:

Loan lengths as a percentage of your overall portfolio.	[IF Q111=2] Current	5^th Year Projection
Q1905a. < 6 months	%	%
Q1905b. 6 – 12 months	%	%
Q1905c. 13 – 24 months	%	%
Q1905d. 25 – 36 months	%	%
Q1905e. 37 – 60 months	%	%
Q1905f. > 60 months	%	%

[IF Q110C=YES AND Q110D=NO, ASK]: Q1906 Please provide the following figures for the project’s CURRENT and PROJECTED portfolio:

Mortgage maturity period as a percentage of the mortgage portfolio.	[IF Q111=2] Current Portfolio	5^th Year Projected DFC-supported portfolio
Q1906a. < 5 years	%	%
Q1906b. 5-10 years	%	%
Q1906c. 11 - 15 years	%	%
Q1906d. 16 – 20 years	%	%
Q1906e. > 20 years	%	%
Purpose of the mortgages as a percentage of the mortgage portfolio.	Current Portfolio	5^th Year Projected DFC-supported portfolio
Q1906f. Mortgages for new homeowners	%	%
Q1906g. Productive loan (e.g. home equity loan/line of credit)	%	%
Q1906h. Other (please specify):	%	%
Target market of mortgages as a percentage of the mortgage portfolio.	[IF Q111=2] Current Portfolio	5^th Year Projected DFC-supported portfolio
Q1906i. Low-income homes	%	%
Q1906j. Middle-income homes	%	%
Q1906k. High-income homes	%	%
Q1906l. Residential rental properties	%	%
Q1906m. Commercial properties	%	%
Q1906n. Other (please specify):	%	%
Demographic distribution of clients as a percentage of the mortgage portfolio.	[IF Q111=2] Current Portfolio	5^th Year Projected DFC-supported portfolio
Q1906o. Percentage of clients that are women (or women-owned or led businesses).	%	%
Q1906p. Urban	%	%
Q1906q. Rural	%	%

[IF Q110C=YES AND Q110D=YES, ASK]: Q1907 Will the Project provide equity investments to rural projects? Yes / No

[IF Q1907=YES, ASK]: Q1907a Please describe how the Project will reach out and provide equity to rural projects. Include both current activities and activities planned for the future. If any activities directly relate to a specific project, please include that in your description.

[IF Q110C=YES AND Q110D=YES, ASK]: Q1908 Will the Project provide equity investments to women-owned or led businesses? Yes / No

[IF Q1902=YES, ASK]: Q1908a Please describe how the Project will reach out to and improve equity available to women-owned or led businesses. Include both current activities and activities planned for the future. If any activities directly relate to a specific project, please include that in your description.

[IF Q110C=YES AND Q110D=YES, ASK]: Q1909 Will the Project provide equity investments to companies from any other traditionally underserved communities? Yes / No

[IF Q1903=YES, ASK]: Q1909a Please describe how the Project will reach out to and improve equity available to companies in underserved communities. Include both current activities and activities planned for the future. If any activities directly relate to a specific project, please include that in your description.

Representative Certification

I hereby represent the information provided in this document is complete and accurate to the best of my knowledge.
Name:	Date:	Telephone:
Title:		Email address:

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