Form DFC‐004 Investment Funds Application

Investment Funds Application

Investments Funds Application (DFC-004)
OMB No. [
]
Expiration Date: _______

United States International Development Finance Corporation
1100 New York Avenue, NW Washington, DC 20527-0001
An Agency of the United States Government
Responses to questions which call for estimates or projections should take the form of good faith statements
made to the best of the applicant’s knowledge and belief. Statements of fact provided in this document must be
accurate as of the date of submission. Anyone who knowingly makes a false statement with the intent to influence
DFC’s guarantees, loans, or other investments may be criminally prosecuted. Such false statements are also
grounds for DFC to terminate a commitment or declare a contract default. These rights are in addition to any
other rights or remedies available to United States government. Neither submission nor acceptance of this
application implies that the proposed transaction is eligible for support or that support will be provided.
When trade secrets or confidential commercial or financial information are submitted to the agency in this
collection, they will be held in confidence to the extent permitted by applicable law including the Freedom of
Information Act (“FOIA”) at 5 U.S.C. § 552(b)(4) and the agency’s implementing regulations at 22 C.F.R. Part
706.
Paperwork Reduction Act Notice: This information is required to obtain benefits. Federal agencies may not
collect information unless a valid OMB Control Number with an expiration date that has not expired is displayed.
The public reporting burden for this collection of information is estimated to average 60 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to
Agency Clearance Officer, Records Management, United States International Development Finance
Corporation, 1100 New York Avenue, NW, Washington, DC, 20527 and to the DFC Desk Officer at the Office of
Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room
10202, Washington, DC 20503.

Investment Funds Application

Proposal Date

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GP Main Point of Contact (First Name)

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GP Main Point of Contact (Last Name)

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GP Main Point of Contact (Email)

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GP Main Point of Contact (Phone Number)

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Name of Firm

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Address of Firm Headquarters

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City of Firm Headquarters

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Country of Firm Headquarters

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Other Firm Locations (cities)

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Year Firm Established

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Website of Firm

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Investment Funds Application

FUND OVERVIEW
Fund Name

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Fund Target Size in USD (including DFC amount)

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Max Fund Target Size in USD (including DFC amount)

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Min Fund Target Size in USD (including DFC amount)

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Proposed GP Commitment (%)

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Proposed DFC Commitment

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Fund Sectors

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If Other Sectors/Industries (please describe)

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Fund Geography (region)

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Fund Geography (targeted countries)

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Projected Fund Multiple and IRR returns (gross)

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Brief Description of the Fund and its Strategy

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Commented [GJ(1]: NAICS/ DFC Sectors:
1. Agriculture, Forestry, Fishing and Hunting
2. Mining, Quarrying, and Oil/Gas Extraction
3. Utilities
4. Construction
5. Manufacturing
6. Wholesale Trade
7. Retail Trade
8. Transportation and Warehousing
9. Information (telecom, publishing, etc.)
10. Finance and Insurance
11. Real Estate, Rental and Leasing
12. Professional, Scientific and Technical Services
13. Management of Companies and Enterprises
14. Administrative Support and Waste Management
Remediation Services
15. Educational Services
16. Health Care and Social Assistance
17. Arts, Entertainment and Recreation
18. Accommodation and Food Services
19. Other Services
20. Public Administration
*should add ability to select multiple sectors.

Brief Description of the Fund for Public Disclosure After TEXT BOX (limit to 40-149 characters)
Approval (character range 40-149)

Commented [GJ(2]: Drop Down Menu:
1.Africa
2. Asia
3.Latin America and Caribbean
4. Europe and Eurasia
5. Global
6. Middle East/ North Africa
Add flexibility to select more than one option.

Investment Funds Application

Fund Team Formation: Describe how the Fund
Manager and the team were initially formed, and
provide a brief history of how they have evolved to
date. You may also refer to appropriate sections in
the PPM or marketing presentation.

Commented [GJ(3]: INFO BUTTON: A “women-owned
enterprise” is one in which women own at least fifty one
percent (51%) of the company, or where the company was
founded by a woman who continues to play an active role in
running the company. A “women-led enterprise” is one in
which the share of women in senior management is at least
30% or women comprise 30% or more of the board,
investment committee or equivalent governing and/or
investment decision-making bodies.

MANAGEMENT
OVERVIEW
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Number of Partners

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Total Number of Employees/Number of Senior
Investment Professionals

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Is the General Partner or Investment Manger a
women-owned enterprise or women-led enterprise?

Yes
No

Please provide the current or projected number of
female members of the GP’s or FM’s board of
directors or other governing body, if applicable

GP _________#
FM___________#

Firm’s Assets Under Management

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Number of Funds Previously Managed by this Firm

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SENIOR INVESTMENT TEAM
BACKGROUND

Name

Title

Year
joined firm

Location (city,
country)

Focus (industry,
function, if any)

Prior work experience
(include firm, position
number of years)

Education

Investment Funds Application

LP BASE
Total Capital Raised to Date in USD

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Total Capital Raised to Date (% of Target Fund Size)

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First Close Date (actual/anticipated) and Amount

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(i) Explain why you are seeking DFC funding. (ii)
What efforts have been taken to raise capital from
private sector investors and what has been the
outcome of those efforts? (iii) Is there a lack of
available private sector support for the Fund, or
for portfolio companies and if so for what reason?

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List of Investors in prior funds and those who
have Committed to this Fund and Amount

Name

List of new Investors committed to this Fund

Name

List any Development Finance Institutions (DFIs)
with whom the Fund is engaged in discussions
(include the stage of discussion/investment
process and whether have provided soft or hard
commitments)

Name

Commitment to prior
fund(s)

Commitment

Stage of discussion

TRACK RECORD
Attach a summary of prior fund performance (see
Track Record template)

Commitment to this
Fund

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Location (country)

Location (country)

Commitment

Soft or hard

Commented [GJ(4]: INFO BUTTON:
For first time Fund Managers, please include applicable track
records of the key investment professionals

Investment Funds Application

INVESTMENT POLICY & ESG
Describe the developmental impact you believe the
Fund will have in the host country/countries (e.g.,
job creation, infrastructure improvements, social
policies/corporate social responsibility initiatives,
technology and knowledge transfer).

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Will the Fund target investments that are femaleowned or serve female clients, clients located in
rural areas, or other underserved populations?

Yes_____
No______

If so, what percentage will be dedicated to these
populations?

Women:_______%
Rural:_______%
Other: _____%
Number/Percentage of staff

Number and percentage of female staff (GP, Fund
Manager and Fund)

General Partner
Fund Manager
Fund

Please describe the Fund’s practices concerning
provision of accountability and access to remedy
for negative sub-project impacts on Individuals
and communities.

TEXT BOX

Commented [GJ(5]: INFO BUTTON: Examples include
but are not limited to: ethnic minorities, youth, handicapped
individuals

Investment Funds Application

OTHER MISCELLANEOUS
(i) Describe any potential conflicts of interest of
which you are aware. (ii) How do you plan to
resolve potential conflicts of interest within the
Fund, or with other investment vehicles managed
by your organization or its affiliates?

TEXT BOX

Are there any substantive litigation, dispute
resolutions, or regulatory actions brought
against the manager, its principals or any
portfolio companies?

TEXT BOX

If yes, please attach an explanation describing any FILE UPLOAD
litigation, community dispute, or complaint
resolution processes that have occurred or are
occurring involving the manager, its principals
and/or its portfolio companies.

ATTACHMENTS
Attach the Fund's most recent
marketing presentation

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Attach the Fund's investment pipeline

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Attach the Fund's PPM (if available)

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Attach Fund’s ESG Policies

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Attach Fund’s Know Your Customer Policies

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Attach LPA (if available)

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PROPOSAL
DOCUMENTS

Document Name

Description

Document Date

File Name

Investment Funds Application

DFC/US Government
Questions
How did you hear about DFC?

DFC is interested in knowing what types of
communications about its programs are most
effective. If this is the first time you are applying
for an DFC product, please select the source of
your initial information about DFC:

___ N/A -- This is not my first application to DFC.
____ DFC’s website or other social media (Twitter, Facebook, etc.)
____ DFC-sponsored workshop or event (Name of event________________)
____ DFC speaker at an industry event (Name of event_________________)
___ _ Other US Government Agency (e.g. State/Embassy, Commerce, Treasury, TDA, DOD, USEXIM,
etc.) (insert a dropdown box with choices)
____ Referred by financial or legal advisor (Name of advisor ______________)
____ Referred by portfolio facility manager (Name of facility manager___________________)
____ Past or present DFC client. (Name of client _______________________)
____ Other (describe: ______)