Overseas Private Investment Corporation Application for Financing

OVERSEAS PRIVATE INVESTMENT CORPORATION APPLICATION FOR FINANCING

OPICForm115

OMB 3420-0015

Expiration:5-31-2015

Disclosure:

ThisformrequestsinformationfrompotentialOPICclientsthatisrequiredbyOPIC’sgoverninglegislation- theForeignAssistanceAct(FAA)of1961,TitleIV,asamended-toassistOPICindeterminingwhethera projectanditssponsor(s)meeteligibilitycriteriaforOPICfinancing,specificallywithregardtothesoundness oftheproject,thequalificationsof thesponsor(s),creditworthiness,and legislativeandregulatorycompliance. Complete responses to the questions are required on this form to apply for OPIC support per the FAA.

Responsestoquestionswhichcallforestimatesorprojectionsshouldtaketheform ofgoodfaithstatements madetothebestoftheapplicant’sknowledgeandbelief. Statementsoffact provided toOPICinthisdocument must be accurate as of the date of execution of this document. In addition to other rights and remedies available toOPIC,misrepresentationsorfailureto discloserelevant informationmayresultincriminalprosecution pursuant to 22 USC 2197(n), as well asa default or termination if a commitment is issued. Neither submission noracceptanceofthisapplicationimpliesthattheprojectiseligible forfinancingorthatfinancingwillbe provided.

Clientinformationcontainedinthis form willbedeemeddesignatedasconfidentialcommercialinformationin accordancewithOPIC'sFreedom ofInformationAct(FOIA)regulations(22CFR706),andwillbetreated as confidentialcommercialinformationtothe extentpermitted byapplicablelaw. Asafederalagency,OPICmay not collect, or sponsor the collection of,informationunlessit displays a valid OMB ControlNumberwithan expiration date that has not expired. Information in Form SF-LLL will be reported to Congress and available for publicinspection.

Paperwork Reduction Act Notice: This information is required to obtain benefits. The public reporting burden forthiscollectionofinformationisestimatedto average45minutesperresponse,includingthetimefor reviewing instructions, searchingexistingdatasources,gatheringandmaintainingthedataneeded, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any otheraspectsofthiscollectionofinformation,includingsuggestionsfor reducingthisburden,toEssieBryant, AgencyClearance Officer, 1100 New York Ave., NW,Washington, DC, 20527andWendyLiberante, RegulatoryAffairs,OfficeofManagementandBudget,NewExecutiveOfficeBuilding,Room

10202, Washington, D.C. 20503.

QUESTION 1: IDENTIFY THEPROJECTCOMPANY/BORROWER
OPICprovidesdirectloansandloanguarantiesthatareusedtoundertakelong-term investmentprojects(eacha “Project”)in OPIC-eligiblecountries(eacha“ProjectCountry”). TheentitythatdirectlyundertakestheProject intheProjectCountry(the“ProjectCompany”)mayalso betheentitythathasthedirectborrowingrelationship withOPICoristhedirectbeneficiaryofanOPIC-guaranteedloan (the“Borrower”),butsometimestheyare different entities, depending upon the proposed structure of the transaction. Please list the location and contact information for the Project Company and Borrower.
Same as Project Company
Project Company / Borrower
Name: / Name:
Address: / Address:
City: / City:
State (if U.S.): / State (if U.S.):
Zip/Postal Code: / Zip/Postal Code:
Country: / Country:
Telephone: / Telephone:
Fax: / Fax:
Email: / Email:
Is the address of the Project Company the location ofthe Project? (Yes/No)
If “No,” please list the specific location of the Project1:
City Country

QUESTION 2: IDENTIFY THEAUTHORIZEDREPRESENTATIVE

Please provide contact information for the individual who will be signing the completed application; i.e. shareholder in or executive of the Project Companyor Borrower, financial advisor, legal counsel, etc.

Nameof Representative(First, Middle, Last): Title:

Relationshipto the Project Company or Borrower: Address:

City:

State (if U.S.): Zip/Postal Code: Country: Telephone:

Fax: Email:

1Projects thatOPICsupports must be physically locatedin an OPIC-eligible country.The Project Companymay be located inthe same place ormay be located offshore. Ifthe physical locationof theProject is differentfromthe address of the Project Company, please click "No" and list thephysical location of the Project.If the Project is not locatedin a city/town,please list thenearest city/town.

QUESTION 3: IDENTIFY THE OWNERS OF THE PROJECTCOMPANY/BORROWER

PleaselistultimatebeneficialownersoftheProjectCompany. Forexample,iftheProjectCompanyiswholly ownedbyanothercompany,andthatothercompanyisowned50-50bytwoindividuals,thatothercompanyis theintermediate owneroftheProjectCompany (with100%directownership), andthetwoindividualsarethe ultimatebeneficialownersoftheProject Company(eachhaving50%indirectbeneficialownership). For an example of this type of structure, please see next page.

Thetable belowallowsyouto listeachdirectowner,andifapplicable, tolisteachindirect ownerundertherelevantdirect owner. You need not list any party that owns (directly or indirectly) less than 5%oftheProjectCompany. For ownerswithlessthan5%,state“Multiple,lessthan5%”andlistthesum oftheirownershipsharessothatyou may account for 100% of the Project Company ownership.

If there is more than one layer of ownership (i.e. someof the ownership is indirect) please attach a diagram showing the ownership structure (on-line formhasan upload link).

Please note that to be eligible for OPIC Financing, the Project Company/Borrower must be at least 50.1% (i.e. majority)ownedbyprivateentities(i.e.agovernmentorparastatal entity is not the majority owner) and must have the meaningful involvement of the U.S.private sector (see Question 4 on next page).

Direct Owner
Name / Country ofCitizenship(for Individuals)or Incorporation (for Entities) / IdentificationInformation2 / Percent DirectOwnership of Project Company/Borrower / Ownership ofthisEntityincludes Entities that Indirectly Own 5% or more of the Project Company/Borrower
Yes/No3
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
TOTAL / 100%

2“Identification Information” for anyperson or organization, whetheror not a legal entity, as applicable,includes:1) asocial security number(for U.S. citizensor legal residents), 2) apassportnumber orother national identity card number (fornon-U.S.citizens),3) a businessregistration licensenumber or tax identification number (for businesses) or 4) other evidence ofidentification (ifapplicable).

3If theuser chooses “yes,” thenadditional sub-lines will dropdownto allow themtoprovide informationabout indirect owners.

Example of a Multi-Level Ownership Structure

Which parties need to be identified individually for OPIC’s analysis?

•OPIC needs to perform background checks and other due diligence on any party (i.e. individuals and business entities) that “ultimately” (i.e. directly or indirectly) owns 5% or more of the Project Company/Borrower. Therefore, any applicant for OPIC financing needs to provide identification information for those parties.

•In the illustration above, the parties in the “blue” boxes must be identified individually because each of them, either directly or indirectly, owns 5% or more of the Project Company/Borrower.

•The parties in the “white” boxes fall below the 5%threshold, so they need not be identified individually. However, since the table in Form 115 requires that the percentages of all the direct owners add upto100% (and that the percentages of all the indirect owners in each direct owner add up to 100%), you need to have a line item for such owners. For instance, in the listing of indirect owners of Direct Owner 2, you could combine Ultimate Owner E and Ultimate Owner G by putting “Multiple, less than 5% each” in the “Indirect Owner Name” field and putting a total of 7% in the percentage ownership field. Please see the following page that shows how this ownership structure would be input into the table in the form.

QUESTION 4: IDENTIFY THE U.S. CONNECTIONS.

For a Project to qualify for OPIC Financing, there must be meaningful involvement of the U.S. private sector

(the “Qualifying Sponsor(s)”) with the Project.

How does OPIC define U.S.?(any one of the following)

Any for-profit entity organized in theUnited States with at least 25% of its equity/share capital U.S. owned.

Anyfor-profitentityorganizedoutsidetheUnitedStateswithmorethan50%ofitsequity/sharecapitalU.S. owned

U.S. citizens or lawful permanent residents (i.e. Green Card holders).

Any non-profit entity that is organized in the United States.

How does OPIC measure meaningful U.S. involvement?

OPICgenerallyrequiresU.S.involvementintheProjectCompany/Borrowerinanamountthatisequivalent to at least 25% ofthe equity/share capital ofthe Project Company/Borrower.

The 25% benchmark may be met with equity investment (ownership/contribution), long-term debt investmentintheProjectorotherU.S.contracts(e.g.constructioncontracts)orbycombiningthesetypesof

involvement in the Project among one or more Qualifying Sponsors.

Other forms of involvement (e.g. franchise or long-term management contracts) may be considered – please discuss withan OPIC staff member, if applicable.

How does OPIC measure the duration of U.S. involvement?

For an on-going project, QualifyingSponsor(s) must retain a 25% interest in the Project through final disbursement of the OPIC supported loan.

In the case of a start-up (or “Greenfield”) projectQualifying Sponsors must retain a 25% interest through physical completion of the Project.

Please list the Qualifying Sponsor(s) information (including a U.S. state of residence or incorporation, if possible) and the nature of each entity’s involvement with the Project.

Name / State / Telephone / Email / Identification
Information4 / Nature of Contribution
5(Ownership %, other –
describe)

4“Identification Information” for anyperson or organization, whetheror not a legal entity, as applicable,includes:1) asocial security number(for U.S. citizensor legal residents), 2) apassportnumber orother national identity card number (fornon-U.S.citizens),3) a businessregistration licensenumber or tax identification number (for businesses) or 4) other evidence ofidentification (ifapplicable).

5Listedabove arethe typesofcontributions toaProject thatOPICdeems "meaningfulU.S. involvement." Pleaseexplain which of those typesof involvement best describesthe Qualifying Sponsor's contribution totheProject. Examples: Ownership -- 25%; SubordinatedDebt;primary constructioncontract; long-term managementcontract.

QUESTION 5: CATEGORIZATION OF U.S. PARTIES INVOLVED WITH THE PROJECT

OPICFinance’ssupportforaProjectCompany/Borrowercantaketheform ofadirectloanoraloanguaranty. Bylaw,onlythoseProjectsthatsignificantlyinvolveaU.S. smallbusinessareeligibleforthedirectloan product. The loan guaranty product is open toall eligible Project Companies/Borrowers.

How does OPIC define U.S. Small Business?

Asmallbusinessisanenterprisewithannualrevenuesduringthelastfiscalyearoflessthan$400 million,orforthoseentities/individualswithoutrevenues,anetworth lessthanorequalto $100million OR

An enterprise with 500 or fewer employees.

Inmakingthedeterminationofwhetheranentityisasmallbusiness,pleasetakeintoconsiderationtherevenues, worthandemployeesofallmajority-ownedaffiliates. Also,if theenterpriseismajority-ownedbyanother business (but not funds or individuals), include the consolidated revenues,worth and employees, as applicable.

Please list all Qualifying Sponsors that fall into any of these categories.

Sponsor Name / Small Business / Minority-Owned / Women-Owned
Yes/No / Yes/No / Yes/No
Yes/No / Yes/No / Yes/No
Yes/No / Yes/No / Yes/No
Yes/No / Yes/No / Yes/No
Yes/No / Yes/No / Yes/No
Yes/No / Yes/No / Yes/No
Yes/No / Yes/No / Yes/No
Yes/No / Yes/No / Yes/No

QUESTION 6: PROJECT DESCRIPTION

Please provide a brief description of the Project, making sure to address the following items:

•DoestheProjectinvolvethestart-upofanewbusinessorisittheexpansionofanexistingoperation? Does itinvolvetheprivatizationofanoperationpreviouslyowned/managedbyagovernmententity? Ifitisan expansionofanexistingoperationoraprivatization, pleaseprovidebasicoperationalandfinancial information (number of years of operation, mostrecent level of annual sales, size of asset base, number of employees).

•Whatproduct(s)orservices(s)willtheProjectproduce/sellandwhatarethetargetmarkets?(local,export–

listspecificcountries, as applicable.)

•WhydotheProject’sinvestors/managersbelievethatthiswillbeacommerciallysuccessfulendeavor?

What positive social/developmental impact do they expect fromthe Project? This includes 1)employment,2) training, 3) infrastructure development,4)introduction of newtechnologies orfinancialor managerial practices, 5) provision ofscarcegoodsandservices, 6) provisionofemployeebenefits,7) community involvement,8)environmental improvements,etc

QUESTION 7: PROJECT COSTS
PleaselistthetypesandestimatedamountsofallProjectcosts. Pleasebeasspecificaspossibleandremember toincludeestimatesofanyapplicableprojectdevelopment/transactioncosts(e.g. engineering or other consulting services, market studies, legal fees, financing fees, etc.) For expansions of existing operations, include only the costs associated with the expansion. Please add additional rows or adjust categories as necessary.
Category / US$ / %
Pre-Operating Costs / $ / %
Land / $ / %
Building/Improvements / $ / %
Equipment / $ / %
Fixtures/Furnishings / $ / %
Construction Cost overrun Contingency (5% of Construction costs) / $ / %
General Development Fees (Engineers, Architects) / $ / %
Marketing / $ / %
Financial/Accounting/Legal Fees / $ / %
$ / %
$ / %
$ / %
$ / %
OPIC Facility and Commitment Fees / $ / %
OPIC FEES (Retainer, Due Diligence, Legal) / $ / %
EDN Fees / $ / %
Interest During Grace Period / $ / %
Total Project Costs / $ / 100%
QUESTION8: PROJECT FUNDING
Pleaseindicatesufficientsourcesoffundingtocover100%oftheProjectcosts. Thetypeslistedbeloware samplecategoriesforyourreference. Youmayeditthe categoriesasnecessarytomatchthetypesoffunding specific to your Project. Please add additional lines for Equity contributions if necessary.
Category / US$ / %
Debt: / $ / %
OPIC loan (indicate proposed term) / $ / %
Other termdebt (indicate proposed termand collateral) / $ / %
Supplier financing / $ / %
Subordinated Debt:
Shareholder subordinated loans7 / $ / %
Third party subordinated debt / $ / %
Equity: / $ / %
Cash / $ / %
In-kind contribution8
Other (please describe) / $ / %
Total Project Funding / $ / 100%

7Insome jurisdictions,theremay belegal,tax or regulatorystructures that incentivizeProjectinvestorsto structure their investment as subordinated debt insteadof equity. In some cases, a Project Company/Borrowermay haveother creditors that are providingsome sortof subordinated facility. Thesestructures are allowedso longas the terms ofthe fundingandthe subordinationare satisfactory to OPIC.

8An"in-kindcontribution"could beahardasset suchasa building or equipment. In orderforOPIC tocredit it asanequity contribution, it must be titled to theProjectCompany/Borrower, andOPIC must receivereasonabledocumentation of its market value (e.g.arecent independent appraisal,salesinvoice,etc.)

QUESTION 9: WHAT COLLATERAL AND/OR CREDIT ENHANCEMENTS ARE AVAILABLE

OPICrequiresacollateral/creditenhancementpackage(the“SecurityPackage”)tailoredtothespecificrisks ofeachProject. ThepurposeofthisSecurityPackageistoprovideasecondarysourceofrepaymentifthe Project’scashflowisinsufficienttoservicethedebtasscheduled. Following areindicativecategoriesof collateral/credit enhancement that OPICmayrequire. Pleaseindicatebelowthosecategoriesthatmaybe available (check all that apply) and list the value of the proposed collateral:

Pledge of shares of the Project Company/Borrower

Liens/Mortgages on Project Company/Borrower assets (Specify types/locations: )

Liens/Mortgages on U.S. assets (Specify types/locations: )

Guaranties fromcreditworthy individuals or companies (Specify name(s) of guarantor(s): )

Irrevocable standby letter(s) ofcredit9

Debt Service Reserve Account10

“Key Man” Life Insurance11

Other (describe:)

9Aletterof credit,issued by abank satisfactory to OPICandwith OPIC as thebeneficiary,that OPIC coulddraw uponasneeded(for example, if theProject Company/Borrowerdoesnot makeapayment that is due to OPIC).OPIChas astandard template for this instrument -- pleaseconsult your OPIC contact. Frequently, a standby letter of credit isusedin lieu of a debt servicereserveaccount (seebelow).

10Aliquidity account, pledged toOPIC and heldat a bank satisfactory toOPIC, in whichthe Project Company/Borrower maintains a sufficient cashbalancetocoveraspecifiedamount of debtservice (usually aspecified numberof payments).

11If there is asingle individualwhoseworkis essential to the successof the Project(e.g. the soleownerof a small business; akey executive), OPIC may requirethat theProject Company/Borrowerobtaina "key man"life insurancepolicy, theproceeds ofwhich would bepledged to OPIC,that could beusedto repay theOPIC loan (inwhole or in part)intheeventof that individual's death.

QUESTION 10: MANAGEMENT EXPERIENCEANDTRACKRECORD

Brieflydescriberelevantexperiencethattheinvestors/shareholders and/orkeyProjectmanagershaveinthe ProjectsectorandProjectCountry. Foreachindividuallistedbelowpleasespecifythatperson’srelationship to the Project (i.e. shareholder, CEO, etc.)

QUESTION 11: PRIVATE SECTOR SOURCES OF FINANCING
OPICdoesnotcompetewithprivatesectorprovidersofprojectfinancing. Therefore, OPIC requires thatProject developers: (a) evaluate the possibility ofobtainingproject financingfromprivatesourcesand(b)decidetopursueOPICfinancingbecauseprivate financingisnotavailableontermssufficientto maketheinvestmentviableorbecauseof specific benefits OPIC participation will bring tothe investment.
HaveyouevaluatedthepossibilityofobtainingfinancingfortheProjectfromprivate sectorsources? / Yes / No
Have you determined that private sector financing is not a viable option for the Project? / Yes / No
IfYes,pleaselistthereasonswhyprivatesectorfinancingisnotaviableoptionforthe
Project (check all that apply):
Private Sector financing is notavailable at all in the Project Country.
____PrivateSectorfinancingisavailable,butnotonterms(tenor,pricing)viable for the Project.
Other (describe):

QUESTION 12: HOW DID YOU LEARN ABOUT OPIC?

OPICisinterestedinknowingwhattypesofcommunicationsaboutitsprogramsaremosteffective. Please select the source of your initial information about OPIC:

OPIC’s website or other social media (Twitter, Facebook, etc.)

OPIC-sponsored workshop or event

OPIC speaker at an industry event

Other US Government Agency (e.g. State/Embassy, Commerce, Treasury, TDA, DOD, USEXIM, etc.)

Enterprise Development Network (EDN) or other financialadvisor

Past or present OPIC client.

Other (describe: )

SUPPORTINGDOCUMENTATION

The following four types of documents are the minimum supporting documentation that OPIC will require to evaluateaProject. Otherdocumentationthatapplicantsmayberequiredtoprovide(suchascopiesofProject contracts) will depend upon the characteristics ofeach individual Project.

1. FINANCIAL STATEMENTS.
The following entities should provide financial statements:
a) Each of the primary shareholders contributing equity or debt to the Project Company/Borrower. b) The Project Company/Borrower itself if it is already operating.
c) Any other party whose creditworthiness is crucial to the financial success of the Project (e.g. guarantors, key contractors, key off-takers).
Corporate financial statements should include a balance sheet, income statement, and cash flow statement, preferably prepared in accordance with U.S. Generally Accepted Accounting Principles (“U.S. GAAP”) or InternationalFinancialReportingStandards(“IFRS”). FinancialStatementsmustbepreparedinEnglishor accompaniedbyacertifiedEnglishtranslation. Listedbelowarethetypesoffinancialstatementsthatshould be submitted for each type of entity:
For an existing Project Company:
Or
For a non-U.S. public company: / Annual Financial Statements (audited, if available; most recent 3 years)
Quarterly Financial Statement (most recent quarter)
For a U.S. public company: / 10K (most recent 3 years)
10Q (most recent quarter)
For a private company: / Annual Financial Statements (audited, if available; most recent 3 years)
Quarterly Financial Statement (most recent quarter)
Tax Returns(most recent 3 years)
For a partnership: / Annual Financial Statements (audited, if available; most recent 3 years)
GeneralPartnerinformation,including(i)currentsigned
Statement of Net Worth (assets, liabilities, net worth) and (ii)
ownership
For an individual: / CurrentSignedPersonalFinancialStatement(assets,liabilities, net worth)
Tax Returns(most recent 3 years)

2. BANK AND TRADE REFERENCES.

OPIC usually asks for up to threebank references and three trade references for companies (except for public companies)orindividualsthatareprovidingessentialfinancialsupporttotheProject. Thepartieswhoneedto solicitreferencesandthenumberofreferencesrequiredwillbedifferentdependinguponthecircumstances. Forexample,iftheOPICapplicant isafinancialinstitution,theyareunlikelytohavetradereferences. Applicants should consult with the OPICofficer with whomthey are working to determine what is required. If thebankorcompanyfrom whichtheyaresolicitingthereferencedoesnotalreadyhaveastandardform for providing such statements, they may use OPIC-provided templates (links are provided in the on-line system).

3. BUSINESSPLAN/PRELIMINARY INFORMATION MEMORANDUM

The following checklist details the itemsto include in the business plan. Please provide as complete a business plan as possible.

Project Summary

 ProjectDescription/Status: DescribethepurposeforwhichtheOPICloanistobeusedandtheProject developmentactivitiescompletedtodate--theProjectCompany’sdateofincorporation,investmentmade todate,marketorfeasibilitystudies performed, status of documentation/permits/government consents/land acquisition,etc.

 FinancialPlanandCreditSupport: DescribetheproposedOPICandotherlenderdebt--loanamount, tenor,graceperiod--andsource,timingandamountofequitycontributions;describeproposedcollateraland other credit support.

Project Ownership and Management

 Ownership of the Project Company: Provide complete Project Company ownership, including all holdingcompaniesorintermediaryoperatingcompanies,andelectronicallyattachanownershipchart,ifavailable.

 ProjectDevelopers: ListprimaryshareholdersdevelopingtheProjectandtheprofessionalexpertiseof such individuals, including experience in the Project Country.

ProjectManagement: DescribeProjectCompanymanagementstructureandprofessionalexpertiseof individuals in key management positions.

Consultants/Advisors: List consultants or advisors to the Project Company,detailingthecontact information and role of such consultants or advisors and work or reports completed to date.

ProjectSector/TargetMarket/Economics

 Sector/Industry: Describehistory,sectorreform,recentmarkettrends,competition,supplyanddemand, pricing, market position of Project Company (at time of market entry and long-term), etc.

 Product/Services: DescribetheproductsorservicestheProjectwillproduce,inwhatquantity,and whether for the local market or for export(and if for export, to which countries).

ProjectEconomic/TechnicalSpecifications: DescribetheProjecteconomics,technicalparameters, construction plans/schedule, equipment/land tobe procured, off-take arrangements, etc.

Agreements: Listallkeyoperatingagreementsnecessary toundertaketheProjectsuch asconcession agreement(s), construction contract(s), off-take agreement(s), environmental impact studies, feasibilitystudies,marketingstudies,technicalassistanceagreement(s),managementservicesagreement(s),lease(s), etc. (and attach electronically if possible).

Legal, Economic, and Political Environment and Government Participation

 Licenses/Permits: Listalllicenses,permits,consents,approvals,environmentalrequirementsetc.required by the Project Country government andthe status of such documentation.

 LegalRegime: ListProjectCountrylaws,regulationsorpendingreformsthatwillimpacttheProjectorthe sector.

 Economic/PoliticalClimate:DescribetheeconomicandpoliticalclimateoftheProjectCountryandthe specific region in which the Project is located, as they may affect the Project.

 Government/MultilateralParticipation: DescribeanygovernmentormultilateralinvolvementintheProject or the sector and any government incentives such as tax holidays.

 CurrentorPendingLitigation: DescribeallcurrentorpendingdisputesorlitigationinvolvingtheProject or the Project Company, or shareholders.