Form OPIC-71 Project Information Report

		OMB 3420-0004 Expires_____________ OPIC-71
		Project Information Report Overseas Private Investment Corporation (An Agency of the United States Government) Office of Investment Policy 1100 New York Avenue, NW Washington, D.C. 20527 This form requests information from OPIC clients which is required by OPIC’s governing legislation. The information provided in this questionnaire will allow OPIC to better assess the effects that OPIC-assisted projects have on the U.S. economy and employment, as well as the environment and economic development abroad. Complete responses to the collection of information in this form are mandatory, per the Foreign Assistance Act of 1961, as amended, Section 231(k)(2). Client information contained in this questionnaire will be deemed designated as privileged or confidential in accordance with OPIC’s Freedom of Information Act (FOIA) regulations (22 CFR part 706) and will be treated as confidential to the extent permitted by the FOIA. An Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number with an expiration date that has not expired. Questions related to this form should be directed to: David Kay – (tel) 202-336-8550 – David.Kay@opic.gov
		NOTICE: Public reporting burden for this collection of information is estimated to average seven 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 aspect of this collection of information, including suggestions for reducing this burden, to Agency Submitting Officer, Overseas Private Investment Corporation, 1100 New York Avenue, NW, Washington DC 20527; and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Washington, DC 20503. An agency may not conduct or sponsor, and a person is not required to respond, to a collection of information unless it displays a valid OMB control number with an expiration date that has not expired.

INSTRUCTIONS: For all questions, the term "project" refers to the specific investment covered by the following OPIC insurance contract number(s) and/or the finance loan agreement number(s):. For many questions, the shaded area has been completed based on the estimates your company provided in its original OPIC insurance/finance application. Please answer all questions, using the most accurate information available. Attach additional pages for answers requiring more space than provided, If this investment is an expansion of an existing enterprise, or otherwise only part of an enterprise, only incremental effects -- i.e., effects directly related to and resulting from the new investment -- should be provided.

PROJECT INFORMATION

Name of Investor: (For OPIC Use) Foreign Enterprise:

Contact: Fax: Phone:

Project location:

City:

Country:

Initial project description:

Total initial investment from OPIC-supported project or expansion: $

1

Has there been a change in the nature of the project from that indicated above?  No If yes, please indicate the current nature of the project:

 Yes

Does the project by itself constitute the entirety of a new enterprise or is the project an expansion or part of an existing enterprise? (If an expansion/part, include only the incremental effects, as defined above, in your answers below.)

 New

 Expansion/ Part

2

a. Month and year when project construction was completed and normal operations commenced:

month/year

Please specify the most recent fiscal year (FY) of operation for which project data are available. Please use data from this year in answering questions 8, 10, 11, 12, and 14, as well as for the information provided on page 2b.

starting month/year

Ending month/year

U.S. EMPLOYMENT

3

How many of the U.S. parent company’s employees in the U.S. were engaged in producing, processing, and/or supporting goods/services comparable to those of the project during the following periods:

a. One year prior to this project’s initiation?

b. After one year of this project’s operation?

c. At present?

If you note a decline in question 3, please answer questions 4 and 5. Otherwise skip to question 6.

4

What was your company’s total number of U.S. employees during the following periods?

a. One year prior to this project’s initiation?

b. After one year of this project’s operation?

c. At present?

5

If the number of your company’s total U.S employees has decreased, please explain why.

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SOURCE OF INVESTMENT
6	What amount of the initial investment (debt & equity) was obtained from:		ORIGINAL ESTIMATE (For OPIC Use)		ACTUAL (For Investor Use)
	You, the investor?		$		$
	Other U.S. sources, including OPIC?		$		$
	Host country investors?		$		$
	Third country investors, including multinational institutions?		$		$
	Total		$		$
	How much of the total U.S. financing (6a+6b) was from off-shore sources (e.g., reinvested retained earnings, Eurodollars, local currency)?		$		$
	How much of total U.S. financing was in the form of capitalized technology?		$		$
PROCUREMENT
7	Of the initial investment, prior to commencement of operations, how much was spent for the procurement of goods and services (including land, buildings, labor and contracts)? For this question, provide the total expenditure since inception of project but prior to commencement of operations. On page 2b please provide details of U.S. initial procurement in the most recent fiscal year.
			ORIGINAL ESTIMATE (For OPIC Use)	ACTUAL (For Investor Use)
	From the United States?		$	$
	From the host country?		$	$
	From other less developed countries? Specify __________________		$	$
	From other developed countries? Specify _____________________		$	$
	Debt service and contingency funds?		$	$
	Total (Should equal 6e)		$	$
8	Of the operational procurement of operational inputs related to the project (e.g., production inputs, spare parts, replacements, services, etc.) how much did you purchase during the most recent fiscal year from:		ORIGINAL ESTIMATE (For OPIC Use)	MOST RECENT FY (For Investor Use)
	a. The U.S.? (Should equal operation procurement total on page 2b)		$	$
	The host country?			$
	Other developing countries? Specify Countries_____________			$
	Other industrialized countries? Specify Countries___________			$
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Page 2b

MOST RECENT FISCAL YEAR - Details of U.S. SUPPLIER AND PROCUREMENT INFORMATION

As indicated on the cover page, the client data you provide is privileged business information that OPIC treats as confidential, to the extent permitted by law. However, it is important for OPIC to be able to demonstrate some of the effects of your project. The detailed historical U.S. supplier and procurement information of this question is particularly useful for OPIC to illustrate the specific benefits of your project for the U.S. economy. Unless you provide an attached sheet with a compelling reason why this information should not be made public, OPIC may use the information on this sheet in public statements and releases.

PLEASE NOTE: If you already have the following information in another format please feel free to photocopy and attach – OPIC is concerned with receiving the information, not the presentation. Also if you have the mailing address of the supplier companies, and they could be easily incorporated, we would appreciate your including them.

U.S. SUPPLIERS

Name of Supplier	City	State	Small Business1 (Y/N)	Women-owned Business (Y/N)	Minority-owned Business (Y/N)	Type of Good or Service	Initial Procurement2	Operational Procurement
						Also indicate if equipment is (N)ew or (U)sed	Project’s first year of operations	Most Recent Fiscal Year3
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
							$	$
Remaining Procurement							$	$
						Totals	$	$

**Please attach additional sheets if necessary.**

PROJECT SALES

9

Project Sales (actual and anticipated) from the first full fiscal year on:

Product Line(s) 1.______________ 2.______________ 3.______________ Total:

Year:_______ $____________ $____________ $____________ $____________

Year:_______ $____________ $____________ $____________ $____________

Year:_______ $____________ $____________ $____________ $____________

Year:_______ $____________ $____________ $____________ $____________

Year:_______ $____________ $____________ $____________ $____________

10

a. Final Destination of Sales: What was the value of your project's sales during the most recent fiscal year to:

PRODUCT LINE

ORIGINAL ESTIMATE (For OPIC Use)

MOST RECENT FY (For Investor Use)

1. The United States?

1.______________ 2.______________ 3.______________ Total:

$________________ $________________ $________________ $

$________________ $________________ $________________ $________________

2. The Host Country?

1.______________ 2.______________ 3.______________ Total:

$________________ $________________ $________________ $

$________________ $________________ $________________ $________________

3. Other Major Countries a. b. c.

$ $ $

$ $ $

4. Remaining Countries

$

$

b. Did any production transformation or extra processing take place between the initial and final destinations of project exports?  No  Yes If yes, what were the dollar values and destinations of initial sales?

REMITTANCES

11

What is the total value of actual remittances from the project, through the fifth year of project operations? Your Five-Year Revised Estimate will be based on both actual data and your projections for the future. Please also provide actual remittances in the following categories for the most recent fiscal year.

a. To the U.S. in the form of:

ORIGINAL ESTIMATE OF FIVE YEAR TOTAL

REVISED ESTIMATE OF FIVE YEAR TOTAL

Most Recent Fiscal Year

1. Loan principal and interest?

$

$

$

2. Dividends and profits?

$

$

$

3. Other (royalties, licensing fees, lease payments, etc.)?

$

$

$

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REMITTANCES, Continued
		b. To other countries, excluding the U.S. and the host country, in the form of:	ORIGINAL ESTIMATE OF FIVE YEAR TOTAL	REVISED ESTIMATE OF FIVE YEAR TOTAL	Most Recent Fiscal Year
		1. Loan principal and interest?	$	$	$
		2. Dividends and profits?	$	$	$
		3. Other (royalties, licensing fees, lease payments, etc.)?	$	$	$
PERFORMANCE REQUIREMENTS
12	Describe any governmental decree, law, directive or agreement, which have affected project imports or exports (i.e. sourcing raw materials locally, exporting a minimum percentage of production, etc.) If such arrangements exist, describe them and estimate any resultant displacement of U.S. trade in the most recent year of operation:
ECONOMIC & INSTITUTIONAL EFFECTS
	NOTE for Questions #13 through 15: Give total through the fifth year of project operations. Revised Estimate based on actual & projected data. Please also provide actual data for the most recent fiscal year.		ORIGINAL ESTIMATE OF FIVE YEAR TOTAL	REVISED ESTIMATE OF FIVE YEAR TOTAL	Most Recent Fiscal Year
13	How much did the project pay to the host government in duties and taxes (include income tax, profits tax, corporate tax and VAT)?		$	$	$
14	Is there a host country tax holiday applicable to this project?			 No	 Yes: Expiration Year
15	If the project's sales in the host country replaced import of like products, please estimate value of the replaced imports.		$	$	$
	If the replaced imports would have resulted in the payment of duties or taxes (include income tax, profits tax, corporate tax and VAT) to the host government, please estimate the value of the foregone revenues to the host government.		$	$	$
	c. Is the investment being implemented in the context of a government regulatory, judicial or other institutional reform program? If yes, please describe the reform program.			No	Yes
	d. As a result or condition of this investment, did the government implement regulatory, judicial or other institutional reforms? If yes, please describe the reforms.			No	Yes
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	HUMAN CAPACITY BUILDING / WORKER RIGHTS
	16	How many workers are expected to be employed by the entire foreign enterprise in the fifth year of operations? (The totals in questions 16 and 17 may differ if the project entailed an expansion of an existing company.)
	17	How many workers are expected to be employed as a result of the project in the project’s fifth year?		MANAGEMENT	PROFESSIONAL/ TECHNICAL	LABOR
		Host country nationals		employees	employees	Employees
		Expatriates		employees	employees	Employees
		Host country nationals trained per category		%	%	%
	18	Does the project provide training outside the host country? If yes, please discuss training programs and indicate countries where training took place.
	19	Labor conditions -- please check any that applied within the last 12 months: 1. Labor Union No  Yes  2. Collective Labor Agreement No  Yes  3. Strike No  Yes  4. Hazardous labor No  Yes  5.Does the project employ anyone under 18? No  Yes  (If yes, attach a description of duties and age of youngest worker) 6. Maximum Workweek Without Overtime: 40-44 Hrs. ________ 45-48 Hrs. ________ more than 48 Hrs. ________
	ENVIRONMENTAL IMPACTS
	20		a. When your project was originally reviewed by OPIC, the following potential occupational health and safety, and/or environmental issues were noted. (For OPIC Use)
			b. Briefly describe the measures taken to address these issues.
			c. Have there been any changes in the project that have created new occupational health and safety and/or environmental issues? If so, briefly describe the measures taken to address them.
			d. Does the project directly restore or preserve the environment? If yes, please explain. (e.g. pollution reduction, eco-tourism, reforestation, water treatment (clean up), or wildlife conservation).				No		Yes
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PRIVATE SECTOR DEVELOPMENT

21

a. What is the percentage of local ownership of the project?

%

b. If there is local ownership, is the local owner a Small & Medium Enterprise (SME)4

No

Yes

c. Does the project encourage private ownership such as through privatization, or creation of opportunities for individual property (including home) ownership? If yes, please explain.

No

Yes

LEVERAGING IMPACTS

22

a. Does the project involve other federal/regional/multilateral organizations (such as AID, TDA, IFC, MIGA, etc.)? If yes, please list organizations.

No

Yes

b. Does the project involve a public-private partnership (e.g. thru local development bank/ministry/NGO)? If yes, please explain.

No

Yes

SOCIAL EFFECTS (GOOD CORPORATE CITIZENSHIP)

23

a. Does the project company have an equal employment policy? Such a policy would cover gender, ethnicity, and social affiliation. If yes, please explain.

No

Yes

b. Are there any benefits or policies in place that specifically address the needs of women at the workplace? (Examples are childcare, maternity leave, non-harassment policies)? If yes, please explain.

No

Yes

c. Does the project benefit a poor (e.g. rural) region of the host country? If yes, please explain.

No

Yes

d. Does the project extend company benefits to its employees? If yes, please explain. (e.g., health coverage, daily meals, transportation, or housing assistance)

No 

Yes 

e. Does the project provide benefits to the local community? If yes, please explain. (e.g., recreational facilities, community center, schools, or medical clinics)

No

Yes

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DEVELOPMENTAL INFRASTRUCTURE IMPROVEMENTS

24

a. Does the project strengthen the physical infrastructure of the host country? (e.g., communications, power, transportation). If yes, please explain.

No 

Yes 

b. Does the project strengthen the financial infrastructure of the host country? If yes, please explain. (e.g., microfinance, on-lending, mortgage lending, or financial market development). If yes, please explain.

No 

Yes 

c. Does the project strengthen the social infrastructure of the host country? (e.g., nutrition, shelter, water & sanitation, health, or education). If yes, please explain.

No 

Yes 

TECHNOLOGY & KNOWLEDGE TRANSFER

25

a. Does the project introduce innovative management practices? If yes, please explain.

No 

Yes 

b. Does the project bring new marketing and distribution strategies to the host country? If yes, please explain.

No 

Yes 

c. Does the project apply new production technology for the first time? If yes, please explain.

No 

Yes 

d. Does the project market products available for the first time? If yes, please explain.

No 

Yes 

e. Does the project lower local prices? If yes, please explain.

No 

Yes 

f. Does the project contribute to the economic diversification of the host country? If yes, please explain.

No 

Yes 

I hereby represent that the information I have provided in this document is complete and accurate to the best of my knowledge.

Signature

Date

Name: (Please Print of Type)

Title:

Email:

OPIC Monitoring Officer (For OPIC Use)

Date Visited:

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1 As of 1998, small businesses are defined by OPIC as companies with annual sales of less than $250 million, taking into account the consolidated sales of the parent company.

2 Procurement using funds from initial project funding.

3 On-going procurement funded by project revenues.

4 Small- and Medium Enterprise (SME): Up to 300 employees, total assets of up to $15 million, and total annual sales of up to $15 million. (IFC)