Form DFC-001A Application for Debt Finance

PDF FOR REFERENCE ONLY

THIS FORM IS TO BE COMPLETED ON-LINE – PAPER SUBMISSIONS WILL NOT BE ACCEPTED

Application for Finance (DFC-001A)

OMB No. 3015-0004

Expiration Date: 8-31-2022

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 the 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 provided 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.

The Better Utilization of Investments Leading to Development (BUILD) Act of 2018 (P.L. 115-254) and the Inspector General Act of 1978 (P.L. 95-452) (as amended) (the “IG Act”) require DFC to have an Inspector General. The Office of the Inspector General’s mission is to provide independent oversight of DFC’s programs and operations for increased efficiency and effectiveness, and to prevent fraud, waste, and abuse. The Office of the Inspector General conducts audits, investigations, and other reviews of DFC programs, transactions, and operations.  The IG Act gives the Office of the Inspector General unrestricted access to all records in the possession and control of DFC and requires that DFC provide the Office of the Inspector General unrestricted access to all DFC project data and systems in response to any request from the Office of the Inspector General. See 5 U.S.C. Appendix 3. The Office of the Inspector General may contact you, your organization, or your personnel in connection with an Office of the Inspector General audit, investigation, or other review and expects that you, your organization and your personnel will cooperate with requests for information from the Office of the Inspector General. More information about the Office of the Inspector General can be found here: https://www.dfc.gov/oig.

Paperwork Reduction Act Notice: This information is required to obtain or retain 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 90 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 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, DC 20503.

This Form and any attached supporting documentation will enable DFC personnel to make a preliminary determination of whether your proposal meets eligibility and basic underwriting requirements. Please click here to review the basic eligibility requirements. For a description of DFC’s Finance origination process and answers to frequently asked questions (FAQs), please click here. For general questions or eligibility questions, please email applydevcred@dfc.gov for amounts <=$50 million and applysfi@dfc.gov for amounts >$50 million. If a particular question on this form is unclear, please email FormsSupport@dfc.gov.

QUESTION 1: SPECIFY FINANCING STRUCTURE

The DFC supports a wide variety of developmental transactions by providing direct loans and guaranties. Though each transaction may have unique structural aspects, all transactions fit into one of four basic structural categories. Please read the definitions below and choose the structure that best fits the type of support that you are seeking.

	Project Finance: DFC lends to a stand-alone project or single purpose entity. Click here for examples.
	Corporate Finance: DFC lends to a general corporate entity that already has an operational track record. Click here for examples.
	Single-Borrower Guaranty: Outside funding party intends to provide financing to a single borrower. DFC will share the funding party’s risk by providing a guaranty. Click here for examples.
	Multi-Borrower Guaranty: Outside funding party intends to provide financing to multiple unrelated borrowers. DFC will share the funding party’s risk by providing a guaranty of the sub-transactions on an individual or portfolio basis, as the case may be. Click here for examples.

QUESTION 2: IDENTIFY THE PROPOSED BORROWER/GUARANTEED PARTY

In each DFC-supported transaction, DFC enters into a contractual relationship with either a Borrower (in the case of Project Finance or Corporate Finance transactions) or a Guaranteed Party (in the case of Single or Multi-Borrower Guaranties). Please list the location and contact information for that party. If that party has not yet been formed/incorporated, please list approximate information that will allow us to create a placeholder for that party in our transaction tracking systems.

Borrower/Guaranteed Party

Name:

Address (incl. city, country and postal code¹):

website (if avail):

Are you registered on SAM.gov? Yes/No

U.S. Tax Identification Number: or N/A – Not a US Taxpayer

Is the country listed in the address of the Borrower/Guaranteed Party the location where the funds provided or guaranteed by DFC will be utilized? (Yes/No)

If “No,” please list the actual location (city, country):

Note: If the Financing Structure chosen in Question 1 is “Single Borrower Guaranty” the form will also include fields for the name and address of the entity to which the Guaranteed Party will be lending.

QUESTION 3: IDENTIFY THE APPLICANT Representative

Please provide contact information for the individual who will be DFC’s primary point of contact regarding this application.

Name and Title of Representative:

Relationship to the Borrower/Guaranteed Party:

Name of Representative’s Company (if different from the Borrower/Guaranteed Party)

Address (if different from the address of the Borrower/Guaranteed Party):

Phone Number 1 (office): Phone Number 2 (mobile):

E-mail:

QUESTION 4: IDENTIFY tHE KEY PARTIES INVOLVED WITH THE TRANSACTION

Evaluating the business entities and/or individuals that will own, manage or make other critical contributions to the transaction being financed is an important part of DFC’s underwriting process.

1. Please attach detailed chart(s)/schematic(s) showing the structure of the proposed transaction and key relationships. These may include ownership charts, organizational/management structures, contractual relationship schematics, etc.

2. Please list and provide requested information on each of the following types of entities/individuals. If an entity/individual plays multiple roles in a transaction, only list them once and indicate their most important/primary role:

• Each business entity/individual that owns 10% or more (either directly or indirectly) of the Borrower/transaction.

• Each business entity/individual that does or intends to provide credit support (e.g. a guarantor)

• Each business entity/individual that does or will have a significant managerial relationship with the Borrower/transaction (e.g. executives/directors).

• Each business entity/individual that does or will have a primary contractual relationship with the Borrower (e.g. construction contractor, operations and maintenance contractor, hotel management company, etc.)

Note: Certain governmental/multilateral² parties that may be involved and shown in the attached charts need not be listed here.

Name
Type of Entity	Two choices: Individual or Business Entity
Country of Citizenship (for Individuals) or Incorporation (for Business Entities)
Primary Relationship to Borrower/Transaction	Choices – Owner/Shareholder, Lender, Manager/Director, Contractor
Minority Individual/Minority-Owned or Led Business3?	Y/N
Female Individual/Women Owned or Led Business4?	Y/N
If Women Owned or Led Business is “Yes,” there will be fields to provide: % owned by women, # of women on Board of Directors, and names and titles of women owners and/or executives.
Is this Party interested in DFC PRI5?

QUESTION 5: DescriBE THE TRANSACTION

Please provide a brief description of the proposed transaction, making sure to address the following:

• What are the objectives – commercial-financial and social-developmental – of the proposed transaction?

• What factors or resources under the control of the involved parties will contribute most toward meeting those objectives and why?

• How would DFC’s participation in the transaction contribute to its success?

Please attach the following supporting documents:

Business Plan/Preliminary Information Memorandum

Financial Projections Model

Historical Financial Statements

QUESTION 6: DETAIL Costs AND FUNDING

If the Financing Structure chosen in Question 1 was Project Finance, then the online form will show the following:

For a Project Finance transaction, please provide a detailed list of the estimated project costs and the types and amounts of funding that will be used to cover them. Remember to include both hard/physical asset costs (e.g. buildings or equipment) and soft/implementation costs (e.g. legal or consultant services, fees, contingency etc.) in the cost estimate. The total cost amount in Column A must equal the total funding amount in Column B. For an example, please click here.

	Column A			Column B
Cost Item	USD	%	Funding Source	USD	%
			Debt:
			DFC loan (indicate proposed term)
			Other term debt (indicate proposed term)
			Supplier financing
			Subordinated Debt:
			Third party subordinated debt
			Shareholder subordinated loans
			Equity:
			DFC Equity
			Cash
			In-kind contribution6
			Grants
Total Project Costs:			Total Project Funding

If the Financing Structure chosen in Question 1 was Corporate Finance, then the online form will show the following:

For a Corporate Finance transaction, please provide a detailed list of how the DFC-supported funding would be used and how the proposed transaction would affect the existing corporate funding structure/leverage of the Borrower. For an example, please click here.

Uses of the DFC-supported Funding

Cost Item	USD	%
Total Costs

Balance Sheet Comparison

Existing7 Balance Sheet	USD	%	Proposed Future Balance Sheet	USD	%
Total Assets			Total Assets
			DFC Debt
Total Debt/Liabilities			Non-DFC Debt/Liabilities
			DFC Equity
Net Worth			Non-DFC Net Worth

Would DFC debt be used to repay any existing debt? Yes/No

If yes, please describe the source and current terms of the debt that would be repaid and why the repayment is important to the overall objective of the transaction.

If the Financing Structure chosen in Question 1 was Single-Borrower Guaranty, then the online form will show the following

For a Single-Borrower Guaranty, please provide a detailed list of the Borrower’s estimated costs, the amount of the guaranteed party’s potential funding to the Borrower and the portion of that funding that DFC would potentially guarantee. For an example, please click here.

Borrower’s Estimated Costs

Cost Item	USD	%
Total Borrower Costs	(added up by system)	100%

USD Amount of Guaranteed Party’s proposed Funding to Borrower
% Amount of DFC’s Potential Guaranty (DFC share)
USD Amount of DFC’s Potential Guaranty	(system multiplies USD by % to get DFC USD share)

If the Financing Structure chosen in Question 1 is Multi-Borrower Guaranty, then the online form will show the following:

For a Multi-Borrower Guaranty, please provide the parameters of the potential facility. For an example, please click here.

Total Size of the Portfolio	$
Avg. % of each sub-transaction to be guaranteed by DFC
Estimated Number of Sub-Transactions/Borrowers

QUESTION 7: DESCRIBE Collateral and/OR Credit Enhancements (IF APPLICABLE)

DFC usually requires a collateral/credit enhancement package tailored to the specific risks of a given transaction. Following are indicative categories of collateral/credit enhancement that DFC may require. Please indicate below those categories that may be available (check all that apply):

____ Pledge of shares of the Borrower

____ Liens/Mortgages on Borrower assets (Specify types/locations: ___________)

____ Liens/Mortgages on other assets (Specify types/locations: _____________)

____ Guaranties from creditworthy individuals or companies (Specify name(s) of guarantor(s): ____)

____ Irrevocable standby letter(s) of credit

____ Debt Service Reserve Account

____ “Key Man” Life Insurance

____ Other (describe:____________________________)

QUESTION 8: Management Experience and Track Record

Briefly describe relevant experience (in the sector, in the market, etc.) that the key parties (individually or as a team) may contribute towards the success of the proposed transaction.

Please attach a document compiling CVs or other documentation that demonstrates this experience:

QUESTION 9: PROVIDE INFORMATION ON PRIVATE SECTOR SOURCES OF FINANCING

DFC does not compete with private sector providers of financing. Therefore, DFC requires that applicants: (a) evaluate the possibility of obtaining financing from private sources and (b) decide to pursue DFC financing because private financing is not available on terms sufficient to make the investment viable or because of specific benefits DFC participation will bring to the investment.

Have you evaluated the possibility of obtaining financing for this transaction from private sector sources?8	Yes	No
Have you determined that private sector financing is not a viable option in this case? 9	Yes	No
If Yes, please list the private sector funding source(s) you have approached regarding this transaction and explain why private financing is not a viable option (i.e. country capacity limits, unworkable tenor and/or pricing).

QUESTION 10: CONSIDERATION FOR GRANT/TECHNICAL ASSISTANCE FUNDING

In situations where the investment being proposed is highly developmental and requires a grant or similar funding for feasibility studies, training or other investment development activities, DFC may be able to provide such funding. If the investment is successful to the extent that it becomes capable of repaying this funding to DFC, then it would be required to do so.

Would you like to be considered for this type of funding? Yes/No

If Yes, please provide the following:

Amount Requested: USD_________

Description of the activities on which the funds would be used and how those activities are required for the successful development of the overall investment:

QUESTION 11: HOW DID YOU LEARN 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 a 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. USAID, State/Embassy, Commerce, Treasury, TDA, DOD, USEXIM, etc. – there is a dropdown list)

____ 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: ______)

QUESTION 12: may we share your information with other dfis? (Yes/No)

Do you permit DFC to share the following information with other development finance institutions (DFIs) who may be interested in the type of project/transaction you are proposing?

• The Borrower/Guaranteed Party Name and Location from Question 2;

• The Representative Name, Title, and E-mail address from Question 3;

• The DFC-designated sectoral category (i.e. financial services, power generation) that corresponds with the nature of your project/transaction.

Please note that this is not a guarantee that DFC will share the information nor a guarantee that recipients of the information will provide additional support to the transaction.

Question 13: Anti-Lobbying Certification

Per 31 USC § 1352, DFC is required to obtain certifications with regard to funds paid to lobbyists. Pursuant to that requirement, please complete the certifications below.

U.S. Government Appropriated Funding¹⁰

The applicant certifies, to the best of the applicant’s knowledge, that no party involved with the proposed transaction has used or will use funds appropriated by the U.S. government (through contracts, grants, loans, or cooperative agreements) to pay any person for influencing or attempting to influence an officer or employee of any U.S. government agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with any federal contract, grant, loan or cooperative agreement.

Private Funding

The applicant certifies, to the best of the applicant’s knowledge, that if any party involved with the proposed transaction has used or intends to use funds other than funds appropriated by the U.S. government to pay any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this proposed Federal contract, grant, loan, or cooperative agreement, such party has completed or shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

SUBMISSION/SIGNATURE Page

Select DFC Origination Officer

Please select a recipient to receive your application materials. If you are already working with a DFC origination officer, please select their name from the menu below. If not, please select “Officer not assigned” and your application will be forwarded to a DFC officer who reviews incoming applications.

Officer Name: (drop-down list)

I certify that the statements and information provided herein are true to and correct to the best of my knowledge and belief.

Name:

Title/Role in Transaction:

Email Address:

[SIGN and SUBMIT BUTTON]

1 For U.S. addresses, the zip code+4 is required for the postal code/zip code field in the address.

2 (a) the World Bank, regional development banks, multilateral and bilateral development institutions and their affiliates; (b) the United Nations or agencies thereof; and (c) U.S. federal, state, regional or municipal governments, or any departments, agencies or instrumentalities thereof.

3 For U.S. entities, at least 51% of the owners or members of the board of directors are African Americans, Hispanic Americans, Native Americans, Asian Pacific Americans and Subcontinent Asian Americans. For non-U.S. entities, at least 51% of the owners or members of the board of directors are members of a demographic/social group considered to be a minority and/or economically disadvantaged in the country where the entity is incorporated/operates.

4 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.

5 DFC offers Political Risk Insurance that covers a variety of political risks, including political violence, expropriation and currency inconvertibility.  Please check this box to indicate if this party would like to learn more about DFC’s political risk insurance program and availability of coverage for this project.

6 An in-kind contribution could be a hard asset such as a building, land or equipment. In order for DFC to credit it as an equity contribution, it must be titled to the Borrower, and DFC must receive reasonable documentation of its market value (e.g. a recent appraisal, sales invoice, etc.)

7 From most recent (audited) financial statement.

8 For guaranty transactions, DFC is asking whether the guaranteed party has evaluated their ability to provide the financing without a guaranty.

9 For guaranty transactions, DFC is asking whether the guaranteed party has determined that it is not possible to provide the financing without a guaranty.

10 The use of funds appropriated by the U.S. government to pay lobbyists is prohibited by law.