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DFC-007 DFC Impact Assessment Questionnaire

The document is an Impact Assessment Questionnaire (DFC-007) from the United States Development Finance Corporation, requiring detailed project information for applicants seeking support. It outlines the necessity for accurate responses, confidentiality of sensitive information, and compliance with legal standards, including the Paperwork Reduction Act. The questionnaire covers various aspects of the project, including ownership, social characteristics, human resources management, community benefits, business innovation, competitive position, operational employment, and macroeconomic impacts.

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Jane Ara Pascual
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0% found this document useful (0 votes)
26 views23 pages

DFC-007 DFC Impact Assessment Questionnaire

The document is an Impact Assessment Questionnaire (DFC-007) from the United States Development Finance Corporation, requiring detailed project information for applicants seeking support. It outlines the necessity for accurate responses, confidentiality of sensitive information, and compliance with legal standards, including the Paperwork Reduction Act. The questionnaire covers various aspects of the project, including ownership, social characteristics, human resources management, community benefits, business innovation, competitive position, operational employment, and macroeconomic impacts.

Uploaded by

Jane Ara Pascual
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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IMPACT ASSESSMENT QUESTIONNAIRE (DFC-007)

OMB No. [ ]
Expiration Date: [ ]
United States 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 2.8 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 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.

I have read and agree to the terms and conditions listed above.
Questions Common to All Project Types

1 PROJECT DESCRIPTION AND OWNERSHIP PROFILE


A. Project Name
B. Project City and Country
Is the Project a new/greenfield enterprise or expansion New Enterprise
C. of an existing operation? (no existing facilities and/or operations) Existing Enterprise
D. Describe the Project, particularly the use of proceeds of the DFC-supported investment:
[text box]
E. Current/projected percentage of local ownership of the Project (if there is/will be none, enter "0"). %
F. Current/projected percentage of female ownership of the Project (if there is/will be none, enter "0"). %
G. Current/projected gender breakdown of the Project's Board of Directors or other governing body (if applicable) # male # female
H. Current/projected number of women in executive management positions (if there are/will be none, enter "0"). #
I. Is the Project a local Small and Medium Enterprise (SME)? Yes No
2 PROJECT SOCIAL CHARACTERISTICS
A. Does the Project have an Environmental and Social Management System (ESMS)? Yes No
Please attach a copy of the ESMS (in English). Button to attach a copy of ESMS
B. Does (or will) the Project have or involve the following:
Migrant or foreign workers (excluding foreign nationals in management or highly-skilled non-manual workers). Yes No
Workers under the age of 18 (directly or indirectly employed by the Project). Yes No
Restructuring that results in a major retrenchment (i.e., lays off significant numbers of workers). Yes No
Please describe
Known non-compliance with local laws or other applicable labor standards (self-diagnosed, or as a result of official inspections or other
audits). Yes No
Please describe
Onsite trade union Yes No
What percentage of workers are covered by a collective bargaining agreement? %
Please attach a copy of the collective bargaining agreement in English, if applicable. Button to attach copy of agreement
Labor-related lawsuits, labor unrest in last 3 years, or ongoing/unresolved disputes with Project trade union. Yes No
Please describe
Onsite security Yes No
Are security guards armed? Yes No
Is security publicly or privately contracted? Public Private

Common Questions: 2 of 23
Questions Common to All Project Types

3 PROJECT HUMAN RESOURCES MANAGEMENT AND JOB QUALITY


A. Does (or will) the entity undertaking the Project have written human resources policies? Yes No
Please attach a copy of the human resources policies (in English). Button to attach copy of policies.
B. How are the terms of employment communicated to each worker? (check all that apply) Verbally Written
Please attach a copy of a sample employment contract (in English). Button to attach copy of contract.
Does (or will) the Project management have experience in applying international labor standards, such as those addressed in the IFC
C. Performance Standards? Yes No
Please specify the standards and describe the experience.
Does (or will) the entity undertaking the Project offer employee development programs, such as tuition reimbursement or formal
D. mentorships to both current and new non-management employees? Yes No
Please describe what type of employee development programs will be available to non-management personnel
Does (or will) the entity undertaking the Project offer other employee benefits that exceed local legal requirements to both current and
E. new non-management employees Yes No
Please provide a list of employee benefits that exceed local law that are or will be available to non-management personnel
4 PROJECT BENEFITS TO WOMEN, ENVIRONMENT, AND COMMUNITY
Does (or will) the Project have any direct or ancillary benefits to women that exceed what is required by law or permit or will the Project
A. consider gender issues in the project design and/or implementation )? Yes No
Please Describe
As a result of this DFC-supported investment, will the Project implement initiatives (either corporate or transactional) which are directed
B. at restoring and/or preserving the environment that exceed what is required by law or permit? Yes No
Please Explain
Does (or will) the Project contribute money towards activities that benefit local communities (e.g., recreational facilities, schools, medical
C. clinics, scholarship programs, other charitable activities ) that exceed what is required by law or permit? Yes No
Actual/Expected annual budget $/Year
Please Describe

Common Questions: 3 of 23
Questions Common to All Project Types

5 BUSINESS INNOVATION
Does the Project involve an innovative financial structure that will mobilize private capital in a way that has not been done previously in
A. this market? Yes No
Please describe
B. Please indicate if the Project will operationalize a product, process, and/or technology that is new as a result of the DFC-supported investment.
Products and/or services Yes No
Please describe
Business Processes Yes No
Please describe
Production and/or processing technologies Yes No
Please describe
C. Will there be any technical assistance provided by the Project to either customers or suppliers? Yes No
Please describe
Has (or will) the Project secure(d) voluntary sustainability certification from an internationally-recognized certifying authority?
D. Yes No
Please identify
6 PROJECT COMPETITIVE POSITION
A. Does (or will) the Project occupy a monopoly position in any of its markets? Yes No
Please explain
Please estimate how many firms currently provide the same or similar products and/or services in the local market? #

Projected
What is the project's market share? Current by 5th year
B. Does (or will) the Project Country government have majority ownership or effective management control of the Project? Yes No
Please explain
C. Does (or will) the Project result from or cause any Project Country reforms, new legislation, or new regulations? Yes No
Please explain

Common Questions: 4 of 23
Questions Common to All Project Types

7 PROJECT OPERATIONAL EMPLOYMENT


Please provide the current and projected number of Project employees for operations only. (Do not include construction/buildout/startup employees. If this is
A. the type of project that has a construction/buildout/startup phase, that information will be provided in a separate question.)
Additional Employment by 5th year of
operations as a result of the DFC-supported
Current Employment investment

Foreign
Local Nationals Local Foreign Nationals DFC will total this data, but the client will not
Male Female Youth see or be asked to enter totals.
Managerial
Professional/
Technical
Unskilled Labor
TOTAL
B. Will the Project utilize workers employed by third parties (i.e. contractors/sub-contractors) for operations? Yes No

For what type(s) of tasks will these workers be employed? Administrative Other

Common Questions: 5 of 23
Questions Common to All Project Types

8 MACROECONOMIC IMPACTS ON THE US, LOCAL AND THIRD COUNTRY ECONOMIES


Please describe how the Project will benefit U.S. businesses or the U.S. economy (e.g., opens new markets, enables efficiencies through vertical integration,
A. reduces costs, increases sales from U.S. businesses (offshore or U.S.-based), support U.S. small business).
[text box]
B. Please provide an estimated breakdown of where the initial Project Funding will come from ("Sources"). To see an example, please click [here].
Public Private Not for Profit
DFC
United States Other USG Agencies
Private/Non-Profit
Host Country
Non-U.S./Non-Host Country(ies)
Multicountry/Multilateral
Please provide an estimated breakdown of where initial Project funding will be spent ("Uses"). To see an example, please click [here]. Note: the total Uses must
C. equal the total Sources above.
Goods and Services Fees/Transaction Costs Contingency/Other
DFC
United States Other USG Agencies
Private/Non-Profit
Host Country
Non-U.S./Non-Host Country(ies)
Multicountry/Multilateral

You estimated that $( ) of initial project funding would be spent on goods/services from U.S. private companies. Please provide detail on the potential suppliers:
Small?
Minority? New/
Company Name City State Women? Used Description of Goods/Services Amount ($US)

Total
You estimated that $( ) of initial project funding would be spent on goods/services from private companies in the Host Country. Please provide a description of
the goods/services that will be procured.
[text field]

Common Questions: 6 of 23
Questions Common to All Project Types

D. Please provide an estimated breakdown of the Project's revenues by market/source by the 5th year of operation:

Estimated % of Total Revenues


United States Host Country Non U.S./Non-Host Country due to DFC-supported investment
Revenues ($US)
Will the Project reduce the Host Country's need to import certain goods? Yes No
Please provide an estimated breakdown of the Project's 1) operating expenditures on goods/services and 2) taxes/fees paid to governments by the 5th year of
E. operation:
Estimated % of Total Operating
Expenditures or Taxes due to DFC-
United States Host Country Non U.S./Non-Host Country supported investment
Operating Expenditures on
goods/services ($US)
Taxes/Fees ($US)
You estimated that $( ) would be spent annually on goods/services from the United States. Please provide detail on the potential suppliers:
Small?
Minority? New/
Company Name City State Women? Used Description of Goods/Services Amount ($US)
Total
You estimated that $( ) would be spent annually on goods/services in the Host Country. Please provide a description of the goods/services that will be procured.
[text field]
9 FINANCIAL OR NON-FINANCIAL SECTOR PROJECT
Will the Project's primary business be to provide:
Financial Products/Services Non-Financial Products/Services

Common Questions: 7 of 23
Questions Common to All Project Types

Cell: B14
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Comment:
An ESMS typically includes the components listed below:
•An overarching policy that defines the environmental and social objectives and principles that will guide the project.
•A process for identifying the environmental and social risks and impacts of the project.
•Management plans and programs that describe mitigation and performance improvement measures that address environmental and social risks of the project.
•An organizational structure that defines roles, responsibilities to implement the management system.
•Emergency preparedness and response plans that will enable the project to respond to accidents and emergency situations.
•Procedures to monitor and measure the effectiveness of the management system.
•A plan for building and maintaining strong, constructive and responsive relationships with communities affected by the project, including mechanisms to respond to
complaints, consultation and reporting.

Cell: B42
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Comment:
Please include “family-friendly” benefits, such as flexible work schedules, extended paid maternity/paternity leave, child care.

Cell: B45
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Comment:
E.g., project provides safer cooking appliances, convenience of clean water close to the household, ample lighting and presence of cameras in parking lots to
increase safety.

Cell: B49
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Common Questions: 8 of 23
Questions Common to All Project Types

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Comment:
Philanthropic and/or charitable initiatives not directly related to the business operations of the Project, required by the host country government, or implemented
for impact mitigation.

Cell: B59
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Comment:
Examples may include, but are not limited to: methods used to deliver products or services; methods used to improve the company’s supply chain; managerial
practices to improve transparency or employee productivity. Expertise provided by Investment Funds to portfolio companies should be included.

Cell: B61
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Comment:
Examples may include, but are not limited to: equipment upgrades, creation of manufacturing technology efficiencies, IT enhancements.

Cell: B65
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Comment:
Examples may include, but are not limited to: Fairtrade International, International Sustainability and Carbon Certification, International Standards Organization
certificates.

Cell: B79
Common Questions: 9 of 23
Questions Common to All Project Types

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Comment:
Number of full-time equivalent employees as per local definition working for the Project. This includes directly hired individuals and individuals hired through third
party agencies as long as those individuals provide on-site services related to the operations of the Project. Also, this includes full-time equivalent worked by
seasonal, contractual and part time employees. Part-time jobs are converted to full-time equivalent jobs on a pro rata basis, based on local definition (e.g., if working
week equals 40 hours, a 24 hr/week job would be equal to 0.6 FTE job). Seasonal or short-term jobs are prorated on the basis of the portion of the year that was
worked (e.g., a full-time position for three months would be equal to a 0.25 FTE job). If the information is not available, the rule-of-thumb is two part-time jobs equal
one full-time job.

Cell: F82
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Comment:
Those of legal working age 15-24

Cell: B100
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Comment:
Some funding entities such as multilateral development banks may fit into this category.

Cell: B121
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Comment:
Common Questions: 10 of 23
Questions Common to All Project Types

For operating expenditures, exclude utility costs, rent and internal labor costs.

Cell: B122
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Comment:
Includes payments to the government in the form of corporate income or profit taxes. Additional forms of transfer to be reported as appropriate include (i) sales
taxes, (ii) net VAT, (iii) royalties, (iv) dividends and related taxes, (v) management and/or concession fees, (vi) license fees, (vii) tax on payment of interest, and (viii)
other material payments net of any direct subsidies received.

Cell: B131
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Comment:
Including but not limited to commercial banks, non-bank financial institutions, insurance companies, re-insurance companies, investment funds (e.g., microfinance,
SME, venture capital, private equity), lending facilities, and financial intermediaries engaged in specialized financial transactions

Common Questions: 11 of 23
Questions for Financial Services Projects Only
1 FINANCIAL INTERMEDIARY OPERATIONAL METRICS
Current 5th Year Projection
A. Number of active clients
B. Number of transactions
C. Total value of financial assets portfolio ($US)
D. Number of branches
2 NATURE OF DFC SUPPORT
What percentage of the DFC-supported investment will be used to expand one or more of the Financial Intermediary's financial product
portfolios? %

For the portion of the DFC-supported investment that will not be used to expand financial product portfolios, please describe in detail how it will be used:
[text field]
3 CLASSIFICATION OF FINANCIAL ASSET PORTFOLIO BY PRODUCT TYPE
For each product type offered by the Financial Intermediary undertaking this Project, indicate what percentage of the portfolio it equals when measured by #
of clients, # of transactions and total value. In addition, please provide the average tenor/holding period of the transactions in each product type offered and
indicate whether the DFC-supported investment will be for expansion of this product type. For examples, please click [here].
A.

Average Tenor/Holding
By # clients By # of transactions By Value ($US) Period (months) DFC-Supported?
Product Type Current 5th Year Current 5th Year Current 5th Year Current 5th Year
Microfinance [Checkbox]
SME Loans [Checkbox]
Corporate Loans [Checkbox]
Consumer Loans [Checkbox]
Mortgages [Checkbox]
Equity Investments [Checkbox]
Leasing Contracts [Checkbox]
Insurance Contracts [Checkbox]
Other (provide) [Checkbox]
100% 100% 100% 100% 100% 100%

B. Does the Financial Intermediary intend to provide any of the potentially DFC-supported products to clients that are larger than SMEs? Yes No
Please describe the relevant client base and the products that would be provided to them.

C. For your Equity Investments portfolio, do you invest in SMEs? Yes No

Financial Services: 12 of 23
Questions for Financial Services Projects Only
4 CLASSIFICATION OF DFC-SUPPORTED BUSINESS LOANS BY SECTOR AND USE
Since you indicated above that the DFC-Supported investment would be used for business loans (i.e. not consumer loans or mortgages), please provide the
A. percentage of such loans expected to be in each sector.
Housing
Manufac- Construc- Transportati Communicat
Sector turing Agriculture tion on ions/ITC Tourism Energy Trade/ Retail Services Health Education
Product Type
[Programming Note: 100%
Show only the 100%
product types that 100%
were chosen as "DFC- 100%
Supported" above] 100%
100%
Since you indicated above that the DFC-Supported investment would be used for business loans (i.e. not consumer loans or mortgages), please provide the
B. percentage of such loans expected to be used for the following purposes.

Purpose Start-up Capital Working Capital Expansion Capital Equipment Purchase Other (please specify):
Product Type
[Programming Note: 100%
Show only the 100%
product types that 100%
were chosen as "DFC- 100%
Supported" above] 100%
100%

Financial Services: 13 of 23
Questions for Financial Services Projects Only
5 DEVELOPMENTAL IMPACTS OF DFC-SUPPORTED FINANCIAL ASSET PORTFOLIO
Of the product types that will benefit from the DFC-supported investment, please indicate the approximate percentage of those portfolios taken up by the
following
Product Type Rural Women Other Underserved Populations
[Programming Note: By # clients By Value ($US) By # clients By Value ($US) By # clients By Value ($)
Show only the Current 5th Year Current 5th Year Current 5th Year Current 5th Year Current 5th Year Current 5th Year
product types that
were chosen as "DFC-
Supported" above]

Please describe current and/or future initiatives that will increase the Financial Intermediary's outreach and/or service to rural borrowers (tailored financial
products/services, training, mobile technology, new branches, etc.). If the initiatives are specific to particular product lines, please include that in the
explanation.
[text field]
Please describe current and/or future initiatives that will increase the Financial Intermediary's outreach and/or service to female borrowers (tailored financial
products/services, training, mobile technology, new branches, etc.). If the initiatives are specific to particular product lines, please include that in the
explanation.
[text field]
Please describe current and/or future initiatives that will increase the Financial Intermediary's outreach and/or service to other underserved borrowers
(tailored financial products/services, training, mobile technology, new branches, etc.). If the initiatives are specific to particular product lines, please include
that in the explanation.
[text field]

Financial Services: 14 of 23
Questions for Financial Services Projects Only
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Comment:
Defined as a borrower of consumer, non-mortgage loan product, such as a car loan, credit card, signature loan, signature line of credit, or Certificate of Deposit
loan.

Cell: B23
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Comment:
The Financial Intermediary will be required to receive DFC approval prior to issuing leases to companies that export products in the following sectors:
•Steel, aluminum and forged metal goods (including automotive parts)
•Textile mills, textile products and apparel
•Chemical products
•Paper and plastic products
•Lumber and furniture production/manufacture
•Agriculture, forestry, fishing and hunting (with the exception of agriculture products not currently commercially grown in the U.S.)

Cell: B27
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Comment:
DFC may need to provide prior approval for support of financial products to companies that meet at least two of the following three criteria: >$15 million
assets, >$15 million in annual revenue, >300 employees.

Cell: H53
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Services: 15 ofto23
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Questions for Financial Services Projects Only
more: https://go.microsoft.com/fwlink/?linkid=870924

Comment:
“Female Borrowers” means the loan will be solely held by a women and not jointly held by her husband or other male person. 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.

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Comment:
Examples include but are not limited to: ethnic minorities, youth, handicapped individuals.

Financial Services: 16 of 23
Questions for Non-Financial Services Projects Only
1 IMPACT ON CURRENT U.S. EMPLOYMENT
Do any of the investors in the Project (or any of their subsidiaries or affiliates) currently produce in the United States the same
A. product(s) as those produced by this Project? Yes No
How many U.S. employees are currently employed by such company, subsidiary, or affiliate that produce the product(s)? #
Has the number of U.S. employees engaged in the U.S. production of the product(s) declined or will it decline as a result of this DFC-
supported investment? Yes No
B. Does the Project involve business process outsourcing for companies operating in the U.S.? Yes No
2 PROJECT ENVIRONMENTAL AND SOCIAL CHARACTERISTICS
A. Project Site Location (please include GPS coordinates and, if available, a map of site location):
Has the Project conducted or will the Project conduct consultations with Project-affected communities (including disadvantaged and
B. vulnerable groups)? Yes No
Please describe the scope and results (if applicable) of these consultations.
C. Has the Project been involved in any past or ongoing community dispute or complaint resolution processes? Yes No
Please describe the nature of the dispute/complaint and steps being taken to resolve (if applicable).
D. Please indicate whether the Project is (or will be) located in or near any of the following:
Natural forest areas, including primary forests, old growth forests, forests that serve as critical carbon sinks or forests with high levels
Yes No
of biodiversity.
Areas on the United Nations List of Natural Parks, World Heritage Areas, or other internationally recognized protected areas (such as
Yes No
wilderness areas, national monuments, or nature preserves.)
Sensitive locations of national or regional importance including wetlands, floodplains, coral reefs, mangrove swamps or areas prone to
Yes No
erosion, desertification or seismic activity.
E. Please indicate whether the Project involves any of the following:
Construction of a dam or weir. Yes No
Production or trade in any product or activity deemed illegal under host country laws or regulations or international conventions and
Yes No
agreement or subject to international phase-outs or bans.

Resettlement of people or disruption of businesses. Yes No


If Yes, please estimate the number of people affected. [insert number]
Use of previously contaminated sites. Yes No

Production or trade in radioactive materials. Yes No


Production or trade in or use of unbounded asbestos fibers. Yes No
Marine or coastal fishing practices harmful to vulnerable and protected species or damaging to biodiversity or habitats. Yes No

Non-Financial: 17 of 23
Questions for Non-Financial Services Projects Only
3 SECTOR-SPECIFIC METRICS
Please select the sector(s) that best describe(s) the Project's purpose/operations:
Agriculture/Agribusiness
Projected
Current by 5th year
# (tonnes per # (tonnes per
Average agricultural yield (tonnes/hectare) hectare) hectare)
Number of smallholder farmers linked to the Project as:
Suppliers # #
Buyers # #
Contractors # #

Education
Projected
Current by 5th year
Number of students enrolled # #
Number of local students enrolled (excluding children of expatriates) # #
Number of local female students enrolled (excluding children of expatriates) # #
Number of needs-based scholarships for local students (per year) # #

Energy
Projected
Current by 5th year

Energy delivered to offtakers(s) per year (GWh)


#GWh #GWh

Energy Access
Projected
Current by 5th year
Number of new on-grid connections # #
Number of new micro-grid connections # #
Number of new household power systems installed # #
Number of new modern lighting devices sold # #

Non-Financial: 18 of 23
Questions for Non-Financial Services Projects Only
Health
Projected
Current by 5th year
Number of patient beds # #
Number of patient consultations provided per year # #
Number of low-income patient consultations provided per year # #

Housing
Projected
Current by 5th year
Number of new residential dwellings # #
Number of new residential dwellings eligible for government housing assistance program for low-income homebuyers # #
Number of new residential dwellings eligible for government housing assistance program for middle-income homebuyers # #
Number of refurbished residential dwellings # #
Number of refurbished residential dwellings eligible for government housing assistance program for low-income homebuyers
# #
Number of refurbished residential dwellings eligible for government housing assistance program for middle-income homebuyers
# #
Please specify the low- and/or middle-income government housing assistance programs for which the homebuyers are eligible.

Information and Communications Technologies


Projected
Current by 5th year
Number of cell towers # #
Number of mobile subscriptions, including voice and/or data # #
Number of fixed data subscriptions # #
Number of fixed voice (telephone) subscriptions # #

Non-Financial: 19 of 23
Questions for Non-Financial Services Projects Only
Transportation
Projected
Current by 5th year
New road construction # km # km
Improved road construction # km # km
Units of cargo containers transported through the road/railway/port/airport per year (twenty foot equivalent units) # TEUs # TEUs
Tonnes of bulk cargo transported through the road/railway/port/airport per year # tonnes # tonnes
Passengers using transportation service per year # #

Waste and Sanitation


Projected
Current by 5th year
Amount of waste disposed per year (tonnes) # tonnes # tonnes
Volume of wastewater treated per year (m3) #m3 #m3

Water
Projected
Current by 5th year
Volume of potable water produced per year (m ) 3 #m3 #m3

Other
Please describe in detail the specific product and/or service that the Project provides: [space for text input]
Projected
Current by 5th year
Number of clients or customers per year
# #

Number of low-income clients or customers per year # #

Number of female clients or customers per year # #

Non-Financial: 20 of 23
Questions for Non-Financial Services Projects Only
4 PROJECT CONSTRUCTION/BUILDOUT/STARTUP

Estimated Construction/Buildout/Start-up Period (if applicable) MM/YYYY TO MM/YYYY

Estimated Operational Start Date (if applicable) MM/YYYY

Does the Project involve physical construction? Yes No

Approximately what percentage of the construction has been completed to date? %

Please provide a breakdown of the estimated number of Project employees that are/will be directly involved in the construction/buildout/startup:
Employment
Local Foreign Nationals
Managerial
Professional/Technical
Unskilled Labor
Total

Will the Project utilize workers employed by third parties (i.e. contractors/subcontractors) for the construction/buildout/ startup? Yes No

For what type(s) of tasks will these workers be employed? physical construction administrative Other

Will the Project require the establishment of temporary construction worker housing facilities? Yes No

How many workers are expected to be housed at these facilities? #

Non-Financial: 21 of 23
Questions for Non-Financial Services Projects Only
Cell: B32
Comment: [Threaded comment]

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Comment:
Smallholder farmers are defined as those farmers owning small plots of land on which they grow subsistence crops and up to two cash crops, relying almost
exclusively on family labor.

Cell: B39
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Comment:
Include both full-time and part-time, where each discrete student is counted regardless of number of courses.

Cell: B59
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Comment:
Low income means subsidized or eligible for subsidized healthcare.

Cell: B74
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Comment:
Including but not limited to GSM, CDMA, BGAN, VSAT, EDGE, UMTS, WiMax, 3G, 4G, LTE. Include both post-pay and pre-pay subscriptions

Cell: B75
Comment: [Threaded comment]
Non-Financial: 22 of 23
Questions for Non-Financial Services Projects Only

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Comment:
Including but not limited to ADSL, Broadband, Fibre. Include both post-pay and pre-pay subscriptions.

Cell: B76
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Comment:
Include both post-pay and pre-pay subscriptions

Cell: B99
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Comment:
Clients/customers who cannot afford the local market cost of basic goods/services, and thus would do without such goods/services if they were not made
available at a reduced cost.

Cell: B107
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Comment:
Number of full-time equivalent construction workers employed for the construction of the Project’s hard assets. Part-time jobs for construction are converted
to full-time equivalent jobs on a pro rata basis, based on local definition (e.g., if working week equals 40 hours, a 24 hr/week job would be equal to 0.6 FTE job).
Seasonal or short-term jobs are prorated on the basis of the portion of the year that was worked (e.g., a full-time position for three months would be equal to a
0.25 FTE job). If the information is not available, the rule-of-thumb is two part-time jobs equal one full-time job.

Non-Financial: 23 of 23

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