SIP Definitive Application for Guarantee
|[pic] |Multilateral Investment Guarantee Agency |
| |SIP Application For Guarantee |
| | |
| |[pic] |
| | |
| |Please send your completed form and all necessary documentation to migainquiry@. Within one week of |
| |filing this electronic SIP Application, please also send MIGA a signed copy of the signature page, by mail or by fax |
| |to: |
| | |
| |MIGA - Applications, Room U12-1205, |
| |1818 H Street, N.W., Washington, D.C. 20433, USA; |
| |Fax no: (1) (202) 522 26 30 |
| | |
| |Please complete all fields. If you are unable to provide all information, please fill out section 1 of the SIP |
| |Application form and MIGA will register the application. However, MIGA requires complete information in order to start|
| |processing and issuing a contract. |
| |
|1. |GENERAL INFORMATION |
| |INVESTOR |
| |
|1.1 |Company's name |[pic] |
| |Company's address |[pic] |
| | |[pic] |
| | |Country |
| | |[pic][pic][pic] |
| | |Telephone (country code-city code-telephone) |
| | |[pic][pic][pic] |
| | |Fax (country code-city code-fax) |
| | |[pic] |
| | |Email |
| |
|1.2 |Size of Company (Average of last three years): |
| | |
| |Number of employees |[pic] |
| |Size of assets |[pic] |[pic] [pic] |
| |Annual revenues |[pic] |[pic] [pic] |
| |
|1.3 |Investor country (where the company is |[pic] |
| |incorporated): | |
| |
|1.4 |Contact person in company: |
| |Name |[pic] |[pic] |
| | |First |Last |
| |Title |[pic] |
| |Address |[pic] |
| | |[pic] |
| | |Country |
| | |[pic][pic][pic] |
| | |Telephone (country code-city code-telephone) |
| | |[pic][pic][pic] |
| | |Fax (country code-city code-fax) |
| | |[pic] |
| | |Email |
| |INVESTMENT |
| |
|1.5 |Host country (where |[pic] |
| |project is located) | |
| | | |
| |
|1.6 |Name of project |[pic] |
| |enterprise | |
| |
|1.7 |Total amount of |[pic] [pic] |
| |investment at this time: | |
| |Equity |[pic] |
| |Shareholder loans |[pic] |
| |Bank loans |[pic] |
| |Other |[pic] Explain [pic] |
| |TOTAL |[pic] |
| |
|1.8 |Brief description of project |
| | |
| |
|1.9 |Is your investment defined as |
| | |
| | [pic]New (i.e. green field) |
| | [pic]Financial restructuring of existing company |
| | [pic]Expansion of existing company |
| | [pic]Privatization |
| |
|1.10 |By what date do you |[pic] [pic] [pic] |
| |expect to make your | |
| |investment in the | |
| |host country? | |
| |
|1.11 |Factors that may influence/delay expected investment date |
| | |
| |
|1.12 |Size of Investment: |
| | |
|a. |For non-financial sector projects only: Size of SME into which investment is being made (must meet two out of three criteria relating to |
| |number of employees, asset size and annual sales): |
| | |
| |SIZE |
| |CRITERIA |
| | |
| |Micro |
| |[pic]Employees ................
................
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