Appendix A to Part 221 - Application for Compensation
22:1.0.2.22.18.7.30.1.23 : Appendix A
Appendix A to Part 221 - Application for Compensation [________]
Agency for International Development, International Development
Cooperation Agency, Washington, DC 20523.
Ref: Guarantee dated as of ______, 19__: Gentlemen:
You are hereby advised that payment of $______ (consisting of
$______ of principal, $______ of interest and $______ in Further
Guaranteed Payments, as defined in § 221.01(f) of the Standard
Terms and Conditions of the above-mentioned Guarantee) [(consisting
of $____ maturity amount and $____ in Further Guaranteed Payments,
as defined in § 221.01(f) of the Standard Terms and Conditions of
the above-mentioned Guarantee)] 1 was due on ______, 19 __, on
$______ principal [maturity] 1 amount of Notes held by the
undersigned of the Government of Israel, on behalf of the State of
Israel (the “Borrower”). Of such amount $______ was not received on
such date and has not been received by the undersigned at the date
hereof. In accordance with the terms and provisions of the
above-mentioned Guarantee, the undersigned hereby applies, under §
221.21 of said Guarantee, for payment of $______, representing
$______, the principal amount of the presently outstanding Note(s)
of the Borrower held by the undersigned that was due and payable on
______ and that remains unpaid, and $______, the interest amount on
such Note(s) that was due and payable by the Borrower on ____ and
that remains unpaid, [$______, the maturity amount of such Note
that was due and payable on ________ and that remains unpaid] 2 and
$______ in Further Guaranteed Payments, 3 plus accrued and unpaid
interest thereon from the date of default with respect to such
payments to and including the date payment in full is made by you
pursuant to said Guarantee, at the rate of ___% per annum, being
the rate for such interest accrual specified in such Note. Such
payment is to be made at [state payment instructions of
Noteholder.]
1 Alternate language for zero-coupon Eligible Notes.
2 Alternate language for zero-coupon Eligible Notes.
3 In the event the Application for Compensation relates to
Further Guaranteed Payments, such Application must also contain a
statement of the nature and circumstances of the related loss.
[Name of Applicant] By Name Title Dated