Appendix A to Part 230 - Application for Compensation
22:1.0.2.22.25.0.30.17.26 : Appendix A
Appendix A to Part 230 - Application for Compensation United States
Agency for International Development Washington, DC 20523 Ref:
Guarantee dated as of ____, 20 __:
Gentlemen: You are hereby advised that payment of $_ (consisting
of $_ of principal, $_ of interest and $_ in Further Guaranteed
Payments, as defined in § 230.02(f) of the Standard Terms and
Conditions of the above-mentioned Guarantee) was due on ___, 20__,
on $_ principal 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 § 230.08 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, and $_
in Further Guaranteed Payments, 1 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 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.
All capitalized terms herein that are not otherwise defined
shall have the meanings assigned to such terms in the Standard
Terms and Conditions of the above-mentioned Guarantee.
[Name of Applicant] By: Name: Title: Dated: