Appendix A to Part 240 - Application for Compensation
22:1.0.2.22.35.0.30.17.36 : Appendix A
Appendix A to Part 240 - 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 § 240.02 of the Standard
Terms and Conditions of the above-mentioned Guarantee) was due on
___, 20_, on $___ Principal Amount of Notes issued by Ukraine (the
“Borrower”) held by the undersigned. 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 § 240.08 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 or Fiscal Agent, as applicable].
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: