Appendix A - Appendix A to Part 235—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 § 235.2 of the Standard Terms and Conditions of the above-mentioned Guarantee) was due on ________, 20__, on $____ Principal Amount of Notes issued by Hashemite Kingdom of Jordan (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 § 235.8 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,
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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: