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Investments Funds Application (DFC-004)
OMB No. 3015-0006
Expiration Date: 09/30/2025
United States International Development Finance Corporation
1100 New York Avenue, NW Washington, DC 20527-0001
An Agency of the United States Government
Responses to questions which call for estimates or projections should take the form of good faith statements
made to the best of the applicant’s knowledge and belief. Statements of fact provided in this document must be
accurate as of the date of submission. Anyone who knowingly makes a false statement with the intent to influence
DFC’s guarantees, loans, or other investments may be criminally prosecuted. Such false statements are also
grounds for DFC to terminate a commitment or declare a contract default. These rights are in addition to any
other rights or remedies available to United States government. Neither submission nor acceptance of this
application implies that the proposed transaction is eligible for support or that support will be provided.
Information provided in this form will be deemed designated as “confidential commercial information” in
accordance with Freedom of Information Act (FOIA) regulations at 22 C.F.R. Part 706 and will be treated as
such to the extent permitted by applicable law.
Paperwork Reduction Act Notice: This information is required to obtain benefits. Federal agencies may not
collect information unless a valid OMB Control Number with an expiration date that has not expired is displayed.
The public reporting burden for this collection of information is estimated to average 60 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to
Agency Clearance Officer, Records Management, United States International Development Finance
Corporation, 1100 New York Avenue, NW, Washington, DC, 20527 and to the DFC Desk Officer at the Office of
Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room
10202, Washington, DC 20503.
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Proposal Date DEFAULT
GP Main Point of Contact (First Name) TEXT BOX
GP Main Point of Contact (Last Name) TEXT BOX
GP Main Point of Contact (Email) TEXT BOX
GP Main Point of Contact (Phone Number) TEXT BOX
Name of Firm TEXT BOX
Address of Firm Headquarters TEXT BOX
City of Firm Headquarters TEXT BOX
Country of Firm Headquarters TEXT BOX
Other Firm Locations (cities) TEXT BOX
Year Firm Established TEXT BOX
Website of Firm TEXT BOX
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FUND OVERVIEW
Fund Name TEXT BOX
Fund Target Size in USD (including DFC amount) TEXT BOX (numerical)
Max Fund Target Size in USD (including DFC amount) TEXT BOX (numerical)
Min Fund Target Size in USD (including DFC amount) TEXT BOX (numerical)
Proposed GP Commitment (%) TEXT BOX (percentage)
Proposed DFC Commitment TEXT BOX (numerical)
Fund Sectors TEXT BOX (drop down menu)
If Other Sectors/Industries (please describe) TEXT BOX
Fund Geography (region) TEXT BOX (drop down menu)
Fund Geography (targeted countries) TEXT BOX
Projected Fund Multiple and IRR returns (gross) TEXT BOX (percentage)
Brief Description of the Fund and its Strategy TEXT BOX
Brief Description of the Fund for Public Disclosure After TEXT BOX (limit to 40-149 characters)
Approval (character range 40-149)
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MANAGEMENT
OVERVIEW
Fund Team Formation: Describe how the Fund TEXT BOX
Manager and the team were initially formed, and
provide a brief history of how they have evolved to
date. You may also refer to appropriate sections in
the PPM or marketing presentation.
Number of Partners TEXT BOX (numerical)
Total Number of Employees/Number of Senior TEXT BOX (numerical)
Investment Professionals
Is the General Partner or Investment Manger a Yes
women-owned enterprise or women-led enterprise? No
Please provide the current or projected number of GP _________#
female members of the GP’s or FM’s board of FM___________#
directors or other governing body, if applicable
Firm’s Assets Under Management TEXT BOX (numerical)
Number of Funds Previously Managed by this Firm TEXT BOX (numerical)
SENIOR INVESTMENT TEAM
BACKGROUND
Name Title Year Location (city, Focus (industry, Prior work experience Education
joined firm country) function, if any) (include firm, position
number of years)
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LP BASE
Total Capital Raised to Date in USD TEXT BOX (numerical)
Total Capital Raised to Date (% of Target Fund Size) TEXT BOX (percentage)
First Close Date (actual/anticipated) and Amount TEXT BOX
(i) Explain why you are seeking DFC funding. (ii) TEXT BOX
What efforts have been taken to raise capital from
private sector investors and what has been the
outcome of those efforts? (iii) Is there a lack of
available private sector support for the Fund, or
for portfolio companies and if so for what reason?
List of Investors in prior funds and those who Name Commitment to prior Commitment to this Location (country)
have Committed to this Fund and Amount fund(s) Fund
List of new Investors committed to this Fund Name Commitment Location (country)
List any Development Finance Institutions (DFIs) Name Stage of discussion Commitment Soft or hard
with whom the Fund is engaged in discussions
(include the stage of discussion/investment
process and whether have provided soft or hard
commitments)
TRACK RECORD
Attach a summary of prior fund performance (see FILE UPLOAD
Track Record template)
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INVESTMENT POLICY & ESG
Describe the developmental impact you believe the TEXT BOX
Fund will have in the host country/countries (e.g.,
job creation, infrastructure improvements, social
policies/corporate social responsibility initiatives,
technology and knowledge transfer).
Will the Fund target investments that are female- Yes_____
owned or serve female clients, clients located in No______
rural areas, or other underserved populations?
Women:_______%
Rural:_______%
If so, what percentage will be dedicated to these Other: _____%
populations?
Number/Percentage of staff
Number and percentage of female staff (GP, Fund General Partner
Manager and Fund)
Fund Manager
Fund
Please describe the Fund’s practices concerning TEXT BOX
provision of accountability and access to remedy
for negative sub-project impacts on Individuals
and communities.
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OTHER -
MISCELLANEOUS
(i) Describe any potential conflicts of interest of TEXT BOX
which you are aware. (ii) How do you plan to
resolve potential conflicts of interest within the
Fund, or with other investment vehicles managed
by your organization or its affiliates?
Are there any substantive litigation, dispute TEXT BOX
resolutions, or regulatory actions brought
against the manager, its principals or any
portfolio companies?
If yes, please attach an explanation describing any FILE UPLOAD
litigation, community dispute, or complaint
resolution processes that have occurred or are
occurring involving the manager, its principals
and/or its portfolio companies.
ATTACHMENTS
Attach the Fund's most recent FILE UPLOAD
marketing presentation
Attach the Fund's investment pipeline FILE UPLOAD
Attach the Fund's PPM (if available) FILE UPLOAD
Attach Fund’s ESG Policies FILE UPLOAD
Attach Fund’s Know Your Customer Policies FILE UPLOAD
Attach LPA (if available) FILE UPLOAD
PROPOSAL
DOCUMENTS
Document Name Description Document Date File Name
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DFC/US Government
Questions
How did you hear about DFC?
DFC is interested in knowing what types of ___ N/A -- This is not my first application to DFC.
communications about its programs are most ____ DFC’s website or other social media (Twitter, Facebook, etc.)
effective. If this is the first time you are applying ____ DFC-sponsored workshop or event (Name of event________________)
for an DFC product, please select the source of ____ DFC speaker at an industry event (Name of event_________________)
your initial information about DFC: ___ _ Other US Government Agency (e.g. State/Embassy, Commerce, Treasury, TDA, DOD, USEXIM,
etc.) (insert a dropdown box with choices)
____ Referred by financial or legal advisor (Name of advisor ______________)
____ Referred by portfolio facility manager (Name of facility manager___________________)
____ Past or present DFC client. (Name of client _______________________)
____ Other (describe: ______)
