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Appendix 4 Financial Statements of the project partners To be used for the application procedure 2013 Content of appendix 4: - Background information - Appendix 4a: Letter of Intent for contribution Public Institutions. - Appendix 4b: Mandatory model Bank Guarantee - Appendix 4c: Mandatory model Third Party Guarantee Background information The information provided in this appendix will be used to assess whether the project partners have sufficient financial means to successfully implement the project. Companies, NGOs, Knowledge Institutes For companies, NGOs and Knowledge Institutes the basis for the financial assessment consists of assessment of the most recent, audited annual reports of the partners which contribute financially to cover the project costs (see below). The figures provided in these reports are used to fill out the Key Standards table in Appendix 3, sheet 4. These key standards are used as a starting point for the financial assessment of the project partners. Should these key standards not be met, or should there be any other reason to doubt the financial position of either one of the partners, additional information should be provided in order to prove the project partners have sufficient financial means to successfully implement the project (e.g signing of third party guarantees, bank guarantees etc.). Mandatory models for the Bank Guarantee and Third Party Guarantee can be found in Appendix 4b and 4c. If applicable and required the subsidy can be granted under provision a legally signed Bank Guarantee or Third Party Guarantee will be provided. Most recent, audited annual report In order for FDW to make the financial analysis, at least the following information needs to be attached to this appendix: 1. Companies: o Most recent: this should be the 2012 report or the 2011 report. Should neither the 2012 nor the 2011 report be available, please explain why those annual reports are not available and submit your most recent available annual report. o Audited: the annual report should be audited by a chartered accountant, according to the law of your country of origin. If your company is not legally bound to have its annual report audited, you should at least provide a compilation statement from a chartered accountant regarding the balance sheet and the income statement. o Annual report: when available, the full annual report should be submitted including all accompanying notes and annexes. If no annual report is available, at least the annual financial statements should be provided, covering the balance sheet and the income statement (the specification of 'most recent', 'audited' and 'company' then naturally applies to the annual financial statements). Annual reports or annual financial statements usually cover the present year's figures in relation to the preceding year's figures. The balance sheet and income statement need to be (translated) in either Dutch or English. In exception to the general rule, it is allowed to only provide digital copies of the annual reports (no hardcopy needed). This ONLY applies to the annual reports, including all accompanying notes and annexes. GWW-FDW 131 o Company: the annual report submitted should at all time be the annual report of the company that is the partner as presented in the application form. If this company has no individual annual report as it is part of a group, this should be explained and the consolidated annual report of this group should be submitted. 2. NGOs and Knowledge Institutes: o Most recent: this should be the 2012 report or the 2011 report. Should neither the 2012 nor the 2011 report be available, please explain why those annual reports are not available and submit your most recent available annual report. o Audited: the annual report should be audited by a chartered accountant, according to the law of your country of origin. If your NGO is not legally bound to have its annual report audited, you should at least provide a compilation statement from a chartered accountant regarding the balance sheet and the income statement. o Annual report: when available, the full annual report should be submitted including all accompanying notes and annexes. If no annual report is available, at least the annual financial statements should be provided, covering the balance sheet and the income statement (the specification of 'most recent', 'audited' and 'NGO or Knowledge Institute’ then naturally applies to the annual financial statements). Annual reports or annual financial statements usually cover the present year's figures in relation to the preceding year's figures. The balance sheet and income statement need to be (translated) in either Dutch or English. In exception to the general rule, it is allowed to only provide digital copies of the annual reports (no hardcopy needed). This ONLY applies to the annual reports, including all accompanying notes and annexes. o NGOs and Knowledge Institutes: the annual report submitted should at all times be the annual report of the NGO or Knowledge institute that is the NGO or Knowledge Institute as presented in the application form. If this NGO or Knowledge Institute has no individual annual report as it is part of a group, this should be explained and the consolidated annual report of this group should be submitted. Public Institutions For Public Institutions the financial statement consist of a legally signed Letter of Intent following the mandatory model of Appendix 4a. Please make sure the Letter is signed by the Public Institution(s) as presented in the application form or the financially mandated Public Institution. Key Standards table: Based on the figures in the annual financial statements, the key standards need to be calculated in Appendix 3, sheet 4 Key Standards Table. Please refer to Appendix 3 for more information on the Key Standards table. Explanation in text: Describe in Appendix 1, Project Plan, paragraph 5.1 ‘Contribution project partners’ how the subsidy will be pre-financed, how the own contribution will be financed and how the working capital will be provided. Also, if partners do not meet the key standards, or if there is any other issue that may lead to doubt about the financial position of either one of the partners, please explain in text how the project partners will finance the project during its implementation. GWW-FDW 131 Appendix 4a Letter of Intent [PROJECT TITLE] [Name of Public Institute] herewith formally states to contribute to the partnership to enable the financing of the project [project title] The contribution of [Name of Public Institute] consist(s) of: A contribution of [EUR amount] With this Letter of Intent the [Name of Public Institute] declares its intention to finance the project [project title]. The contribution will be made available to the project organization and will be subject to the conditions decided upon by the partnership. [name, title, authority and signature] GWW-FDW 131 Appendix 4b, Mandatory model Bank Guarantee Ghana Wash Window-FDW BANK GUARANTEE THIS GUARANTEE is issued on ________________ (date) By ________________ (name of bank that provides guarantee), (the "Guarantor"), in favour of THE STATE OF THE NETHERLANDS on behalf of the Minister for Foreign Trade and Development Cooperation, in this matter represented by NL EVD International, Agency NL (the "State"); WHEREAS A) On ___________ (date), the State issued an administrative decision ('beschikking') to the company/NGO/knowledge institute named ________________ (the "Private Party") providing a grant for a project under the Ghana WASH Window-Sustainable Water Fund (GWW-FDW). The project is titled ________________ (the "Project") and will be implemented in Ghana. B) For this project, the State requires that the Private party fulfils its obligations mentioned in the administrative decision in order to ensure implementation of the Project. C) These obligations include a financial contribution of the Private Party to the Project. HEREBY DECLARES AS FOLLOWS: 1. The Guarantor stands surety vis-à-vis the State for an amount not exceeding EUR ________________. 2. This unconditional bank guarantee comes into effect on ___________ (date start of project) and will remain in effect until ___________ (date two months after end of project). 3. The Guarantor enters into the obligation to pay to the State all that owed in the matter by the Private Party according to the State's statement, at the State's first written request and at the mere communication that the Private Party is in default of compliance with the obligations referred to above. 4. The Guarantor is not required to make payment under this advance payment guarantee in the event that the written claim from the State is not accompanied by a statement by the State, bearing a legally valid signature, indicating that the State has served the Private Party notice of default, and that the Private Party then failed, in the State's opinion, to meet its obligation(s) within 14 calendar days of the date on which notice of default was served, no later than the date on which the GWW-FDW grant for the Project is fixed. A notice of default, as described above, is not required in the following cases: GWW-FDW 131 a) the Private Party is in a state of bankruptcy b) the Private Party is granted protection from its creditors, or c) the Private Party dissolves its company. This declaration is subject to the law of The Netherlands. Thus signed and drawn up in _______________ (place) on _______________ (date). For _______________ (name of the Guarantor), _______________ (signature) (stamp) _______________ (name and position) GWW-FDW 131 Appendix 4c, Mandatory model Bank Guarantee Ghana WASH Window -FDW THIRD PARTY GUARANTEE THIS GUARANTEE is made on ________________ (date) By ________________ (name of legal entity/company/person that provides guarantee), a company or legal entity established under the laws of __________ (the "Guarantor"), in favour of THE STATE OF THE NETHERLANDS on behalf of the Minister for Foreign Trade and Development Cooperation, in this matter represented by NL EVD International, Agency NL (the "State"); WHEREAS A) On ___________ (date of submission), the company/organization named ________________ (the "Applicant") submitted an application to the State for a grant under the Ghana WASH Window - Sustainable Water Fund (GWW-FDW). The project is titled ________________ (the "Project") and will be implemented in Ghana. B) In case the application is accepted, the State requires that the Applicant/(Partnership?) fulfils its obligations mentioned in the administrative decision ('beschikking') in order to ensure implementation of the Project. C) These obligations include a financial contribution of the Applicant/Project partner to the Project. HEREBY DECLARES AS FOLLOWS: 1. The Guarantor irrevocably and unconditionally stands surety vis-à-vis the State for the financial contribution of the Applicant/Project partner in the project, which amounts to EUR ________________. 2. This Guarantee will become effective once the GWW-FDW grant for the Project has been awarded and will terminate when the Project has been concluded and the GWW-FDW grant has been fixed. 3. The Guarantor provides, together with this guarantee, the State with its latest audited annual report and accounts in order to enable the State to assess the Guarantor's financial standing. 4. The Guarantor enters into the obligation to pay to the State all that owed in the matter by the Company according to the State's statement, at the State's first written request and at the mere communication that the Company is in default of compliance with the obligations referred to above. 5. The Guarantor is not required to make payment under this advance payment guarantee in the event that the written claim from the State is not accompanied by a statement by the State, GWW-FDW 131 bearing a legally valid signature, indicating that the State has served the Company notice of default, and that the Company then failed, in the State's opinion, to meet its obligation(s) within 14 calendar days of the date on which notice of default was served, no later than the date on which the GWW-FDW grant for the Project is fixed. A notice of default, as described above, is not required in the following cases: a) the Company is in a state of bankruptcy b) the Company is granted protection from its creditors, or c) the Company dissolves its company. This declaration is subject to the law of The Netherlands. Thus signed and drawn up in _______________ (place) on _______________ (date). For _______________ (name of the Guarantor), _______________ (signature) _______________ (name and position) Please note: The most recent audited annual report and/or annual accounts of the Guarantor, including a copy of the passport of the signatory who is legally empowered to sign on behalf of the guarantor, must be presented together with this document! GWW-FDW 131