Appendix 1

Agent Bank Application Form

Agent Bank Application Form

____________________________________________________________ ____________________________________________________________ ____________________________________________________________ 2. Principal contact for the Application: ______________________________________________________ (Name) (Position/Title) 3. Telephone: ___________________________ a!: ". ___________________________

#e$al orm of the %nstit&tion: ______________________________ 'ate o&nded: _________________________________________ 'ate of (o&rt )e$istration or #ast Amendment: _________________

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Appendix 1

Agent Bank Application Form

*. Please describe briefl+ the histor+ of the bank, and its e-ol&tion to its c&rrent market strate$+.

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Agent Bank Application Form

Part II:

Lending Experience of the Bank

.. Pro-ide the follo/in$ data on the 0ank1s ann&al lendin$ acti-it+ in the +ears 122. and 1223, and thro&$h 4&ne 1225 (or for /hate-er part of that time data is a-ailable) a. N&mber and -al&e ('6) of loans o&tstandin$ at the end of each period. 1996 Number of Loans at end of Period Value of Loans at end of Period b. Total n&mber and -al&e of ne/ loans ori$inated d&rin$ the +ear. 1996 Number of New Loans in Period Value of New Loans in Period c. N&mber and total -al&e of delin7&ent loans at the end of each +ear. 1996 Number of Delinquent Loans at End of Period Value of Delinquent Loans at End of Period d. Acco&ntin$ standard for delin7&enc+ in &se at the 0ank. 8o/ lon$ past d&e is a loan before it is considered delin7&ent9 'oes the bank consider the total remainin$ loan -al&e to be delin7&ent, or :&st the -al&e of the pa+ments delin7&ent to date9 1997 an ! "ne 199# 1997 an ! "ne 199# 1997 an ! "ne 199#

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Agent Bank Application Form

e.

N&mber and -al&e of loans /ritten off at the end of each +ear: 1996 1997 an ! "ne 199#

Number of Loans Written ff at End of Period Value of Loans Written ff at End of Period f. Acco&ntin$ standard for re7&irin$ a loan /rite off:

$. ;hat is the appro!imate a-era$e term of loans in the portfolio, e!tended from the bank1s o/n f&nds9

3.

;hat is the $eo$raphic territor+ ser-ed b+ the 0ank1s lendin$ pro$ram9

5. ;hat are the principal b&siness sectors to /hich the bank is c&rrentl+ lendin$ (e.$. farmin$, a$ric&lt&ral processin$, forestr+, /ood processin$, te!tiles, metal/orkin$ ind&str+, retail trade, transport, etc). Please specif+ sector concentration of lendin$ from bank1s o/n f&nds, as /ell as of the bank1s lendin$ thro&$h internationall+ f&nded pro$rams, s&ch as 0 .

2. Appro!imatel+ /hat percenta$e of the -al&e of the c&rrent portfolio is in the follo/in$ three cate$ories:
Portfolio !inan"ed wit# wn !unds Pri*ate !irms +tate-owned Enter%rises Pri*ati,in) !irms Portfolio !inan"ed $at least %artiall&' b& (nternational Pro)rams

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Agent Bank Application Form

1<. 'escribe briefl+ the t+pe of market o&treach +o&r bank /o&ld &ndertake to e!pand 0 lendin$, if selected as an A$ent 0ank.

11. ;hat is +o&r estimate of the n&mber and -al&e of ne/ loans +o& belie-e the 0ank co&ld prod&ce as an A$ent 0ank o-er the ne!t t/o +ears9
+e%t. 1../ 0 Au). 1... Number of New Loans Value of New Loans +e%t. 1... 0 Au). 2111

)ationale for pro:ection:

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Appendix 1

Agent Bank Application Form

12. %f the 0ank is c&rrentl+ participatin$ in the 0 Pro$ram as an A$ent 0ank, /hat has been the e!perience of +o&r bank /ith 0 , in terms of n&mber of loans recommended and disb&rsed, -al&e of loans, and repa+ment performance of loans9 8o/ and /h+ do +o& anticipate that e!perience /ill chan$e o-er the ne!t t/o +ears9

13. 'escribe +o&r bank1s participation in other credit initiati-es s&pported b+ international de-elopment or reconstr&ction a$encies.

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Agent Bank Application Form

Part III: Financial $%&tem& and 'ontrol& 1". 'escribe the s+stem of acco&ntin$ and financial controls c&rrentl+ bein$ &sed in +o&r bank. %f the s+stem is comp&teri=ed, describe the t+pes of acco&ntin$ pro$rams /hich are bein$ &sed and the t+pe and fre7&enc+ of reports /hich are prod&ced. 'escribe the t+pes of >checks and balances? that are in place to protect a$ainst mis&se of f&nds.

1*. @nder /hich acco&ntin$ standards (international acco&ntin$ standards (%AA), @.A. BAAP, and/or 0osnian Acco&ntin$ Atandards) does +o&r bank prepare its financial statements9

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Agent Bank Application Form

1.. 'oes +o&r bank recei-e an independent, certified financial a&dit9 %f +o&r 0ank does not recei-e an independent financial a&dit, describe an+ steps /hich ma+ be &nder/a+ to instit&te s&ch proced&res.

13. 'oes +o&r bank ha-e correspondent relationships /ith banks o&tside of 0osnia9 Pro-ide the name of each correspondent and the e!tent of +o&r bank1s relationship /ith each.

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Appendix 1

Agent Bank Application Form

PA() I*: +E, PE($-..EL Please "om%lete t#e followin) table for all %ersonnel in t#e 5an6 w#o will #a*e a 6e& role in t#e im%lementation of t#e 5! Pro)ram. !or %ur%oses of t#is a%%li"ation7 6e& %ersonnel in"ludes +enior 8ana)ement7 9#ief !inan"ial ffi"er or :reasurer7 8ana)er of 9redit De%artment7 ;ead of %erations7 and Loan ffi"ers assi)ned to t#e 5! %ro)ram. Pla"e an < after t#e name of ea"# indi*idual w#o is a s#are#older in t#e ban6. Pla"e a << after t#e name of ea"# indi*idual w#o "urrentl& owes at least D8 117111 to t#e ban6. Position in 5an6 =ross Name $!irst and famil& Pla"e and Date Permanent Address 9urrent Address $if Edu"ation $list @ears in !at#erBs Name 8ont#l& name. !or married females7 of 5irt# same as %ermanent de)rees or 5an6in) A 9om%en- %ro*ide maiden name as address7 %lease edu"ation' Wit# @our sation well.' $%la"e7 da&7 indi"ate >same?' 5an6 mont#7 &ear' A A A A A A A A A

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Appendix 1

Agent Bank Application Form

PA() *: B-A(/ -F /I(E')-($ Please "om%lete t#e followin) table for all members of t#e ban6Bs board of dire"tors. Pla"e an < after t#e name of ea"# dire"tor w#o is a s#are#older in t#e ban6. Pla"e a << after t#e name of ea"# dire"tor w#o "urrentl& owes at least D8 117111 to t#e ban6. Position in utside =ross Name $!irst and famil& Pla"e and Date Permanent Address 9urrent Address $if Edu"ation $list @ears in !at#erBs Name 9om%an& or Publi" 8ont#l& name. !or married females7 of 5irt# same as %ermanent de)rees or 5an6in) A ffi"e7 in 5an67 or on 9om%en- %ro*ide maiden name as address7 %lease edu"ation' Wit# @our 5an6Bs 5oard of sation well.' $%la"e7 da&7 indi"ate >same?' 5an6 Dire"tors mont#7 &ear' A A A A A A A A A

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Appendix 1

Agent Bank Application Form

PA() *I: -0.E($ Please "om%lete t#e followin) table for ea"# %erson ownin) at least 11 %er"ent of t#e ban6. Pla"e a << after t#e name of ea"# owner w#o "urrentl& owes at least D8 117111 to t#e ban6. (f a compan% owns at least 11 %er"ent of t#e ban67 %lease list t#at "om%an&Bs name7 %er"enta)e owners#i%7 "urrent address7 and &ears of owners#i% onl&. Position in utside Per"ent Name $!irst and famil& Pla"e and Date Permanent Address 9urrent Address $if 5a"6)round in Number of !at#erBs Name 9om%an& or Publi" wnername. !or married females7 of 5irt# same as %ermanent 5an6in)7 (f An& @ears as ffi"e7 in 5an67 or on s#i% of %ro*ide maiden name as address7 %lease wner of 5an6Bs 5oard of ban6 well.' $%la"e7 da&7 indi"ate >same?' 5an6 Dire"tors mont#7 &ear'

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Appendix 1

Agent Bank Application Form

Part *II: Bank Financial Attachment& Please attach to this A$ent 0ank Application an ann&al balance sheet, income statement, and (if prepared) statement of cash flo/ for the +ears 122*, 122., and 1223. or the past +ear (i.e., 4&l+ 1223 C 4&ne 1225) attach copies of the monthly financial reportin$ +o&r bank pro-ides to the 0A.

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Appendix 1

Agent Bank Application Form

Part *III:

'ertification&

Please ret&rn the follo/in$ statements /ith the si$nat&re of the bank1s director and (if applicable) chairman of the board. We #ereb& "ertif& t#at all of t#e information %ro*ided #ere is7 to t#e best of our 6nowled)e7 true7 "orre"t and "om%lete. We #ereb& "ertif& t#at we7 our 6e& %ersonnel7 and t#e ban6Bs owners7 mana)in) board members7 and members of t#e board of dire"tors #a*e re*iewed all A)ent 5an6 res%onsibilities7 in"ludin) t#ose des"ribed in t#e A)en"& A)reement and t#e A)ent 5an6 %erations and Pro"edures 8anual. We a""e%t t#ese res%onsibilities and are %re%ared to o%erate in a""ordan"e wit# t#e s%e"ified %ro"edures. We #ereb& "ertif& t#at we7 our 6e& %ersonnel7 and t#e ban6Bs owners7 mana)in) board members7 and members of t#e board of dire"tors #a*e re*iewed t#e 9ode of Et#i"s in"luded in t#e A)ent 5an6 %erations and Pro"edures 8anual. We are %re%ared to o%erate in a""ordan"e wit# t#e 9ode of Et#i"s and enfor"e it for all 9o*ered Persons.

+i)ned t#is da& of ________________7 1.._7

_________________________________
9#airman of t#e 5oard

+tam%

__________________________________ Dire"tor

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