DESEMBOLSOSdbank

THEWORLDBANKIBRD*IDAWORLDBANKGROUPYESEYABOUSAKHOOFFICIALCountryDirectorOFCACentralAmericaCountryManagementUnitLatinAmericaandtheCaribbeanRegionDOCUMENTSFebruary12,2018Mrs.
FloribelM6ndezFonsecaManager(Gerente)InstitutoNacionaldeEstadisticayCensosApartadoPostal10163-1000SanJos6,CostaRicaRe:TFSCBGrantNo.
TF0A6379CostaRicaIntegratedSystemofHouseholdSurveysProjectAdditionalInstructions:DisbursementLetterDearMrs.
Mendez:IrefertotheLetterAgreement("Agreement")betweentheInternationalBankforReconstructionandDevelopment("WorldBank"),actingasadministratorofgrantfundsprovidedbythedonors("Donors")undertheMultiDonorTrustFundforStatisticalCapacityBuilding-Hn,andInstitutoNacionaldeEstadisticayCensos(INEC)(the"Recipient")fortheabove-referencedproject,datedFebruary12,2018.
TheAgreementprovidesthattheWorldBankmayissueadditionalinstructionsregardingthewithdrawaloftheproceedsofGrantNo.
TF0A6379("Grant").
Thisletter("DisbursementLetter"),asrevisedfromtimetotime,constitutestheadditionalinstructions.
TheattachedWorldBankDisbursementGuidelinesforProjects,datedFebruary1,2017,("DisbursementGuidelines")(Attachment1),areanintegralpartoftheDisbursementLetter.
ThemannerinwhichtheprovisionsintheDisbursementGuidelinesapplytotheGrantisspecifiedbelow.
Sections.
andsubsectionsinparenthesesbelowrefertotherelevantsectionsandsubsectionsintheDisbursementGuidelinesand,unlessotherwisedefinedinthisletter,thecapitalizedtermsusedhavethemeaningsascribedtothemintheDisbursementGuidelines.
I.
DisbursementArrangements(i)DisbursementMethods(section2).
ThefollowingDisbursementMethodsmaybeusedundertheGrant:*Reimbursement*Advance*DirectPaymentPublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorizedPublicDisclosureAuthorized2(ii)DisbursementDeadlineDate(subsection3.
7).
TheDisbursementDeadlineDateis4monthsaftertheClosingDatespecifiedintheGrantAgreement.
AnychangestothisdatewillbenotifiedbytheWorldBank.
(iii)DisbursementConditions(subsection3.
8).
PleaserefertotheDisbursementCondition(s)intheGrantAgreement.
II.
WithdrawalofGrantProceeds(i)AuthorizedSignatures(subsection3.
1).
AletterintheFormattached(Attachment2)shouldbefurnishedtotheWorldBankattheaddressindicatedbelowprovidingthename(s)andspecimensignature(s)oftheofficial(s)authorizedtosignApplications:TheWorldBank1818HStreet,N.
W.
Washington,DC20433UnitedStatesofAmericaAttention:YayeSeynabouSakho,CountryDirector(ii)Applications(subsections3.
2-3.
3).
Pleaseprovidecompletedandsigned(a)applicationsforwithdrawal,togetherwithsupportingdocumentstotheaddressindicatedbelow:BancoMundialSectorComercialNorte,Quadra02,LoteAEdificioCorporateFinanceCenter70Andar70712-900Brasilia,D.
F.
BrazilAttention:LoanDepartment(iii)ElectronicDelivery(subsection3.
4)TheWorldBankmaypermittheRecipienttoelectronicallydelivertotheWorldBankApplications(withsupportingdocuments)throughtheWorldBank'sClientConnection,web-basedportal.
TheoptiontodeliverApplicationstotheWorldBankbyelectronicmeansmaybeeffectedif:(a)theRecipienthasdesignatedinwriting,pursuanttothetermsofsubparagraph(i)ofthisSection,itsofficialswhoareauthorizedtosignanddeliverApplicationsandtoreceivesecureidentificationcredentials("SIDC")fromtheWorldBankforthepurposeofdeliveringsuchApplicationsbyelectronicmeans;and(b)allsuchofficialsdesignatedbytheRecipienthaveregisteredasusersofClientConnection.
IftheWorldBankagrees,theWorldBankwillprovidetheRecipientwithSIDCforthedesignatedofficials.
Followingwhich,thedesignatedofficialsmaydeliverApplicationselectronicallybycompletingForm2380,whichisaccessiblethroughClientConnection(https://clientconnection.
worldbank.
org).
TheRecipientmaycontinuetoexercisetheoptionofpreparinganddeliveringApplicationsinpaperform.
TheWorldBankreservestherightandmay,initssolediscretion,temporarilyorpermanentlydisallowtheelectronicdeliveryofApplicationsbytheRecipient.
(iv)TermsandConditionsofUseofSIDCtoProcessApplications.
BydesignatingofficialstouseSDICandbychoosingtodelivertheApplicationselectronically,theRecipientconfirmsthroughtheauthorizedsignatoryletteritsagreementto:(a)abidebytheTermsandConditionsofUseofSecureIdentificationCredentialsinconnectionwithUseofElectronicMeanstoProcessApplicationsandSupportingDocumentation("TermsandConditionsofUseofSIDC")providedinAttachment3;and(b)tocausesuchofficialtoabidebythosetermsandconditions.
3(v)MinimumValueofApplications(subsection3.
5).
TheMinimumValueofApplicationsisUS15,000.
(vi)Advances(sections5and6).
*TypeofDesignatedAccount(subsection5.
3):Segregated*CurrencyofDesignatedAccount(subsection5.
4):USDollars*FinancialInstitutionatwhichtheDesignatedAccountWillBeOpened(subsection5.
5):BancoNacionaldeCostaRica(BNCR)*Ceiling(subsection6.
1):US60,000III.
ReportingonUseofGrantProceeds(i)SupportingDocumentation(section4).
Supportingdocumentationshouldbeprovidedwitheachapplicationforwithdrawalassetoutbelow:*ForrequestsforReimbursement:oStatementofExpenditureintheformattached(Attachment4).
*ForreportingeligibleexpenditurespaidfromtheDesignatedAccount:0StatementofExpenditureintheformattached(Attachment4);andoDesignatedAccountActivityStatement(Attachment5)withacopyoftheDesignatedAccountBankStatement.
*ForrequestsforDirectPayment:recordsevidencingeligibleexpenditures,e.
g.
,copiesofreceipts,supplierinvoices(ii)FrequencyofReportingEligibleExpendituresPaidfromtheDesignatedAccount(subsection6.
3):Quarterly.
IV.
OtherImportantInformationForadditionalinformationondisbursementarrangements,pleaserefertotheDisbursementHandbookavailableontheWorldBank'spublicwebsiteathttps://www.
worldbank.
organditssecurewebsite"ClientConnection"athttps://clientconnection.
worldbank.
or.
Printcopiesareavailableuponrequest.
FromtheClientConnectionwebsite,youwillbeabletodownloadApplications,monitorthenearreal-timestatusoftheGrant,andretrieverelatedpolicy,financial,andprocurementinformation.
Ifyouhavenotalreadydoneso,theWorldBankrecommendsthatyouregisterasauseroftheClientConnectionwebsite(https://clientconnection.
worldbank.
org).
FromthiswebsiteyouwillbeabletodownloadApplications,monitorthenearreal-timestatusoftheGrant,andretrieverelatedpolicy,financial,andprocurementinformation.
AllRecipientofficialsauthorizedtosignanddeliverApplicationsbyelectronicmeansarerequiredtoregisterwithClientConnectionbeforeelectronicdeliverycanbeeffected.
4Formoreinformationaboutthewebsiteandregistrationarrangements,pleasecontacttheWorldBankbyemailat.
Ifyouhaveanyqueriesinrelationtotheabove,pleasecontactMariaVirginiaHormazabal,FinanceOfficeratmhormazabal@worldbank.
org,withcopytoFernandaBalduino,FinanceAnalystatfbalduino@worldbank.
orgusingtheabovereference.
Yourssincerely,YayeSeynabouSakhoCountryDirectorCentralAmericaCountryManagementUnitLatinAmericaandtheCaribbeanRegionAttachments1.
WorldBankDisbursementGuidelinesforProjects,datedFebruary1,20172.
FormforAuthorizedSignatures3.
TermsandConditionsofUseofSecureIdentificationCredentialsinconnectionwithUseofElectronicMeanstoProcessApplicationsandSupportingDocumentation,datedMarch1,20134.
StatementofExpenditure5.
DesignatedAccountActivityStatement5Attachment1DIRECTRICESDELBANCOMUNDIALSOBRELOSDESEMBOLSOSDEFINANCIAMIENTOPARAPROYECTOSDEINVERSINFEBRERODE2017(WORLDBANKGROUP6NDICEPGINA1Objetivo12.
MétodosdeDesembolso13.
RetirodeFondosdelaCuentadelFinanciamiento44.
RequisitossobreDocumentacióndeRespaldo65.
CuentasDesignadas76.
CondicionesAplicablesalosAnticipos97.
GastosNoElegibles10S.
Reintegros117LObjetivo1.
1ElobietivodelasDirecticessobrelosDesembolsosdeFinancianientoparaProyectosdeInversión(lasdirectrices)consisteenestpularlosprocedimientosY.
reqiusitosqueaplicaelBancoMundialparaeldesembolsodelosfondosenlosproyectos-Enellasseestablecen.
especificamente.
a)losdiferentesmetodosutilizadosporelBancoMundialparadesembolsarfondosdelaCuentadelFianciamiento.
bYlosrequisitosaplicablesalarealizaciónderetirosdelaCuentadelFinanciamiento.
c)ladocumentaciónderespaldoquepudieraexigirsealprestatanoparacomprobarquelosfondosdelpréstamosehanutiLzadopararealizargastoselegibles.
d)loscritenosparaelestablecimientodeCuentasDesignadas3.
e;lostermnosylascondicionesaplicablesalosanticipos.
f)lostiposdemedidasrelacionadasconlosdesembolsosquepuedeadoptarelBancoMundialsiconcluyequelosfondosdepositadosenlaCuentadelFinanciamientonosenecesitanosehanutilizadoparafnahdadesnoelegibles,yg)laconsecuenciadelosreinterosdefondosenloquerespectaalosdesembolsos.
2.
MetodosdeDesembolso21ElBancoMundialestablecelosarreglosdedesembolsodefondosdestinadosaunproyectoenconsultaconelprestatano.
teniendoencuenta.
entreotrascosas.
unaevaluacióndelossistemasdegestiónfinancieraydeadquisicionesdelprestatario.
lasnecesidadesdeflujodefondosdelproyecto.
ysuexperienciaconelprestatarioenmateriaEelprese=edocumento.
eltern"BancoMundia1~conprendealBancoI:ernacionaldeReconmccionvFomento9l.
yalaAsoctactorInren.
actonaldeFo=enoyA.
.
vaseaqueacruenpormenípropiaoencarac:erdea-4m=sw,dordefondosftducianossolventadosporotrodonantesLostrninos-Jnanciamieno~o-p:-estamodelBanco~conprendenprestamos.
credtiosodonacionesoorgadospo:elBanzoMIundalconcargoasuspropiosrecursos.
atravesde-ndExcepcionalmente.
presentardocumentaciónsustitutivaquecompruebeotrosgastoselegiblesTrasrecibirlanotificaciónpertinentedelBancoMundialelprestatariodeberáadoptarprontamentelamedidasolicitada.
2GastosNoElegiblespagadosconreusosdelaCuentaDesignada.
SielBancoMundialconcluyequelaspruebasqueselepresentaronnojustificanalginpagorealizadoconrecursosdelaCuentaDesignadaoqueelpagoserealizóparacubnrunyastonoelegible,podrádiscrecionalmenteexigiralprestatanolaadepcióndeunadelasmedidasqueacontinuaciónsemencionan.
"E2las-CondcionesGenales`seestipuLan-os-erainosycondiciosesapLcablesengeneralalospres:amosdelBIPFyaloscreditosylasdonaconesdelaAI-,SEaaas--ConaconesEstadar"seesnpulanlosernunosycondconesaplicablesengeneralalosfondosfidiariosYLosanrc,posefectuadosporelBancoenelarcodelSer,-ciodeFmaauim2entoparaPreparaciondeP:o%cts.
15a>PresentarlaspruebasadicionalesrequendasporelBancoMundial.
b:.
Depositarunasumaequr:alenteenlaCuentaDesignada.
c)'ReintegraralBancoMundialunmontoequrvalente.
d)Excepcionalmente.
presentardocumentacionsusttutivaquecompruebeotroszastoseleeibles.
TrasrecibirlanotíficaciónpertinentedelBancoMundial.
elprestatariodebernadoptarprontamentelamedidasolicitada8.
Reinterros81Decisióndelprestarmiodeefecra;elreintegro.
ElprestatariotrasnotificaralBancoMundiaLpuedereembolsaraeste.
entodooenparte.
elmontodelpréstamodepositadoenlaCuentaDesignadaparaacreditaralaCuentadelFiranciamientoS2Consecuenciadelosreintegros.
ElBancoMundialdeberádetermmarsilosreintegrosqueselehayanefectuadoconformealodispuestoenlassecciones6y7venlasubsección8.
1delaspresentesdirectnceshandeacredirarsealaCuentadelFmancianuento.
LosreintecrosdefondosalaCuentadelFinanciamientopuedengenerara;cargosporternmacióndeiwibcostosdecancelacióncorrespondientesamontoscuyabasedetasasdeinteresodivisashayasidoobjetodeconversiónocobertura.
c)ambaseroaciones.
S.
3Or,osderechosyobligacionesnoafectadospoilosreinregios.
LosreintegrosdesumascorrespondientesalpréstamonoafectanaotrosderechosyobligacioneslegalesdelaspartesenvituddelConveniodeFinanciamiento.
1116Attachment2FormofAuthorizedSignatoryLetter[Letterhead]MinistryofFinance[Streetaddress][City][Country][DATE]TheWorldBank1818HStreet,N.
W.
Washington,D.
C.
20433UnitedStatesofAmericaAttention:[CountryDirector]Dear[CountryDirector]:Re:TFSCBGrantNo.
TF0A6379(CostaRicaIntegratedSystemofHouseholdSurveysProject)IrefertotheGrantAgreement("Agreement")betweentheInternationalBankforReconstructionandDevelopment("WorldBank"),actingasadministratorofgrantfundsprovidedbythedonors("Donors")undertheMultiDonorTrustFundforStatisticalCapacityBuilding-III,andInstitutoNacionaldeEstadisticayCensos(INEC)(the"Recipient"),datedFebruary_,2018providingtheaboveGrant.
ForthepurposesofSection3.
04(b)oftheStandardConditions,asdefinedintheAgreement,any['one]ofthepersonswhoseauthenticatedspecimensignaturesappearbelowisauthorizedonbehalfoftheRecipienttosignapplicationsforwithdrawal[andapplicationsforaspecialcommitment]underthisGrant.
ForthepurposeofdeliveringApplicationstotheWorldBank,2[each]ofthepersonswhoseauthenticatedspecimensignaturesappearsbelowisauthorizedonbehalfoftheRecipient,acting3[individually]4[jointly],todeliverApplications,andevidenceinsupportthereofonthetermsandconditionsspecifiedbytheWorldBank.
'[ThisconfirmsthattheRecipientisauthorizingsuchpersonstoacceptSecureIdentificationCredentials(SIDC)andtodelivertheApplicationsandsupportingdocumentstotheWorldBankbyelectronicmeans.
InfullrecognitionthattheWorldBankshallrelyuponsuchrepresentationsandIInstructiontotheRecipientwhensendingthislettertotheWorldBank:StipulateifmorethanonepersonneedstosignApplications,andhowmanyorwhichpositions,andifanythresholdsapply.
PleasedeletethisfootnoteinfinalletterthatissenttotheWorldBank2InstructiontotheRecipient:StipulateifmorethanonepersonneedstojointlysignApplications,ifso,pleaseindicatetheactualnumber.
PleasedeletethisfootnoteinfinalletterthatissenttotheWorldBank.
InstructiontotheRecipient:Usethisbracketifanyoneoftheauthorizedpersonsmaysign;ifthisisnotapplicable,pleasedelete.
PleasedeletethisfootnoteinfinalletterthatissenttotheWorldBank.
'InstructiontotheRecipient:UsethisbracketonlyifseveralindividualsmustjointlysigneachApplication;ifthisisnotapplicable,pleasedelete.
PleasedeletethisfootnoteinfinalletterthatissenttotheWorldBankInstructiontotheRecipient:AddthisparagraphiftheRecipientwishestoauthorizethelistedpersonstoacceptSecureIdentficationCredentialsandtodeliverApplicationsbyelectronicmeans;ifthisisnotapplicable,pleasedeletetheparagraph.
PleasedeletethisfootnoteinfinalletterthatissenttotheWorldBank17warranties,includingwithoutlimitation,therepresentationsandwarrantiescontainedintheTermsandConditionsofUseofSecureIdentificationCredentialsinconnectionwithUseofElectronicMeanstoProcessApplicationsandSupportingDocumentation("TermsandConditionsofUseofSIDC"),theRecipientrepresentsandwarrantstotheWorldBankthatitwillcausesuchpersonstoabidebythosetermsandconditions.
]ThisAuthorizationreplacesandsupersedesanyAuthorizationcurrentlyintheWorldBankrecordswithrespecttothisAgreement.
[Name],[position]SpecimenSignature:[Name],[position]SpecimenSignature:[Name],[position]SpecimenSignature:Yourstruly,/signed/[Position]18Attachment3TermsandConditionsofUseofSecureIdentificationCredentialsinconnectionwithUseofElectronicMeanstoProcessApplicationsandSupportingDocumentationMarch1,2013TheWorldBank(Bank)'willprovidesecureidentificationcredentials(SIDC)topermittheBorrower'todeliverapplicationsforwithdrawalandapplicationsforspecialcommitmentsundertheAgreement(s)andsupportingdocumentation(suchapplicationsandsupportingdocumentationtogetherreferredtointheseTermsandConditionsofUseasApplications)totheBankelectronically,onthetermsandconditionsofusespecifiedherein.
SIDCcanbeeither:(a)hardware-based(PhysicalToken),or(b)software-based(SoftToken).
TheBankreservestherighttodeterminewhichtypeofSIDCismostappropriate.
A.
IdentificationofUsers1.
TheBorrowerwillberequiredtoidentifyinacompletedAuthorizedSignatoryLetter(ASL)dulydeliveredtoandreceivedbytheBankeachpersonwhowillbeauthorizedtodeliverApplications.
TheBankwillprovideSIDCtoeachpersonidentifiedintheASL(Signatory),asprovidedbelow.
TheBorrowershallalsoimmediatelynotifytheBankifaSignatoryisnolongerauthorizedbytheBorrowertoactasaSignatory.
2.
EachSignatorymustregisterasauserontheBank'sClientConnection(CC)website(https://clientconnection.
worldbank.
or)priortoreceiptofhis/herSIDC.
RegistrationonCCwillrequirethattheSignatoryestablishaCCpassword(CCPassword).
TheSignatoryshallnotrevealhis/herCCPasswordtoanyoneorstoreorrecordtheCCPasswordinwrittenorotherform.
UponregistrationasaCCuser,theSignatorywillbeassignedauniqueidentifyingaccountname.
B.
InitializationofSIDC1.
PriortoinitializationofSIDCbyaSignatory,theSignatorywillacknowledgehavingread,understoodandagreedtobeboundbytheseTermsandConditionsofUse.
2.
WhereaPhysicalTokenistobeused,promptlyuponreceiptofthePhysicalToken,theSignatorywillaccessCCusinghis/heraccountnameandCCPasswordandregisterhis/herPhysicalTokenandsetapersonalidentificationnumber(PIN)tobeusedinconnectionwiththeuseofhis/herPhysicalToken,afterwhichthePhysicalTokenwillbeinitializedforusebytheSignatoryexclusivelyforpurposesofdeliveringApplications.
WhereaSoftTokenistobeused,theSignatorywillaccessCCusinghis/heraccountnameandCCPasswordandsetapersonalidentificationnumber(PIN)tobeusedinconnectionwiththeuseofhis/herSoftToken,afterwhich"Bank"includesIBRDandIDA.
2"Borrower"includestheborrowerofanIBRDloan,IDAcredit,orProjectPreparationFacilityadvanceandtherecipientofagrant.
19theSoftTokenwillbeinitializedforusebytheSignatoryexclusivelyforpurposesofdeliveringApplications.
UponinitializationoftheSIDC,theSignatorywillbea"SIDCUser".
TheBankwillmaintaininitsdatabaseauseraccount(Account)foreachSIDCUserforpurposesofmanagingtheSIDCoftheSIDCUser.
NeithertheBorrowernortheSIDCUserwillhaveanyaccesstotheAccount.
3.
PriortofirstuseoftheSIDCbytheSIDCUser,theBorrowershallensurethattheSIDCUserhasreceivedtrainingmaterialsprovidedbytheBankinuseoftheSIDC.
C.
UseofSIDC1.
UseoftheSIDCisstrictlylimitedtouseinthedeliveryofApplicationsbytheSIDCUserinthemannerprescribedbytheBankintheAgreement(s)andtheseTermsandConditions.
AnyotheruseoftheSIDCisprohibited.
2.
TheBankassumesnoresponsibilityorliabilitywhatsoeverforanymisuseoftheSIDCbytheSIDCUser,otherrepresentativesoftheBorrower,orthirdparties.
3.
TheBorrowerundertakestoensure,andrepresentsandwarrantstotheBank(suchrepresentationandwarrantybeingexpresslyrelieduponbytheBankingrantingSIDC)thateachSIDCUserunderstandsandwillabideby,theseTermsandConditionsofUse,includingwithoutlimitationthefollowing:4.
Security4.
1.
TheSIDCUsershallnotrevealhis/herPINtoanyoneorstoreorrecordthePINinwrittenorotherform.
4.
2.
TheSIDCUsershallnotallowanyoneelsetoutilizehis/herSIDCtodeliveranApplicationtotheBank.
4.
3.
TheSIDCUsershallalwayslogoutfromCCwhennotusingthesystem.
Failuretologoutproperlycancreatearouteintothesystemthatisunprotected.
4.
4.
IftheSIDCUserbelievesathirdpartyhaslearnedhis/herPINorhaslosthis/herPhysicalTokenhe/sheshallimmediatelynotifyclientconnectiona@)worldbank.
org.
4.
5.
TheBorrowershallimmediatelynotifytheBankatclientconnectionaworldbank.
orgofanylost,stolenorcompromisedSIDC,andtakeotherreasonablestepstoensuresuchSIDCaredisabledimmediately.
5.
ReservationofRighttoDisableSIDC5.
1.
TheBorrowershallreservetherighttorevoketheauthorizationofaSIDCUsertouseaSIDCforanyreason.
5.
2.
TheBankreservestheright,initssolediscretion,totemporarilyorpermanentlydisableaSIDC,de-activateaSIDCUser'sAccountorboth.
206.
CareofPhysicalTokens6.
1.
PhysicalTokenswillremainthepropertyoftheBank.
6.
2.
TheBankwillphysicallydeliveraPhysicalTokentoeachSignatorydesignatedtoreceiveoneinamannertobedeterminedbyandsatisfactorytotheBank.
6.
3.
PhysicalTokenscontaindelicateandsophisticatedinstrumentationandthereforeshouldbehandledwithduecare,andshouldnotbeimmersedinliquids,exposedtoextremetemperatures,crushedorbent.
Also,PhysicalTokensshouldbekeptmorethanfive(5)cmfromdevicesthatgenerateelectromagneticradiation(EMR),suchasmobilephones,phone-enabledPDAs,smartphonesandothersimilardevices.
Physical-TokensshouldbecarriedandstoredseparatefromanyEMRdevice.
Atcloserange(lessthan5cm),thesedevicescanoutputhighlevelsofEMRthatcaninterferewiththeproperoperationofelectronicequipment,includingthePhysicalToken.
6.
4.
WithoutderogatingfromtheseTermsandConditionsofUse,othertechnicalinstructionsontheproperuseandcareofPhysicalTokensareavailableathttp://www.
rsa.
com.
7.
Replacement7.
1.
Lost,damaged,compromised(intermsof4.
5,above)ordestroyedPhysicalTokenswillbereplacedattheexpenseoftheBorrower.
7.
2.
TheBankreservestheright,initssolediscretion,nottoreplaceanyPhysicalTokeninthecaseofmisuse,ornottoreactivateaSIDCUser'sAccount.
21Attachment4BANCOINTERNACIONALDERECONSTRUCCIONYFOMENTOCerticadodeGatosFinanaador:No.
delPrétamo/CréditoDonación:PagostechosenelpenododeaNo.
deSolicitud:No.
deCategoria:Losgastosabajofueronincurridosduranteelperiododeretractidad)(porfaor,marclue)siNoNo.
dePágina:Losgastosabajotieronincurridosantesdelafechadecierredelpréstamo/crédto/donación(porfaormarue)siNoCUENTADESIGNADASOLAMENTE123456789101112131415No.
delMonedayCantidadContiraRegistroMontdelNúmeroMontMontoMontoTasaFechaDebitadaNo.
NombredelBrevedescnpciónSujetoadeldeldelaacumuladoFechadelPagadoalFinanc.
AdmisibledeDébitoCuentaliemProveedordelgasorevisiónpreviacontratoContratoFacturadelcontralPagoProveedorporBIRF(COl10X11)CambioCuentaDesignada(SioNO)enC.
C.
(original+oRecibo(incluidoenDesignada(Col12,13)enmiendas)SOEsanterioresl0.
000.
00TOTALOX00LadocumentaciónsoporteaeseCertficadodeGastosestádisponibleen(insenrlocaleación)Unformulariodistintodebeserusadoparacadacategora22-Attachment5CONCILIACIONDELACUENTADESIGNADAPréstamo/Crédito/DonaciónN°:NombredelBanco:NúmerodelaCuenta:1.
TotaldeDepósitos-2.
MenosTotalqueyafuedocumentado-3.
SaldoPendiente(pordocumentar)-4.
SaldodelaCuentaDesignadaen1/(deacuerdoalEstadoBancarioAdjunto)-5.
MontoaserdocumentadoenlapresenteSolicitudN___-6.
MásmontopendientedereposiciónporelBIRF1-7.
MásretirosefectuadosaúnnosolicitadosalBIRF28.
Menosmontosdebitadosdespuésdelafechadelestadobancarioadjunto-9.
MenosinteresesgeneradosporlaCuentaDesignada-10.
Total(4+5+6+7+8-9)-11.
Discrepanciasentre(3y10)-Observaciones:1ValorpendientedereposiciónporelBIRFSolicitudN°Monto2RetirosefectuadosaúnnosolicitadosalBIRFFechaDescripciónMonto