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Pt. 221, App. A
Appendix A to Part 221—Application for Compensation
Agency for International Development, International Development Cooperation Agency, Washington, DC 20523.
Ref: Guarantee dated as of ______, 19__:
You are hereby advised that payment of $______ (consisting of $______ of principal, $______ of interest and $______ in Further Guaranteed Payments, as defined in § 221.01(f) of the Standard Terms and Conditions of the above-mentioned Guarantee) [(consisting of $____ maturity amount and $____ in Further Guaranteed Payments, as defined in § 221.01(f) of the Standard Terms and Conditions of the above-mentioned Guarantee)] 1 was due on ______, 19 __, on $______ principal [maturity] 1 amount of Notes held by the undersigned of the Government of Israel, on behalf of the State of Israel (the “Borrower”). 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 § 221.21 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 $______, the interest amount on such Note(s) that was due and payable by the Borrower on ____ and that remains unpaid, [$______, the maturity amount of such Note that was due and payable on ________ and that remains unpaid] 2 and $______ in Further Guaranteed Payments, 3 plus accrued and unpaid interest thereon from the date of default with respect to such payments to and including the date payment in full is made by you pursuant to said Guarantee, at the rate of ___% per annum, being the rate for such interest accrual specified in such Note. Such payment is to be made at [state payment instructions of Noteholder.]
1 Alternate language for zero-coupon Eligible Notes.
2 Alternate language for zero-coupon Eligible Notes.
3 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.
[Name of Applicant]