22 CFR Appendix Exhibit A to Part 204, Application for Compensation
You are hereby advised that payment of $_____ (consisting of $_____ of principal, $_____ of interest and $_____ in Further Guaranteed Payments as defined in Section 204.01(i) of the Standard Terms and Conditions of the above-mentioned Guaranty 1) was due on ____, 19__, on $____ principal amount of Notes held by the undersigned of the ______ (the “Borrower”), issued pursuant to the Loan Agreement, dated as of ___, ___, between the Borrower and ______. 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 Guaranty, the undersigned hereby applies, under Section 204.21 of said Guaranty, for payment of a total of $______, representing $______, the outstanding principal amount of the presently outstanding Notes of the Borrower held by the undersigned issued pursuant to said Loan Agreement, and $______ in Further Guaranteed Payments, 2 plus accrued and unpaid interest thereon to and including the date payment in full is made by you pursuant to said Guaranty. Such payment is to be made at your office in Washington, DC.
1 Strike inapplicable portion.
2 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.