22 CFR Appendix A to Part 221 - Appendix A to Part 221—Application for Compensation
Agency for International Development, International Development Cooperation Agency, Washington, DC 20523.
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.