APPLICATION FORM

SECTION 1 – APPLICANT DETAILS
Name	Contact Person/Authorised representative
First name, last name or company name	First name, last name
Address
House number, street	Postcode	City
Phone	Email
SECTION 2 – COMPANY INFORMATION
Type of Business choose one option	General Business, private company, enterprise, firm, sole proprietor or other legal entity Service Provider providing maintenance, operation, installation, construction, refurbishment or similar services under a contractual arrangement with a client Vendor participating in the Facility’s vendor financing programme Energy Service Company (ESCO) providing energy services and/or other energy efficiency improvement measures in a final user’s facility or premises, including the supply and installations of energy efficient equipment, and accepts some degree of financial risk in doing so (i.e. payment for the services delivered is based (either wholly or in part) on the achievement of energy efficiency improvements and on the meeting of the other agreed performance criteria) Local Sustainable Energy Equipment Manufacturer
Company Ownership Structure choose one option	Private Public Company Registration Number ________________________
European industrial activity classification (NACE code ) choose one option	A. Agriculture, Forestry and Fishing B. Mining and Quarrying C. Manufacturing D. Electricity, Gas, Steam and Air Conditioning Supply E. Water Supply, Sewerage, Waste Management and Remediation Activities F. Construction G. Wholesale and Retail Trade, Repair of Motor Vehicles and Motorcycles H. Transport and Storage I. Accommodation and Food Service Activities J. Information and Communication K. Financial and Insurance Activities L. Real Estate Activities M. Professional, Scientific and Technical Activities N. Administrative and Support Service Activities O. Public Administration and Defence, Compulsory Social Security P. Education Q. Human Health and Social Work Activities R. Arts, Entertainment and Recreation S. Other Service Activities
Company size indicate as appropriate	Employees 1 – 249 employees 250 and more employees Balance Sheet annual balance-sheet total exceeds 43 million EUR annual balance-sheet total does not exceed 43 million EUR Turnover annual turnover exceeds 50 million EUR annual turnover does not exceed 50 million EUR

SECTION 3 – PROJECT INFORMATION
Project description	Briefly describe the project including motivation for investment and investment measures planned
Estimated investment cost for project	Requested loan amount
Currency	EUR/USD/EGP	Currency	EUR/USD/EGP
How did you hear about GEFF? choose one option	Advertisement through financing institution Industry Event Internet Word of mouth Other
Project location if different from applicant’s address
Building number, street	Postcode	City
Locality of Sub-project choose one option	Urban (city > 50,000 or within commuting zone of such city) Rural (small town <50,000, villages or rural areas)
Project Eligibility choose one option	I am intending to purchase equipment; material, products or systems listed in the Online Technology Selector I would like to request assistance by an expert team to assess my project proposal and assess if is eligible under the Green Economy Financing Facility. I don’t have a project idea yet and would like the Consultant to propose prospective measures I already have a project idea and have attached the technical project documents (please select one or more) Feasibility Study Summary of project idea Own energy audit Supplier offer Other - please specify:
declaration
We/I, the undersigned Applicant, intend(s) to enter into a loan agreement for the implementation of the above mentioned project with ……PFI …….. in the GEFF Project implemented by the EBRD, with financial support from the … co- financer………………………………… 2. We/I request from Egypt GEFF Team (the “Facility Consultant”) informal consultations (including the use of the Online Technology Selector) and / or an assessment of the eligibility of the project if needed, assistance in the formulation of loan application with PFI if and when the project is completed, the verification of the project. The verification will be conducted by a Verification Consultant appointed by the EBRD (and together with the Facility Consultant). 3. We/I hereby agree and understand explicitly that all services provided by the Facility Consultant are free of charge to us/me and no payment is supposed to be offered by us/me and/or our/my vendors or suppliers or requested by the Facility Consultant. 4. We/I hereby declare that no other grant support has been/is expected to be received for the above mentioned Sub-project, if this loan/lease application is approved. 5. We/I understand that this application is subject to the approval of ………PFI ……….., EBRD and the Project Consultant. 6. In case of an assessment of the eligibility, we/I hereby agree to provide access for the Facility Consultant to our/my facilities and financial, technical and other information requested by the Facility Consultants for the performance of such assessment. 7. We/I hereby agree that the EBRD, the Facility Consultant and the …co-financer… may publish information about the project, including naming the undersigned company, as a beneficiary under the GEFF in the context of promoting green economy financing and publicising the results/success of the of this facility]. 8. We/I understand that we/I shall use the GEFF facility for the implementation of an eligible project only. 9. I confirm that We/I will obtain all necessary consents and statutory approvals (building control, town & country planning etc.) and have authority to install the technologies on the site (including permission from the owner of the dwelling if applicable). 10. If requested by the EBRD or the Facility Consultant, we/I agree to give access to any information and/or records related to my project and grant access to the premises where the project has been implemented. 11. We/I confirm that information provided in this Application Form is correct, precise and complete, filled in to my best knowledge. Full name of person signing Position of person signing Signature Place, Date