APPLICATION FORM

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

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 Vendor participating in the Facility’s vendor financing programme Producer / “green” technology manufacturer planning to sustain or expand the “green” part of its business Special eligibility requirements may apply to your type of business. Please visit the Facility website for more details or contact our partner bank or the local Facility office.
Company Ownership Structure choose one option	Private	Company Registration Number
Company size (SME Qualification) indicate as appropriate	Small or medium sized enterprise (SME) including micro enterprises yes no
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 (Please Describe below)

PROJECT INFORMATION
Project description	Briefly describe the project including the investment measures planned
Estimated investment cost for project	Requested loan amount
Currency	USD	Currency	USD
How did you hear about GEFF-Lebanon choose one option	Advertisement through financing institution Consultant promotion 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 GEFF Lebanon Online Technology Selector. Please attach the Eligibility Certificate for the Technology you intend to purchase to this application. The Certificate can be generated on the GEFF website: www.geff.org/TechnologySelector . I would like to request assistance by an expert team to assess my project proposal and assess if is eligible under the GEFF. 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
1. We/I, the undersigned Applicant, intend(s) to enter into a loan agreement for the implementation of the above mentioned project Bank Audi participating in the Green Economy Financing Facility (GEFF) implemented by the European Bank for Reconstruction and Development (EBRD), with financial support from the Taiwan International Cooperation and Development Fund (Taiwan ICDF). 2. We/I request from GEFF Lebanon (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 applications to Bank Audi and If and when the project is completed, the verification of the project. 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. 5. 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. 6. We hereby agree that the EBRD, the Facility Consultant and the donor, Taiwan ICDF, 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 GEFF. 7. We/I understand that we/I shall use the GEFF loan for the implementation of an eligible project only. 8. 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). 9. If requested by the EBRD or the Facility Consultant, 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. 10. 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