overseas investment takaful (oit) - exim€¦ · overseas investment takaful definitive application...

DEFINITIVE APPLICATION FORM

OVERSEAS INVESTMENT TAKAFUL

(OIT)

For Bank’s Use Only :

NAME OF APPLICANT

ITEM DATE

Received

Acknowledgement

BDC

FACILITY

FIIC

CCB

BOD

Overseas Investment Takaful Definitive Application

EXPORTER REF. NO. : REGISTRATION NO. :

DEFINITIVE APPLICATION

OII(D)/PQM/10/12 Page 1 of 10

1.0 DEFINITIVE APPLICATION

1.1 DETAILS OF INVESTOR

Company Name

Address

Name of Parent Company (please attach latest Annual Report)

City Telephone Number

State Facsimile Number

Country Telex Number

Authorised Representative (for contact by EXIM Bank)

Name Title

Company Name (if different from above) Address

Telephone Number City

Facsimile Number State

Telex Number Country

Investor Eligibility (legal status)

Nationality Individual

Incorporated in… Corporation

Principal Place of Business in…

Majority of Capital Owned by National(s)

i.

Majority of Capital Owned by Government(s)

i.

ii. ii.

iii. iii.

If a Partnership, is it treated as a juridical person under laws of Malaysia?

Other (specify) ______________________________ Yes No





1.2 DETAILS OF INVESTMENT OR PROJECT ENTERPRISE

Project Enterprise in which the Investment or Project is to be made.

Project Enterprise Name

Address

City

State

Country

Legal Form of Project Enterprise

Investment or Project Type

*Please Tick () Where Applicable

Existing

Place of Organization

New

Location of Project Facilities (if different from above)

Privatization

Briefly describe the activities of the project (e.g. establishment of facility to process edible oils, etc.)

If the investment project involves acquiring and existing enterprise, describe anticipated changes and restructuring of the enterprise following acquisition

Indicate Proportion of Investor’s Contributions

Acquisition % Financial Restructuring % Expansion %





Project Financing

(Please indicate below the capital structure of the project enterprise. If the project is an expansion of an existing investment, please indicate on a separate sheet the capital structure of the project enterprise before and after the expansion)

Currency in which values are denominated

Percentage of Ownership (%)

Amount of Contribution

Equity Debt Total

A. Investor

____________________________________ ___________ _________________ _________________ _________________

B. Other Foreign Investor(s)

Private (name):

____________________________________

____________________________________

____________________________________

Government (name):

____________________________________

____________________________________

____________________________________

___________

___________

___________

___________

___________

___________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

C. Host Country Investor(s)

Private (name):

____________________________________

____________________________________

____________________________________

Government (name):

____________________________________

____________________________________

____________________________________

___________

___________

___________

___________

___________

___________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

D. International Financial Institution (name):

____________________________________

____________________________________

____________________________________

___________

___________

___________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

_________________

Total Project Financing 100% _________________ _________________ _________________

If ownership percentages are different from equity contributions above, please explain





Investor’s contribution for which insurances are sought.

A. Form of Contribution*

Equity Debt Other : ______________________

Foreign Exchange

Local Currency

Retained Earnings

Machinery and Equipment

Inventory

Technology

Other (specify)

__________________

Total

* Attach all documents relating to the contribution to be insured (e.g. loan and loan insurance agreement(s), technical assistance and management agreement(s), etc.).

B. Equity Securities

Indicate the type and the number of equity securities (e.g. common stock) the investor is to receive from the project enterprise

Type No. of Shares As a Percentage of Total Outstanding

Shares*

* If there are no equity shares, indicate percentage interest in project enterprise (e.g. 50% interest in a joint venture company).

Are there any restrictions on transfer on transfer of ownership of equity securities?

Yes No

C. If the investor’s contribution will include equipment and machinery.

Is the equipment and machinery…

Owned by Investor Produced by Investor

Is the equipment and machinery…

New Used

Basis of valuation of equipment and machinery

D. If the investor’s will include local currency.

Is it freely convertible for remittance by the investor out of the host country?

Yes No

E. If the investor’s contribution will include any type of ‘non-equity direct investment’ (e.g. technical assistance, production-sharing contracts, etc.).

Indicate the nature of the contribution(s), the duration, the terms of remuneration, how the value was established, and attach the relevant contracts

F. Estimated date(s) investment is to be made :





1.3 PROJECT VIABILITY

A. Feasibility Study

(Please attach a copy of the feasibility study for this project, including cash flow projections, market analyses, etc.)

Projected Start-Up Date

B. Financial Viability

Anticipated After-Tax Returns

Upon what principal assumptions are these projections dependent?

Return on Investment %

Return on Equity %

Will the project’s profitability depend significantly upon certain existing or anticipated host government incentives or restrictions (e.g. tax holiday, subsidies, trade barriers, etc.)

If ‘Yes’, please explain

Yes

No

E. If the investor’s contribution will include any type of ‘non-equity direct investment’ (e.g. technical assistance, production-sharing contracts, etc.).

Briefly describe the manufacturing process used, including comments on whether the technology is new or currently in use

Briefly describe the services furnished by the investor (i.e. process knowledge, financing etc.)

Briefly describe the availability of critical raw material and other supplies, including their sources

Briefly describe shipping routes for supplies and for furnished goods





1.4 ECONOMIC IMPACT ON HOST COUNTRY

A. Host government revenues

Estimate the revenues to the host government that will result from this project (annual average over first five years of operation)

i. Taxes, royalties and duties to be paid

ii. Dividends payable to the government:

iii. Taxes, royalties and duties foregone as a result of the investment (e.g. due to import substitution)

Net impact (i. + ii. – iii.)

Impact of project on host country balance of payments (annual average over first five years)

i. Value of imports replaced :

ii. Value of exports generated :

Total (i. + ii.) = X

iii. Value of imported goods and services used in production (excluding those capitalized as part of the initial investment):

iv. Remittances of dividends, interest, fees, etc:

Total (iii. + iv.) = Y

Net foreign exchange impact (X – Y)

B. Employment

(Please indicate the number of persons expected to be employed during the project construction, including outside contractors: __________ and at fifth year of operations)

Management Professional/Technical Labor TOTAL

Local

Expatriate

TOTAL

Describe the contributions of the project to the development of host country management, technical and other skills through internal or external training programs

Describe probable effects of the project on the economic and social development of the region in which the project is located, such as infrastructure, labor unions, schools, healthcare, etc.

What impact will the project have on host country enterprises (e.g. local suppliers of materials and services, etc.)

What percentage of the host country’s total production and supply of same or comparable goods and services will the project provide?

Explain the expected impact of the project’s operations on:

Host country domestic prices of same or comparable goods and services

Quality and availability of the relevant goods or services to host country consumers





1.5 ENVIRONMENTAL IMPACT AND WORKER SAFETY

Has an environmental assessment been made?

(If yes, please attach a copy of the study)

Yes No

Briefly describe any potential negative impact on the environment and/or on employees, and the measures that will be taken to minimize the environmental/worker safety problems

Are there environmental protection regulations in the host country?

Yes No

Worker safety regulations?

Yes No

Does the project comply with these regulations?

Yes No

Please explain:

Will the project comply with the investor’s home country environmental protection regulations?

Yes No

Worker safety regulations?

Yes No

Please explain:





1.6 INVESTOR RELATIONS WITH HOST GOVERNMENT

A. Agreements with the host government

Briefly describe all contracts and agreements with the government of the host country and attach a copy of the relevant documents

Briefly describe relevant laws or decrees in the host country likely to affect this investment

Does the investor or project enterprise have the right to an offshore and/or a foreign currency bank account?


Yes

No

B. Host government approvals

What type of approval(s) is required from the government of the host country before the investment can be made?

Has it been requested?

Yes, Date : ____________________ No

Has it been received?

Yes, Date : ____________________ No

C. Disputes and Litigation

Have there been any disputes or litigation involving the investor or project enterprise and any host government or private entity?


Yes

No

Briefly describe the mechanism for resolution of dispute(s) available to the investor

D. Others

Investor’s foreign investment experience in host country and other developing countries (in the last five years)

Briefly describe security measures taken to protect the project facilities (e.g. security guards, walls around the project site, etc.)





1.7 INSURANCE COVERAGES

A. Insurance Requested from EXIM Bank

EXIM Bank can consider covering up to (a) 90 percent of the investment contribution, plus (b) an additional 200 percent for earnings attributable to the investment.

For coverage selection : Please complete the worksheet attached as Appendix 1 using the indicative rates in EXIM Bank’s OII

leaflet.

B. Insurance Requested from Other Insurers

(Please list other political risk insurers (both public and private) from which insurances have been requested for this project)

Company Name of Representative Telephone Number

May EXIM Bank contact the above for purposes of coinsurance and reinsurance?

Yes No

1.8 LIMITED WAIVER OF EXIMBANK”S DUTY OF CONFIDENTIALITY

EXIM Bank may require approval of the host government before it issues insurance. The investor understands and agrees that by signing this Definitive Application for Investment Insurance, it authorizes EXIM Bank to request approval from the host government for EXIM Bank to issue insurances on the investment project and to release to the host government summary information pertaining to the investment, the investment project, the project enterprise, the amount and types of coverage, and the insurance period requested.





2.0 DECLARATION

2.1 I/We submit a copy of the following documents :

i. Certified copy of Business Registration

ii. Copy of Memorandum of Article of Association and certified copies of Form 24 and 49 of the Companies Act 1965

iii. Last 3 years Annual Report, Accounts and Auditor’s Report

iv. Interim Balance Sheet and Profit & Loss Account

2.2 I/We understand that EXIM Bank will rely in part on the information provided both in this Definitive Application, including

attachments or amendments, and in any project documentation (e.g. feasibility study, joint venture contract, etc.) submitted

along with the application, in deciding whether to issue insurance. False or misleading statements and information may

result in the termination of any Contract of Insurance issued on the basis of this application.

2.3 We hereby participate in this Overseas Investment Takaful (OIT) based on the Wakalah and Mudarabah model, wherein the

contribution paid shall be on the basis of Tabarru’ (donation) for the purpose of helping each other participants who suffered

any events as specified in this Certificate and with this contribution, We are entitled to the Takaful cover as expressed in the

terms and conditions of this Takaful contract.

2.4 We hereby irrevocably appoint EXIM Bank as our agent/wakil to manage the fund and agreed that 60% of the contribution

paid shall be apportioned to Agency/Wakalah fee in consideration of EXIM Bank managing and administering the

contributions.

2.5 We further appointed EXIM Bank as our Manager/Mudarib to manage the investment of 40% of the contribution in the Risk

Fund (Tabarru’) which shall be invested in Shariah-compliant investment funds and agreed that the profit sharing ratio shall

be on apportion of 80:20 to participant and EXIM Bank accordingly in consideration of EXIM Bank managing the investment

of Risk Fund (Tabarru’).

2.6 We also permit all cost, expenses, charges and levies for maintaining and investing the assets of the Risk Fund (Tabarru’)

and any related expenses shall be borne and paid from the Risk Fund (Tabarru’).

Notes :

As part of its evaluation of projects submitted for possible EXIM Bank insurances, EXIM Bank frequently consults Multilateral Investment Insurance Agency (MIGA) of the World Bank Group. The investor understands and agrees that by signing this Definitive Application for Investment Insurance, it authorizes EXIM Bank to share information with MIGA to the extent necessary to evaluate such information for the purpose of project approval.

If the investor, at this time, is not prepared to have the host government informed of this application for political risk insurance, please state in a cover letter. EXIM Bank will review the application, but will be unable to issue insurance until it has received the host government approval.

The words NIL or NOT APPLICABLE should be entered in any space where appropriate, NO SPACE SHOULD BE LEFT BLANK.

If space in any of the above tables is insufficient, please attach separate SIGNED statements.

Authorised Signatory

Company Official Stamp

Name

Designation

Date

HOW DID YOU GET TO KNOW EXIM BANK? CONTACT PERSON

Please tick () Where Applicable Name Direct Line Email

Seminar/Talk/Exhibition

Business Associates/Friends

Media (TV, Billboard, etc.)





Others (please specify):

Note: The applicant/borrower shall not under any circumstances offer, promise or make any gift, payment, loan, reward, inducement, benefit or other advantage to any of the Bank’s employees, members of the boards of directors, representatives and/or agents in relation to this application/facility/agreement. Such acts are criminal offences under the Malaysian laws and shall entitle the Bank and without prejudice to the Bank’s other rights and remedies, to terminate the application/facility/agreement forthwith, and the applicant/borrower shall be liable for all consequential losses incurred by the Bank as a result of such termination, and shall indemnify and render the Bank harmless from all such costs. The Bank is also entitled to report the same to the relevant authorities including but not limited to the Malaysian Anti-Corruption Commission and/or the Royal Malaysian Police.

Please send your submission with your supporting documents to :

Export-Import Bank of Malaysia Berhad (357198-K)

Level 1, EXIM Bank Jalan Sultan Ismail

50250 Kuala Lumpur MALAYSIA

Tel: (603) 2601 2000 Fax: (603) 2601 2454

Website Address : www.exim.com.my

http://www.exim.com.my/

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