DFC-008 Annotated

DEVELOPMENT OUTCOMES SURVEY (DFC-008)

OMB [ 3015-0015 ]

Expiration Date: [ ]

United States International Development Finance Corporation

1100 New York Avenue, NW Washington, DC 20527-0001

An Agency of the United States Government

Responses to questions which call for estimates or projections should take the form of good faith statements made to the best of the Project officer’s knowledge and belief. Anyone who knowingly makes a false statement with the intent to influence DFC’s guarantees, loans, or other investments may be criminally prosecuted. Such false statements are also grounds for DFC to terminate a commitment or declare a contract default.  These rights are in addition to any other rights or remedies available to United States government. Neither submission nor acceptance of this application implies that the proposed transaction is eligible for support or that support will be provided.

Paperwork Reduction Act Notice: This information is required to retain benefits. Federal agencies may not collect information unless a valid OMB Control Number with an expiration date that has not expired is displayed. The public reporting burden for this collection of information is estimated to average 2.0 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing this burden, to Agency Clearance Officer, Records Management, United States International Development Finance Corporation 1100 New York Ave., NW, Washington, DC 20527 and to the DFC Desk Officer at the Office of Information and Regulatory Affairs, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503.

I have read and agree to the terms and conditions listed above.

1. PROJECT DESCRIPTION AND OWNERSHIP PROFILE

The questions in this section will ask for background and descriptive information about the Project and the company managing the Project (i.e., the DFC client company). For the purposes of the DOS, Project generally refers to a specific project or portion of a client's business that is supported by DFC and defined in the client’s contract with DFC. More specifically:

• For project finance, "Project" refers to a specific project supported by DFC. This definition includes standalone greenfield or brownfield projects (e.g., wind turbine farm) as well as projects undertaken by operating enterprises (e.g., expansion of manufacturing facilities).

• For corporate finance, “Project” refers to an enterprise that received DFC support to grow and/or sustain its business activities (e.g., working capital, refinancing, etc.).

• For enterprises engaged in the provision of financial services, "Project" refers to the portfolio of financial product(s) (e.g., loans, equity investments, leasing contracts, insurance contracts, etc.) supported by DFC.

If you are not sure about what to consider as the Project for this survey, please contact dos@dfc.gov.

Q101 Project Name (PRE-FILLED)

Q102 How much did the Project spend or have in outstanding investments during the Reporting Period in each country? Please include all countries in which the Project invested or spent funds. (SELECT ONE OR MORE COUNTRIES FROM COUNTRY LIST; then FILL IN amount in U.S. Dollars)

Q103 Please provide a brief description of the key Project activities during the Reporting Period. (OPEN-ENDED)

Q104 Is the Project supporting the provision of financial services (i.e., loans, equity investments, insurance, leasing) during the Reporting Period via:

• No, the Project does not provide financial services

• Yes, portfolio of loans (e.g., from a commercial bank, non-bank financial institution, microfinance institution, single-purpose entity/trust)

• Yes, investment fund

• Yes, portfolio of lease or insurance contracts

• Yes, other financial services

[IF Q104 does NOT equal “Yes, investment fund”, ASK] Q105 Does this Project operate or invest in any of the following sectors? (Please check all that apply)

1. Agriculture

2. Education

3. Energy

4. Healthcare

5. Housing

6. Information and Communications Technology

7. Transportation

8. Waste, Water, and Sanitation (including WASH)

9. Other

Q106 Does this Project advance the 2X Initiative? (SELECT ONE: Yes / No)

Q107 What percentage of ownership of the company managing the Project (i.e., the DFC client company), in terms of shares or other ownership portions, is held by nationals of the Project’s country or countries of operations)? If there is no local ownership, enter ‘0’. If not applicable, please leave blank. (PERCENTAGE)

Q108 What percentage of ownership of the company managing the Project (i.e., the DFC client company), in terms of shares or other ownership portions, is held directly by women? If not applicable, please leave blank. (PERCENTAGE)

Q109 Is the company managing the Project (i.e., the client company), or the Project itself, overseen by a Board of Directors? (SELECT ONE: Yes / No)

• [IF Q109=YES, ASK] Q109A What is the total number of active Board of Directors members? (NUMBER)

• [IF Q109=YES, ASK] Q109B How many active Board of Directors members are women? (NUMBER)

Q110 Has the project become operational? (SELECT ONE: Yes / No)

• [IF Q110=YES, ASK] Q110A Please enter the date when the project became operational. (DATE: MM/DD/YYYY)

Q111 Please specify the Project’s most recently completed fiscal year (representing 12 months of data) and use data from this year to complete the rest of this form.

• Reporting Period Start Date: (DATE: MM/DD/YYYY)

• Reporting Period End Date: (DATE: MM/DD/YYYY

2. PROJECT ENVIRONMENTAL AND SOCIAL CHARACTERISTICS

The questions in this section will ask about environmental and social characteristics for the project.

Q201 Is the Project currently in compliance with all conditions in the DFC contract with respect to environment, social impacts, and health and safety? (SELECT ONE: Yes / No / Do not know)

• [IF Q201=NO, ASK] Q201A Please describe the reason for non-compliance: (OPEN-ENDED)

Q202 Has the Project submitted all DFC-required deliverables on social, environmental, health and safety during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q202=NO, ASK] 202A Please note the required deliverables for the Reporting Period that were not submitted, and list the deliverables that were submitted including due date and date of transmission: (OPEN-ENDED)

Q203 Did the Project experience significant or material change, or does the project expect to experience significant or material change, with respect to its: (SELECT ONE: Yes/No)

	Experienced during Reporting Year	Expects to experience in the future
Design or scope	☐	☐
Environmental and social organizational structure or staff management structure	☐	☐
Environmental and Social Management System (policies and procedures related to environmental health and safety, human resources, etc.)	☐	☐

• IF ANY FIELD IN Q203=YES, ASK] Q203A Please describe: (OPEN-ENDED)

Q204 Has the Project (including the company managing the Project, i.e., the client company), its suppliers, or its investees met and received any third party internationally recognized environmental or social standards, certifications, or accreditations during the Reporting Period? (Please select all that apply.) [MULTI-SELECT]

• Aquaculture Stewardship Council

• Client Protection Principles and/or Pathway

• EDGE

• Forest Stewardship Council

• FairTrade

• Gogla

• Healthcare accreditation (i.e., from a national or international body)

• ISO

• LEED

• Marine Stewardship Council (MSC)

• Rainforest Alliance

• Sustainable Forestry Initiative

• USDA Organic

• Other (please describe)

• [IF 204 includes ‘ISO’ as a response, ASK] Q204A Please detail which ISO standards are met by the Project or its investees.

• [IF 204 includes ‘Other’ as a response, ASK] Q204B Please describe.

[IF Q104 does NOT = “Yes, investment fund” THEN ASK] Q205 To the best of your knowledge, has the Project experienced any of the following during the Reporting Period? This can be self-diagnosed or as a result of official inspections or other audits. (Please select all that apply.) [MULTI-SELECT]

• Strikes or other labor disputes, including ongoing or unresolved disputes with a trade union.

• Community strike, protest, or opposition.

• Incidents of gender-based violence or sexual harassment.

• Accidents that resulted in loss of human life or serious injuries (e.g., Lost Time Injuries, and/or near misses)

• Accidents that resulted material impacts on the environment

• Land acquisition

• [IF 205 = YES to any response, ASK] Q205A Please describe.

• [IF 205=YES to ‘Land acquisition’, ASK] Q205B How many households were physically displaced and resettled during the Reporting Period? (NUMBER)

• [IF 205=YES to ‘Land acquisition’, ASK] Q205C How many households were economically displaced (disruption of loss of livelihood, jobs or income) during the Reporting Period? (NUMBER)

[IF Q104 = “Yes, investment fund” THEN ASK] Q206 To the best of your knowledge, have any of the DFC-supported Fund’s portfolio companies experienced any of the following during the Reporting Period? This can be self-diagnosed, or as a result of official inspections or other audits. (Please select all that apply.) [MULTI-SELECT]

• Strikes or other labor disputes, including ongoing or unresolved disputes with a trade union.

• Community strike, protest, or opposition.

• Incidents of gender-based violence or sexual harassment.

• Accidents that resulted in loss of human life or serious injuries (e.g., Lost Time Injuries, and/or near misses)

• Accidents that resulted material impacts on the environment

• Land acquisition

• [IF 206 = YES to any response, ASK] Q206A Please describe.

• [IF 206 = YES to any response, ASK] Q206B How has the Fund responded to the incident(s)?

Q207 Has the Project engaged with communities impacted by the Project (including disadvantaged and vulnerable groups) during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q207=YES, ASK] Q207A Please describe.

[IF Q104 does NOT = “Yes, investment fund” THEN ASK] Q208 – Q210

Q208 Has the Project been involved in a formal, third-party dispute resolution process during the Reporting Period, including an Independent Accountability Mechanism of an International Financial Institution and/or OECD National Contact Point? (SELECT ONE: Yes / No)

• [IF Q208=YES, ASK] Q208A Please describe the dispute or complaint and list steps being taken to resolve it: (OPEN-ENDED)

Q209 Have the Project’s impacts been monitored or audited by any government regulatory agencies and/or third-party environmental and social auditors or companies during the Reporting Period? (SELECT ONE: Yes / No)

• [IF 209=YES, ASK] Q209A What agency or company performed this audit? (OPEN-ENDED)

Q210 Has the Project been cited or fined, or been the subject of any investigation or litigation, for any violation of local or host country environmental, human rights, labor, health or safety laws during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q210=YES, ASK] Q210A Please explain. (OPEN-ENDED)

IF Q104 = “Yes, investment fund” THEN ASK] Q211 During the Reporting Period, has the Fund or any of its portfolio companies been: [MULTI-SELECT ]

• Involved in a formal, third-party dispute resolution process, including an Independent Accountability Mechanism of an International Financial Institution and/or OECD National Contact Point

• Monitored or audited by any government regulatory agencies and/or third-party environmental and social auditors or companies

• Cited or fined, or been the subject of any investigation or litigation, for any violation of local or host country environmental, human rights, labor, health, or safety laws

• [IF Q211 = YES to any response, ASK] Q211A Please describe.

3. PROJECT HUMAN RESOURCES MANAGEMENT AND JOB QUALITY

The questions in this section will ask about human resource policies, labor standards, and employee benefits.

Q301 Does the Project or the company managing the Project have a written human resources policy consistent with the law of the country or countries of operations? (SELECT ONE: Yes / No)

• [IF Q301=NO, ASK] Q301A Please explain.

Q302 During the Reporting Period, did the Project or company managing the Project offer employees any of the following family friendly benefits that go beyond what is legally required by the country or countries of operations? (Please select all that apply.) [MULTI-SELECT]

• Flexible work schedules

• Extended paid maternity leave

• Paid paternity leave

• Access to on-site childcare or childcare stipends

• Family healthcare

• Other

• [IF Q302 includes “Other” as a response, ASK] Q302A Please describe.

Q303 During the Reporting Period, did the Project implement any of the following initiatives to support women in the workforce beyond what is legally required by the country or countries? (Please select all that apply.) [MULTI-SELECT]

• Diversity: Explicit efforts to increase the share of women in the workforce.

• Equal pay: Regular efforts to analyze and address any gender pay gap(s) identified.

• Equal care: Efforts in place to support the workforce with their care responsibilities.

• Health and well-being: Initiatives implemented to support the gender-specific health and well-being needs of the workforce.

• Protection against GBVH: Advanced programs or policies implemented that address and prevent gender-based violence and harassment (GBVH) beyond basic safeguarding.

• Other

• [IF Q303 includes “Other”] Q303A Please describe. (OPEN-ENDED)

Q304 During the Reporting Period, did the Project or company managing the Project have any of the following workplace initiatives in place? (Please select all that apply.) [MULTI-SELECT]

• Active union or collective bargaining agreement

• Written employment contracts for all staff

• Training and professional development opportunities

Q305 Has the Project experienced worker layoffs during the Reporting Period? Please only include layoffs that were part of workforce reductions for business reasons, rather than workers let go for performance reasons. (SELECT ONE: Yes / No)

• [IF Q305=YES, ASK] Q305A How many workers were laid off? (NUMBER)

Q306 Does the Project expect any significant changes to the workforce in the next year (i.e., layoffs/demobilization, increase in contracted workers, re-organization)? (SELECT ONE: Yes / No)

4. PROJECT OPERATIONAL EMPLOYMENT

The questions in this section will ask about local Project employees (i.e., nationals of the country or countries of operations) at the end of the Reporting Period, including full-time, part-time, seasonal, and contract employees. We will ask several detailed questions about the staff you currently employ so you may need to refer to your employment records to answer questions in this section.

If the Project is an investment fund, please report the number of staff of the fund itself. Please do NOT include employment facilitated through an online or other matchmaking/peer-to-peer platform in this table. If the Project does not yet have any employees, or no longer has employees, please enter “0”.

Q401

	Full-Time Local Employees (non-construction)	Part-Time Local Employees (non-construction)	Temporary/Seasonal Local Workers (non-construction)	Temporary/Seasonal Local Workers (construction)
Total
Women
Young adults (15-24 years old)
Other disadvantaged groups (not included in Women or Young adults)

• [IF any fields for “Part-Time Local Employees (non-construction)” >0, ASK] Q401A Approximately what proportion of a typical work week, on average, do the part-time local employees (non-construction) work (expressed as a percentage)? (PERCENTAGE)

• [IF any fields for “Temporary/Seasonal Local Workers (non-construction)” > 0, ASK] Q401B Approximately how many months, on average, did the temporary/seasonal local workers (non-construction) work during the Reporting Period? (MONTHS)

• [IF any fields for “Temporary Seasonal Local Workers (construction)” > 0, ASK] Q401C Approximately how many months, on average, did the temporary/seasonal local workers (construction) work during the Reporting Period? (MONTHS)

Q402 How many full-time Senior Managers were employed by the Project at the end of the Reporting Period? (NUMBER)

• [IF Q402>0, ASK] Q402A Of these full-time Senior Managers, how many are women? (NUMBER)

Q403 Did the Project employ any disabled people from the country or countries of operation at the end of the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q403=YES, ASK] Q403A How many disabled employees from the country or countries of operations did the Project employ at the end of the Reporting Period? (NUMBER)

Q404 Did the Project facilitate employment through an online or other matchmaking/peer-to-peer platform (sometimes referred to as “gig economy”) during the Reporting Period? (SELECT ONE: Yes/No)

• [IF Q404=YES, ASK] Q404A How many of these jobs were facilitated during the Reporting Period?

Q405 Please provide the total amount, in U.S. Dollars, paid during the Reporting Period to Project employees in the country or countries of operations (total annual local payroll in U.S. Dollars). Do not include foreign nationals working on the Project. (DOLLARS)

5. PROJECT BENEFITS TO THE ENVIRONMENT

This section will ask about the Project’s environmental stewardship.

Climate Action: GHG Emissions

Q501 What are the greenhouse gas (GHG) emissions generated as a result of the Project’s activities during the Reporting Period? Please report in metric tons of carbon dioxide equivalent (CO2e) per year.

• Q501A Scope 1: (NUMBER)

• Q501B Scope 2: (NUMBER)

[IF Q104=any response EXCEPT “Yes, investment fund”, ASK] Q501C Scope 3 GHG emissions (NUMBER)

• [If Q501=RESPONSE, ASK] Q501D Please provide an explanation of how the reported figures were calculated. (OPEN-ENDED)

Q502 What is the total amount of greenhouse gas (GHG) emissions sequestered by the Project during the Reporting Period? Please report in metric tons of carbon dioxide equivalent (CO2e) per year. (NUMBER)

• [IF 502=RESPONSE, ASK] Q502A Please provide an explanation of how the reported figure was calculated. (OPEN-ENDED)

Q503 What is the total amount of greenhouse (GHG) emissions avoided by the Project during the Reporting Period? Please report in metric tons of carbon dioxide equivalent (CO2e) per year. (NUMBER)

• [IF 503=RESPONSE, ASK] Q503A Please provide an explanation of how the reported figure was calculated. (OPEN-ENDED)

Q504 Did the Project register carbon credits to a carbon credit registry? (YES/NO)

• [IF Q504=YES] Q504A What is the total amount of carbon credits registered by the Project during the Reporting Period? Please report in metric tons of CO2e. (NUMBER)

• [IF Q504=YES] Q504B Please identify the carbon credit registry to which the credits were registered. (OPEN-ENDED)

• [IF Q504=YES] Q504C What is the total amount of carbon credits retired or sold by the Project during the Reporting Period? Please report in metric tons of CO2e. (NUMBER)

Q505 Did the Project support customers or suppliers to adapt to or become more resilient to the impacts of climate change? (SELECT ONE: Yes/No)

• [IF Q505=YES, ASK] Q505A How many clients, customers or suppliers did the Project support during the Reporting Period? (NUMBER)

• [IF Q505=YES, ASK] Q505B Please identify how the Project supported clients, customers, or suppliers to adapt or become more resilient to the impacts of climate change. (Please select all that apply.) [MULTI-SELECT]

• Reduced crop (or post-harvest) loss

• Reduced flooding risk

• Improved drought resilience

• Improved access to climate information (e.g., early warning systems, weather data, climate projections)

• Improved resilience of residential buildings

• Improved resilience of office buildings or manufacturing facilities

• Increased access to safe drinking water

• Increased adoption of water-efficient practices (e.g., energy-efficient irrigation)

• Other

• [IF Q505B includes “Other”, ASK] Q505C Please describe.

Ecosystems

Q506 Did the Project or the company managing the Project (i.e. the client company) take any actions to conserve, preserve, and/or restore terrestrial or aquatic ecosystems through sustainable resource management practices? (SELECT ONE: Yes / No)

• [IF Q506=YES, ASK] Q506A Area of land directly controlled or supported by the Project under sustainable management during the Reporting Period. Please report in hectares of land sustainable managed. (NUMBER)

• [IF Q506=YES, ASK] Q506B Area of ocean or other marine habitat directly controlled or supported by the Project under sustainable management during the Reporting Period. Please report in square kilometers. (NUMBER)

Responsible Consumption

Q507 What was the Project’s energy consumption during the Reporting Period, expressed in (kWh)? (NUMBER)

Q508 Volume of waste produced, expressed in metric tons. (NUMBER)

Q509 Volume of waste disposed that was recycled or reused, expressed in metric tons. (NUMBER)

Q510 Volume of waste avoided, expressed in metric tons. (NUMBER)

6. BUSINESS INNOVATION AND TECHNICAL ASSISTANCE

The information in this section will ask about the Project's support for innovation and provision of technical assistance. For investment funds answering the following questions, please consider investments made by the fund in portfolio companies and the impacts of those investments.

Q601 If applicable, what is the Project’s target population? (Please select all that apply.) [MULTI-SELECT]

• Women-owned/women-led enterprises

• Small and medium enterprises (SMEs)

• Microenterprises

• Women

• Young adults (15-24 years old)

• Rural populations

• Smallholder farmers

• Low-income populations

• Disabled populations

• Other disadvantaged group not included above

• [IF Q601 includes “Other disadvantaged group”, ASK] Q601A Describe the other disadvantaged groups the Project is targeting.

Q602 During the Reporting Period, how has the Project incorporated the needs and preferences of target populations in the design and delivery of products and services? (Please select all that apply.) [MULTI-SELECT]

• The Project has added or adjusted product or service offerings to meet its target populations’ needs and preferences.

• The Project designed its pricing models according to its target populations’ ability to pay.

• The Project adjusted its operational and/or expansion strategy to better reach its target populations.

• The Project has not yet adapted the design of its products and services according to its target populations’ needs and preferences.

• Other.

• [IF Q602 includes any selection except for “The Project has not yet adapted the design of its products and services according to its target populations’ needs and preferences.”, ASK] Q602A Please describe how the Project has incorporated the needs and preferences of target populations in the design and delivery of products and services. (OPEN-ENDED)

Q603 Did DFC’s support contribute to the production of goods during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q603=YES, ASK] Q603A Please list and describe the DFC-supported products produced during the Reporting Period.

Description of product	Unit (e.g., product type)	Number of products produced

Q604 Did DFC’s support contribute to the sale of products during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q604=YES, ASK] Q604A Please list and describe the DFC-supported products sold during the Reporting Period.

Description of product	Unit (e.g., product type)	Number of products sold

Q605 Did DFC’s support contribute to the distribution of products during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q605=YES, ASK] Q605A Please list and describe the DFC-supported products distributed during the Reporting Period.

Description of product	Unit (e.g., product type)	Number of products distributed

Q606 Did DFC’s support contribute to the storage of products during the Reporting Period? (SELECT ONE: Yes/No)

• [If Q606=YES, ASK] Q606A Please list and describe the DFC-supported products stored during the Reporting Period.

Description of product	Unit (e.g., product type)	Number of products stored

Q607 Did the Project introduce or disseminate an innovation leading to any of the following benefits during the Reporting Period? (Please select all that apply.) [MULTI-SELECT]

• Reducing prices to customers

• Time saved by customers, clients, or other target stakeholders

• Improved access to quality information

• Improved accessibility to product or service

• Increasing prices paid to producers

• Other

• [IF ‘Reducing prices to customers’ is checked, ASK] Q607A What was the average percentage savings premium to customers accessing the innovative product or service during the Reporting Period? (PERCENTAGE)

• [IF ‘Time saved by customers’ is checked, ASK] Q607B How many hours were saved by the average customer as a result of the Project’s products or services during the Reporting Period (HOURS)?

• [IF ‘Increasing prices paid to producers’ is checked, ASK] Q607C What was the average percentage premium paid to producers due to the product or service innovation during the Reporting Period? (PERCENTAGE)

• [IF any fields in Q607 are checked, ASK] Q607D Please describe. (OPEN-ENDED)

Q608 During the Reporting Period, did the Project increase its market share? (SELECT ONE: Yes / No)

• [IF 608=YES, ASK] Q608A Please estimate the percent increase in market share gained by the Project during the Reporting Period. (PERCENTAGE)

Q609 Did the Project provide advisory services (such as training, advice, or technical assistance designed to improve business performance) to customers, suppliers, or investees during the Reporting Period? (SELECT ONE: Yes / No)

• [IF Q609=YES, ASK] Q609A How many customers, suppliers, or investees did the Project provide advisory services to during the Reporting Period? For investees, please include those for whom a Project representative had an active role on the investee Board. (NUMBER)

• [IF Q609=YES, ASK] Q609B How much money (U.S. Dollars) was spent on advisory services for customers, suppliers, or investees during the Reporting Period? (DOLLARS)

7. PROCUREMENT AND TAXES

This section will ask about different ways that the Project has an impact on the economy.

Q701 Please enter the total dollar amount (in U.S. Dollars) spent by the Project on goods and services procured in the country or countries of operations during the Reporting Period. (DOLLARS)

• [IF Q701>0, ASK] Q702 How many local suppliers did you purchase goods and services from during the Reporting Period? (NUMBER)

• [IF Q701>0, ASK] Q703 How many of these local suppliers are women-owned or women-led enterprises? (NUMBER)

• [IF Q701>0, ASK] Q704 How many of these local suppliers are microenterprises? (NUMBER)

• [IF Q701>0, ASK] Q705 How many of these local suppliers are SMEs? (NUMBER)

• [IF Q701>0, ASK] Q706 How many local suppliers are smallholder farmers? (NUMBER)

• [IF Q701>0, ASK] Q707 How many local suppliers are owned or led by disadvantaged populations not included in above categories? (NUMBER)

  • [If Q707>0, ASK] Q707A Please describe the disadvantaged population not included in above categories.

Q708 During the reporting period, which of the following efforts has the Project implemented to support women in its supply chain? (Please select all that apply.) [MULTI-SELECT]

• Diversity: Explicit efforts to increase the share of women-owned or -led suppliers in the Project's supply chain

• Equal pay: Capacity building or other support to suppliers in order to address gender pay gap(s) in the Project’s supply chain

• Equal care: Capacity building or other support to suppliers in order to inform policies that assist supply chain workers with their care responsibilities

• Health and well-being: Capacity building or other support to suppliers in order to inform measures that meet the gender-based health and well-being needs of supply chain workers

• Other

• None of the above

• [IF Q708A includes “Other”, ASK] Q708A Please describe. (OPEN-ENDED)

Q709 Please enter the total dollar amount (in U.S. Dollars) spent by the Project on goods and services procured from the United States during the Reporting Period. (DOLLARS)

Q710 Please enter the total dollar amount (in U.S. Dollars) spent by the Project on goods and services procured from any other countries (i.e., not the United States, and not the country or countries of operations) during the Reporting Period. (DOLLARS)

Q711 Please enter the total dollar amount (in U.S. Dollars) paid by the Project to the government of the country or countries of operations in taxes, royalties, concessions, or other fees during the Reporting Period. (DOLLARS)

8. REVENUE AND EXPORTS

This section will ask a few questions about the revenue and exports of the Project during the Reporting Period.

Q801 What was the gross revenue for the Project during the Reporting Period? Please express in U.S. Dollars. (DOLLARS)

Q802 How much of the Project's revenue during the Reporting Period came from sales in the country or countries of operations? Please express in U.S. Dollars. (DOLLARS)

Q803 How much of the Project's revenue during the Reporting Period came from exports to the United States? Please express in U.S. Dollars. (DOLLARS)

Q804 How much of the Project's revenue during the Reporting Period came from exports to countries other than the United States? Please express in U.S. Dollars. (DOLLARS)

9. SECTOR-SPECIFIC METRICS

IF Q104 does not = “Yes, investment fund” then ask Section 9.]

The questions in this section will ask about your results for the specific sectors on which the Project focused during the Reporting Period. For each sector, we will ask for information about services provided and the number of people who benefit from these services.

NOTE: Projects will only answer questions for the sectors selected in Section 1.

AGRICULTURE SECTOR [IF Q105A=YES, ASK Q901-Q903]

Please only report data for the Reporting Period.

Q901 Average annual yield from this Project during the Reporting Period, expressed in tons per hectare. (NUMBER)

Q902 Number of agricultural producers or suppliers with increased income. (NUMBER)

Q903 Percentage of post-harvest loss experienced. (PERCENTAGE)

EDUCATION SECTOR [IF Q105B=YES, ASK Q904-Q907]

Please only report data for the Reporting Period.

Q904 Total number of students enrolled. (NUMBER)

Q905 Number of women/girl students enrolled. (NUMBER)

Q906 Number of students enrolled who are from low-income households. (NUMBER)

Q907 Number of students enrolled who are from disadvantaged backgrounds. These are students from other disadvantaged backgrounds, other than women/girl students or students from low-income households. (NUMBER)

ENERGY SECTOR [IF Q105C=YES, ASK Q908-Q916]

Please only report data for the Reporting Period.

Q908 Amount of non-renewable energy produced, expressed in gigawatt hours (GWh). (NUMBER)

Q909 Amount of renewable or low-carbon energy produced, expressed in gigawatt hours (GWh). (NUMBER)

[IF Q909=RESPONSE, ASK] Q909A What type of renewable or low-carbon energy was produced?

• Biomass

• Geothermal

• Hydro energy

• Nuclear

• Solar

• Wind

• Other (Write-in)

Q910 Number of on-grid connections:

• For households (NUMBER)

• For businesses (NUMBER)

Q911 Number of off-grid power systems installed:

• For households (NUMBER)

• For businesses (NUMBER)

Q912 Energy capacity installed (expressed in MWh). (NUMBER)

Q913 Energy storage capacity (expressed in MWh). (NUMBER)

Q914 Length of energy transmission and/or distribution lines built or improved, expressed in kilometers. (NUMBER)

Q915 Frequency of power outages (reported as total number of customer interruptions / total number of customers served). (NUMBER)

Q916 Average duration of power outages (reported in hours). (NUMBER)

HEALTHCARE SECTOR [IF Q105D=YES, ASK Q917-Q921]

Please only report data for the Reporting Period.

Q917 How does the Project adjust service or coverage based on patients’ ability to pay?

Q918 Number of patient beds available as of the end of the Reporting Period. (NUMBER)

Q919 Number of patients served. (NUMBER)

Q920 Number of women or girl patients served. (NUMBER)

Q921 Number of low-income patients served (NUMBER)

Q922 Number of patients from disadvantaged backgrounds served. (These are patients from other disadvantaged backgrounds, other than women or girl patients, or low-income patients.) (NUMBER)

Q923 What is the average cost of the most common Project-provided healthcare service/product to the patient (in USD)? (NUMBER)

HOUSING SECTOR [IF Q105E=YES, ASK Q924-Q929]

Please only report data for the Reporting Period. If a unit was constructed or refurbished prior to the Reporting Period, do not include it here.

Q924 Number of residential dwellings constructed. (NUMBER)

• [IF Q922>0, ASK] Q924A Of these new residential dwellings, how many were certified as green buildings (green buildings refer to resource-efficient buildings that are third-party certified, for example, Edge, LEED, etc.) (NUMBER)

Q925 Number of residential dwellings for low-income homebuyers or renters constructed. (NUMBER)

Q926 Area of buildings receiving energy efficiency improvements during the Reporting Period, expressed in square meters. (NUMBER)

Q927 Number of residential dwellings refurbished (NUMBER)

• [IF Q925>0, ASK] Q927A Of these refurbished residential dwellings, how many were certified as green buildings (green buildings refer to resource-efficient buildings that are third-party certified, for example, Edge, LEED, etc.) (NUMBER)

Q928 Number of residential dwellings refurbished for low-income homebuyers/renters. (NUMBER)

Q929 Number of residential dwellings constructed or refurbished with resiliency features for extreme weather events and/or natural disasters. (NUMBER)

INFORMATION AND COMMUNICATIONS TECHNOLOGY SECTOR [IF Q105F=YES, ASK Q930-Q935]

Please only report data for the Reporting Period.

Q930 Number of cell towers constructed. (NUMBER)

Q931 Number of mobile subscriptions as of the end of the Reporting Period. (NUMBER)

Q932 Number of subscribers to an affordable data plan (priced at less than 2% of local average annual income) as of the end of the Reporting Period. (NUMBER)

Q933 Median download speed of data subscriptions, expressed in megabytes per second (MBps). (NUMBER)

Q934 Number of low-income subscribers as of the end of the Reporting Period. (NUMBER)

Q935 Number of data center racks as of the end of the Reporting Period. (NUMBER)

TRANSPORTATION SECTOR [IF Q105G=YES, ASK Q936-Q943]

Please only report data for the Reporting Period. If a length of road was constructed or improved in a previous Reporting Period, do not include it here.

Q936 Length of road constructed, expressed in kilometers. (NUMBER)

Q937 Length of road maintained or improved, expressed in kilometers. (NUMBER)

Q938 Number of twenty foot-equivalent units of cargo containers transported through the road/railway/port/airport. (NUMBER)

Q939 Bulk cargo transported through the road/railway/port/airport, expressed in metric tons. (NUMBER)

Q940 Number of passengers using transportation service. (NUMBER)

Q941 Number of warehouses or storage units constructed or improved. (NUMBER)

Q942 Number of vehicles using roads daily. (NUMBER)

Q943 Number of people benefitting from transportation system(s) constructed or improved for climate resiliency. (NUMBER)

WASTE, WATER, AND SANITATION (INCLUDING WASH) SECTOR [IF Q105H=YES, ASK Q944-Q948]

Please only report data for the Reporting Period.

Q944 Volume of wastewater disposed, expressed in metric tons. (NUMBER)

Q945 Volume of wastewater treated, expressed in metric tons. (NUMBER)

Q946 Volume of water produced and/or delivered, expressed in metric tons. (NUMBER)

Q947 Number of households with new or improved water and sanitation facilities as of the end of the Reporting Period. (NUMBER)

Q948 Number of residential connections to water and wastewater services as of the end of the Reporting Period. (NUMBER)

2X [IF Q106=YES, ASK Q949-951]

Please only report data for the Reporting Period.

[IF Q104 does NOT = “Yes, investment fund”] Q949 Which of the following has the project implemented to demonstrate strategic action on gender? (Please select all that apply.) [MULTI-SELECT]

• Public commitment related to gender equity

• Clear, measurable & time-bound gender targets beyond the specific minimum requirements for 2X alignment

• Action items or action plan to drive gender equity that may be linked to gender targets with clear roles/ responsibilities and timelines

• Standalone gender strategy and/or gender explicitly integrated into business strategy or strategic plan

• None of the above

[IF Q104 does NOT = “Yes, investment fund”] Q950 Which of the following has the project implemented to demonstrate management systems on gender? (Please select all that apply.) [MULTI-SELECT]

• Core gender policies

• Accountability for gender including regular monitoring / monitoring plan of gender-related efforts and/or progress against gender targets

• Risk management efforts that explicitly consider gender

• Internal and/or external stakeholder engagement capturing a gender perspective

• Impact measurement & management (IMM) on gender

• None of the above

[IF Q950 includes “Core gender policies"] Q951 Which of the following core gender policies has the Project implemented during the Reporting Period? (Please select all that apply.) [MULTI-SELECT]

• Non-discrimination or equal opportunity policy that explicitly addresses gender / sex

• Explicit policy related to zero tolerance of gender-based violence and harassment

• No requirement for private arbitration of violence and harassment claims

• Explicit policy or clause related to equal pay

• Explicit policy that acknowledges and/or indicates commitment to respecting the gender-specific health & well-being needs of employees

• Explicit care (leave) policy (i.e., paid primary carer / maternity leave; paid secondary carer/paternity leave; work/life balance or flexible work policy)

• None of the above

10. FINANCIAL SERVICES PORTFOLIO

This section includes information regarding the DFC Client’s portfolio supported by the DFC project. NOTE: This section is ONLY for projects providing financial services. [IF Q104=any response EXCEPT “Yes, investment fund”, ASK Section 10]

Q1001 Is the DFC Client Company a Client Protection Certified Institution? (SELECT ONE: Yes/No)

• [IF Q1001=YES, ASK] Q1001A What year was the certification provided? (YYYY) (YEAR)

• [IF Q1001=NO, ASK] Q1001B Is the DFC Client Company part of the Client Protection Pathway? (SELECT ONE: Yes/No)

  • [IF Q1001B=YES, ASK] Q1001C When did the DFC Client Company become part of the Client Protection Pathway? (YYYY) (YEAR)

[IF Q106=YES] Q1002 Please provide information below with respect to the DFC Client Company’s 2X-eligible portfolio:

Number of clients	Number of loans or contracts outstanding	Value of loans or contracts outstanding

Q1003 Does the DFC supported project provide climate finance? (SELECT ONE: Yes/No)

• [IF Q1003=YES, ASK] Q1003A Please provide information below with respect to the DFC Client Company’s climate finance portfolio:

Number of clients	Number of loans or contracts outstanding	Value of loans or contracts outstanding

[IF Q104 = “Portfolio of loans”, ASK] Q1004 - 1008:

Q1004 Please describe how the financial services activities supported by the DFC Project are different from the typical alternatives offered in the local market. (Please select all that apply.) [MULTI-SELECT]

• Lower interest rates or cost of capital

• Longer tenor

• Longer grace period

• Reduced security/collateral requirements

• Increased exposure to women or women-owned/women-led clients

• Increased exposure to low-income clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to disadvantaged groups other than those listed above

• No difference

• Other

• [IF Q1004 includes ‘Other’, ASK] Q1004A Please describe.

Q1005 Was the DFC Project intended to support the DFC Client Company’s microenterprise loan portfolio? (SELECT ONE: Yes / No)

• [If Q1005 = YES, ASK] Q1005A Please provide information below with respect to the DFC Client Company’s microenterprise loan portfolio:

• [If Q1005 = YES, ASK] Q1005B Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

Sector	Number of Clients	Number of Loans Outstanding	Value of Loans Outstanding (USD)
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Financial Services	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

Q1006 Was the DFC Project intended to support the DFC Client Company’s small and medium enterprise (SME) loan portfolio? (SELECT ONE: Yes / No)

• [IF Q1006 = YES, ASK] Q1006A Please provide information below with respect to the DFC Client Company’s SME loan portfolio:

• [IF Q1006 = YES, ASK] Q1006B Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

Sector	Number of Clients	Number of Loans Outstanding	Value of Loans Outstanding (USD)
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Financial Services	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

Q1007 Was the DFC Project intended to support the DFC Client Company’s consumer loan portfolio? (SELECT ONE: Yes / No)

• [IF Q1007 = YES, ASK] Q1007A Please provide information below with respect to the DFC Client Company’s consumer loan portfolio:

• [IF Q1007 = YES, ASK] Q1007B Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

Sector	Number of Clients	Number of Loans Outstanding	Value of Loans Outstanding (USD)
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Financial Services	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

Q1008 Was the DFC Project intended to support a DFC Client Company portfolio (or portfolios) not articulated in the above sections (microenterprise, SME, consumer finance)? (SELECT ONE: Yes / No)

• [IF Q1008 = YES, ASK] Q1008A Please describe the other type of portfolio supported. [OPEN-ENDED]

• [IF Q1008 = YES, ASK] Q1008B Please provide information below with respect to the DFC Client Company’s portfolio(s).

• [IF Q1008 = YES, ASK] Q1008C Of the total number of clients and outstanding loans listed above, what is the allocation to the following sectors:

Sector	Number of Clients	Number of Loans Outstanding	Value of Loans Outstanding (USD)
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Financial Services	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

[IF Q104 = “Yes, portfolio of lease or insurance contracts”, ASK] Q1009 – Q1013:

Q1009 Please describe how the leasing or insurance activities supported by the DFC Project are different from the typical alternatives offered in the local market. (Please select all that apply.) [MULTI-SELECT]

• Lower policy rates, premiums, or other costs

• Improved coverage

• Improved risk analyses

• Other difference in financing structure

• Increased exposure to women or women-owned/women-led clients

• Increased exposure to low-income clients

• Increased exposure to rural clients

• Increased exposure to smallholder farmer clients (subset of rural)

• Increased exposure to disadvantaged groups other than those listed above

• No difference

• Other

• [IF Q1009 includes ‘Other’, ASK] Q1009A Please describe.

Q1010 Was the DFC Project intended to support the DFC Client Company’s consumer leasing or insurance portfolio? (SELECT ONE: Yes / No)

• [IF Q1010 = YES, ASK] Q1010A Please provide information below with respect to the DFC Client Company’s consumer portfolio:

• [IF Q1010 = YES, ASK] Q1010B Of the total number of clients and outstanding contracts listed above, what is the allocation to the following sectors (if applicable):

Sector	Number of Clients	Outstanding Portfolio - Number of Contracts	Outstanding Portfolio - Value (USD) of Contracts
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

Q1011 Was the DFC Project intended to support the DFC Client Company’s microenterprise portfolio? (SELECT ONE: Yes / No)

• [IF Q1011 = YES, ASK] Q1011A Please provide information below with respect to the DFC Client Company’s microenterprise portfolio:

• [IF Q1011 = YES, ASK] Q1011B Of the total number of clients and outstanding contracts listed above, what is the allocation to the following sectors (if applicable):

Sector	Number of Clients	Outstanding Portfolio - Number of Contracts	Outstanding Portfolio - Value (USD) of Contracts
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

Q1012 Was the DFC Project intended to support the DFC Client Company’s small and medium enterprise (SME) portfolio? (SELECT ONE: Yes / No)

• [IF Q1012 = YES, ASK] Q1012A Please provide information below with respect to the DFC Client Company’s SME portfolio:

• [IF Q1012 = YES, ASK] Q1012B Of the number of total number clients and outstanding contracts listed above, what is the allocation to the following sectors (if applicable):

Sector	Number of Clients	Outstanding Portfolio - Number of Contracts	Outstanding Portfolio - Value (USD) of Contracts
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

Q1013 Was the DFC Project intended to support a DFC Client Company portfolio (or portfolios) of leasing or insurance contracts to enterprises that are NOT micro, small, and medium enterprises (MSME)? (SELECT ONE: Yes / No)

• [IF Q1013 = YES, ASK] Q1013A Please describe the other type of portfolio supported.

• [IF Q1013 = YES, ASK] Q1013B Please provide information below with respect to the DFC Client Company’s portfolio(s):

• [IF Q1013 = YES, ASK] Q1013C Of the number of total number clients and outstanding contracts listed above, what was the allocation to the following sectors:

Sector	Number of Clients	Outstanding Portfolio - Number of Contracts	Outstanding Portfolio - Value (USD) of Contracts
Agriculture	(Number)	(Number)	(USD)
Education	(Number)	(Number)	(USD)
Energy	(Number)	(Number)	(USD)
Healthcare	(Number)	(Number)	(USD)
Housing	(Number)	(Number)	(USD)
Information and Communication Technology	(Number)	(Number)	(USD)
Transportation	(Number)	(Number)	(USD)
Waste, Water, Sanitation (including WASH)	(Number)	(Number)	(USD)
Other	(Number)	(Number)	(USD)

11. INVESTMENT FUNDS

This section includes information regarding the portfolio supported by the DFC project. NOTE: This section is ONLY for projects that are funds. [IF Q104 = “Yes, investment fund”, ASK Section 11]

Fund characteristics

Q1101 What amount (U.S. Dollars) of the DFC Client Company’s total assets are represented by the DFC Project (e.g., investment fund)? For example, if the intent of the DFC Project was to provide debt or equity capital to the DFC Client Company’s investment fund, the response should relate to the entirety of the DFC Client Company’s investment fund supported by DFC. (DOLLARS)

Q1102 Does the DFC Client Company have an Investment Committee?

• [IF Q1001=YES, ASK] Q1002A What is the total number of active Investment Committee members? (NUMBER)

• [IF Q1001=YES, ASK] Q1002B How many of the active Investment Committee members are women? (NUMBER)

Q1103 Please select all of the following which apply to the DFC-supported Project’s impact management efforts:

• A written policy or strategy statement describing the fund manager’s intent to generate positive development impact, impact theory of change, objectives, and metrics

• A framework detailing the policies and procedures for how the fund manager integrates development impact considerations into its origination and monitoring processes

• Fund manager personnel dedicated to managing the fund manager’s impact program

• Internal and/or external reports that articulate achieved impacts

• None of the above

Q1104 Please describe how the DFC-supported Project is different from the typical investment fund investing in this market? (Please select all that apply.) [MULTI-SELECT]

• Type and/or size of investee company

• Longer loan tenor and/or equity holding period for investee companies

• Number of investee companies

• Average size of investment in investee company

• Type of engagement with investee company

• Other loan/equity investment structure difference

• Increased exposure to new sector/industry

• Increased exposure to new geography

• Increased exposure to new thematic thesis (e.g., impact investing, water access, women-led enterprises, etc.)

• Increased exposure to other strategic difference

• Other

• [IF Q1103 includes “Other”, ASK] Q1104A Please describe.

Q1105 Which of the following has the project implemented to demonstrate strategic action on gender? (Please select all that apply.) [MULTI-SELECT]

• Public commitment related to gender equity and/or investing with a gender lens

• Clear, measurable & time-bound gender targets beyond the specific minimum requirements for 2X alignment at the portfolio level or that are agreed with portfolio companies directly

• Action items or action plan to drive gender equity at the portfolio level that may be linked to gender targets with clear roles/ responsibilities and timelines

• Standalone gender lens investing strategy and/or gender explicitly integrated into business strategy or strategic plan

Q1106 Which of the following has the project implemented to demonstrate management systems on gender? (Please select all that apply.) [MULTI-SELECT]

• Core gender policies that cover portfolio companies and/or requiring portfolio companies to have these explicit policies

• Accountability for gender including regular monitoring / monitoring plan of gender-related efforts and/or efforts including gender expertise, monitoring (at the portfolio level) and/or incentives to improve gender equity outcomes and/or progress against gender targets

• Risk management efforts that explicitly consider gender that cover portfolio companies and/or require portfolio companies to have

• Support for and/or requirements for portfolio companies to have internal and/or external stakeholder engagement capturing a gender perspective among the portfolio companies

• Impact measurement & management (IMM) on gender among the Fund’s portfolio companies

• Stages in the investment cycle that embed gender

Portfolio data

Please provide information below with respect to the DFC Project (e.g., investment fund):

Q1107 Investment characteristics:

Client name	Client type	Client sector	Strategic priority alignment	Investment type	Primary country of operations	Value of investment outstanding	Ownership percentage
	Dropdown: Microenterprise Small or medium enterprise (SME) Other enterprise type	Dropdown: Agriculture Education Energy Financial services Healthcare Housing Information and Communication Technology Transportation Waste, Water, Sanitation (including WASH) Other	Multi-pick: 2X Climate-linked	Dropdown: Debt Equity Other	Dropdown: [List of countries]

Q1108 Populations reached

Please answer with regard to…	Employees			Leadership			Customers
Client name	Number of employees (full-time equivalent): Total	Number of employees: Women (full-time equivalent)	Number of senior managers: Total		Number of senior managers: Women	Number of customers: Total		Number of customers: Women

Q1109 Sector impacts

Please answer if company sector is…	Agriculture	Climate	Education	Energy	Energy	Health	Housing	ICT	Transportation	WASH
Client name	Number of local suppliers: Smallholder farmers	Scope 1 and 2 GHG emissions	Number of students enrolled	Amount of renewable energy produced (GWh)	Number of on- or off-grid connections supported	Number of patients served	Number of residential dwellings constructed or improved	Number of mobile or fixed data subscribers	Number of passengers served	Number of households with new or improved sanitation facilities

12. CUSTOMER DEMOGRAPHICS

The questions in this section will ask about the customers or clients reached by the Project during the Reporting Period. Results reported in Section 9 may also be reported here if applicable.

[IF no answer is selected for Q104, ASK 1201 - 1202]

Q1201 How many enterprises/other organizational customers did the Project reach? (NUMBER)

• [IF Q1201>0, ASK] Q1201A Number of women-owned/women-led enterprises (or women-owned/women-led organizational customers of other types) reached during the Reporting Period (NUMBER)

• [IF Q1201>0, ASK] Q1201B Number of small and medium enterprise (SME) customers or clients reached during the Reporting Period (NUMBER)

• [IF Q1201>0, ASK] Q1201C Number of microenterprises reached during the Reporting Period (NUMBER)

Q1202 How many individual customers (i.e., people and households) did the Project reach during the Reporting Period? (NUMBER)

• [IF Q1202>0, ASK] Q1203 Number of women customers or clients reached during the Reporting Period (NUMBER)

• [IF Q1202>0 OR Q104 = Any response, ASK] Q1203A Please describe the ways, if any, that the Project worked to support women during the Reporting Period. (OPEN-ENDED)

• [IF Q1202>0, ASK] Q1204 Number of rural customers or clients reached during the Reporting Period (NUMBER)

• [IF Q1202>0 OR Q104 = Any response, ASK] Q1204A Please describe the ways, if any, that the Project worked to support rural communities during the Reporting Period. (OPEN-ENDED)

• [IF Q1202>0, ASK] Q1205 Number of smallholder farmer customers or clients reached during the Reporting Period. (NUMBER)

• [IF Q1202>0 OR Q104 = Any response, ASK] Q1205A Please describe the ways, if any, that the Project worked to support smallholder farmers during the Reporting Period. (OPEN-ENDED)

• [IF Q1202>0, ASK] Q1206 Number of low-income customers or clients reached during the Reporting Period. (NUMBER)

• [IF Q1202>0 OR Q104 = Any response, ASK] Q1206A Please describe the ways, if any, that the Project worked to support low-income communities during the Reporting Period. (OPEN-ENDED)

• [IF Q1202>0, ASK] Q1207 Number of customers or clients from disadvantaged populations reached during the Reporting Period (other than those included above). (NUMBER)

• [IF Q1202>0 OR Q104 = Any response, ASK] Q1207A Please describe the ways, if any, that the Project worked to support other disadvantaged communities during the Reporting Period. (OPEN-ENDED)

• [IF Q1202>0 OR Q104 = Any response, ASK] Q1208 Number of customers receiving new access to the Project’s product or service during the Reporting Period. This should only be reported if the Project is able to track whether customers previously had access to the relevant product or service prior to accessing it from the Project. (NUMBER)

• [IF Q1202>0, ASK] Q1209 Number of customers receiving improved access to the Project’s product or service during the Reporting Period. This should only be reported if the Project is able to track the type of access customers previously had to the relevant product or service prior to accessing it from the Project. (NUMBER)

Q1210 Did the Project or the company managing the Project (i.e., the DFC client company) support any charitable activities to benefit the local community in which the Project operates during the Reporting Period? (Do NOT include the goods and/services the Project will produce for customers in the local community.) (SELECT ONE: Yes / No)

• [IF Q1210=YES, ASK] Q1210A How much money (in U.S. Dollars) was spent on these charitable activities during the Reporting Period? (DOLLARS)

Q1211 Please describe any other significant development impacts from the Reporting Period that you wish to share that are not reflected elsewhere in this survey. (OPEN-ENDED)

Representative Certification

I hereby represent the information provided in this document is complete and accurate to the best of my knowledge.
Name:	Date:	Telephone:      
Title:      		Email address:      

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