UECCC PROJECT IDENTIFICATION NOTE APPLICATION TEMPLATE Completed application template and supporting documentation to be submitted to: The Managing Director Uganda Energy Credit Capitalisation Company Amber House, Plot 29/33 Kampala Road, 3rd Floor, Block E P.O. Box 29725 Kampala Information for Nos. 1-13 shall be handed in as a written text document with reference to supporting documentation (page 6 + 7), which has to be enclosed in the application in the predefined order and numbered accordingly. Project Overview 1. Project Sponsor 2. Project Title 3. Project Summary (max. 150 words) Rationale for the project. Overview of project. Current status and timelines. 4. Corporate Data a) - Ownership and control Name of incorporation Date of incorporation Address (both Postal and Physical) Identification of shareholders Identification of directors Foreign/ institutional participation Other relevant businesses sponsors involved b) Management - Key managers 5. Project Description (brief summaries, based on existing planning documentation) a) - Technology and planning Location and access Brief technical description (key data) Basis and status of technical planning (feasibility studies, tenders etc.) b) Water availability/ Fuel and energy output calculations - Overview of water/ fuel/ other -1- UECCC PROJECT IDENTIFICATION NOTE - renewable source availability Basis for estimates (relevant studies) Expected annual energy output c) Status of permits and licences (w/o E+S/ RAP) - Overview of permits and licenses required (ERA, DWD, etc.) - Status of permit and license applications and outlook d) Land - Land required, acquisition or rental - Status and potential challenges e) - Grid interconnection issues distance from grid voltage level potential new construction/ reinforcements necessary financing arrangements 6. Environmental, Social and Resettlement issues a) Overview of key environmental and social issues associated with the project b) Overview of resettlement issues (if any) c) Overview of key health and safety issues (during construction and operation) d) Stakeholder Engagement Plan (SEP) e) Non Technical Summary (NTS) f) Overview of planned mitigation measures g) Outlines on: - Area of influence AoI - CHG emissions h) Permits and licenses - Overview of permits and licenses legally required - Status of applications (if any submitted) i) - Relevant studies conducted/ underway ESIA (consultant name, status) RAP (consultant name, status) -2- UECCC PROJECT IDENTIFICATION NOTE - Information on compliance with IFC Performance Standards Livelihood Restoration Framework LRF (consultant name, status) 7. Total Expected Project Cost - Basis for cost estimate (feasibility studies, tenders etc) 8. Budgeted annual running cost (fuel, O&M) - Cost of fuel - Maintenance cost - Operation cost Expenditure Category Project Development Costs Project Construction Costs Item description Land Access and site development Studies Legal Fees Other Sub-total Civil works Electro-Mechanical works Interest during construction Consulting fees Other Sub-total Project Financing Costs Sub-total Contingencies Sub-total Other Sub-total TOTAL Cost 8. Proposed Project Financing -3- Cost UECCC PROJECT IDENTIFICATION NOTE Finance Category Source Senior Debt Equity Other Total Financing 9. Financial and economic analysis a) What analyses have been conducted? - financial analysis - economic analysis - financial model b) - Key results project IRR EBITDA Debt service cover Sensitivity analysis (changes in construction costs -/+20%, changes in water/ fuel availability -/+20%) 10. Proposed implementation arrangements a) - Procurement arrangements EPC, single lots, etc. Procurement method Current status b) Construction oversight arrangements - Owner’s engineer - Other arrangements to ensure quality c) Contract management arrangements - Sponsor’s capacity - Legal advisory -4- Contribution UECCC PROJECT IDENTIFICATION NOTE 11. Proposed O&M arrangements 12. Current implementation status and next steps 13. Any other information deemed relevant Authorized signature Date -5- UECCC PROJECT IDENTIFICATION NOTE Supporting documentation to be submitted with the application template. If not all documents are available the applicant should briefly explain why. I. Legal 1. Certificate of Registration / Incorporation of the Company 2. Valid Memorandum and Articles of Association 3. Form of Directors and Secretaries 4. Official Annual Returns (if available and registered in Uganda) 5. Partnership / Joint Venture Agreement / Shareholder and Subscription Agreements (if applicable) 6. Shareholders/Directors Resolutions impacting on the Company operations and ownership 7. Title Deeds / Lease Agreement / Purchase contracts for sites or evidence of according efforts (minimum benchmark: detailed overview of necessary properties, owners, availability) 8. Available permits and licenses (ERA, DWD, NEMA, others) or according applications (Art. 34 EA (1999)) II. Technical 9. Pre-feasibility study report if available. 10. Assessment of power evacuation options (pre-feasibility) and initial costing of preferred option 11. Detailed design (if available) 12. Any other documents relevant for the assessment of the technical viability of the project and level of project preparation (e.g. additional hydrology analyses etc.) III. Financial 13. Audited annual statements for the past three years (for existing entities) 14. Flower letters (for debt and equity), draft term sheets for project financing (if available) 15. Financial Model Template if available. 16. Information regarding proposed structuring of the project (proposed security arrangements etc) IV. Organization and Management 17. Documentation on completed RE / Small Hydro projects in other less developed countries. 18. CV's of key management staff of project developer 19. Information regarding proposed implementation modalities Approach to project delivery (EPC, single lots, construction supervision) Approach to procurement for key contracts -6- UECCC PROJECT IDENTIFICATION NOTE V. Environmental and Social 20. Environmental and Social Impact Assessment (in compliance with IFC Performance Standards (2012) & IFC EHS Guidelines (2007)) 21. Environmental and Social Management Plan (in compliance with IFC Performance Standards (2012) & IFC EHS Guidelines (2007)) 22. Information about potential resettlement requirements, approach to resettlement proposed, and roadmap for resettlement act (including timeline for production of Resettlement Action Plan (RAP)) (in compliance with IFC Performance Standards (2012)) 23. Livelihood Restoration Framework (in compliance with IFC Performance Standards (2012)) -7-