OFFICIAL DOCUMENTS THE WORLD BANK I WORLDBANKGROUP Date: 08/26/221 His Excellency Issa Doubragne Minister of Economy and Development Planning B.P. 286 N'Djamena Republic of Chad Re: Health System Performance Strengthening Project Global Financing Facility Grant No. TF0B5488 Additional Instructions: Disbursement and Financial Information Letter Excellency: I refer to the Grant Agreement ("Agreement") between the INTERNATIONAL DEVELOPMENT ASSOCIATION] ("World Bank"), acting as administrator of grant funds provided by the GLOBAL FINANCING FACILITY GRANT for the Health System Performance Strengthening Project ("Donor") and Republic of Chad (the "Recipient") for the above-referenced project. The Standard Conditions, as defined in the Grant Agreement provides that the World Bank may issue additional instructions regarding the withdrawal of the proceeds of Grant TFOB5488 ("Grant").") and may set out Project specific financial reporting requirements. This letter ("Disbursement and Financial Information Letter"), as revised from time to time, constitutes such additional instructions. I. Disbursement Arrangements and Withdrawal of Grant Funds The World Bank Disbursement Guidelines for Projects, dated February 1, 2017, ("Disbursement Guidelines") are available in the World Bank's public website at .ts://ww.worldbank.org, and are an integral part of the Disbursement and Financial Information Letter. The manner in which the provisions in the Disbursement Guidelines apply to the Grant is specified below. Sections and subsections in parentheses below refer to the relevant sections and subsections in the Disbursement Guidelines and, unless otherwise defined in this letter, the capitalized terms used have the meanings ascribed to them in the Disbursement Guidelines. (i) Disbursement Arrangements The table in Schedule 1 provides the disbursement methods which may be used by the Recipient, information on registration of authorized signatures, processing of withdrawal applications (including minimum value of applications and advances), instructions on supporting documentation, and frequency of reporting on the Designated Account. (ii) Withdrawal of Grant Funds (Electronic Delivery) Section 7.01(c) of the Standard Conditions. The Recipient shall deliver Withdrawal Applications (with supporting documents) electronically through the World Bank's web-based portal "Client Connection" at https: /clientconnection.worldbank.ore. This option will be effected after the officials designated -2- in writing by the Recipient who are authorized to sign and deliver Withdrawal Applications have registered as users of "Client Connection". The designated officials shall deliver Withdrawal Applications electronically by completing the Form 2380, which is accessible through "Client Connection". By signing the Authorized Signatory Letter, the Recipient confirms that it is authorizing such persons to accept Secure Identification Credentials (SIDC) and to deliver the Withdrawal Applications and supporting documents to the World Bank by electronic means. The Recipient may exercise the option of preparing and delivering Withdrawal Applications in paper form on exceptional cases (including those where the Recipient encounters legal limitations), and which were previously agreed with the World Bank. By designating officials to use SIDC, the Recipient confirms through the authorized signatory letter its agreement to: (a) abide by the Terms and Conditions of Use of Secure Identification Credentials in connection with Use of Electronic Means to Process Withdrawal Applications and Supporting Documentation, available in the World Bank's public website at httos: woridbank.org and "Client Connection"; and (b) to cause such official to abide by those terms and conditions. II. Financial Reports and Audits. Section 2.07 (a) and (b) of the Standard Conditions. (i) Financial Reports.-The Recipient must prepare and furmish to the Bank not later than forty-five (45) days after the end of each calendar quarter, interim unaudited financial reports ("IFR") for the Project covering the quarter (ii) Audits. Each audit of the Project Financial Statements shall cover the period of one fiscal year of the Recipient, commencing with the fiscal year in which the first withdrawal was made. The audited Financial Statements for each such period must be furnished to the Bank not later than six (6) months after the end of such period. III. Other Important Information For additional information on disbursement arrangements, please refer to the Loan Handbook available on the World Bank's website (htt- !www.worldbank.org) and "Client Connection". The World Bank recommends that you register as a user of "Client Connection". From this website you will be able to prepare and deliver Withdrawal Applications, monitor the near real-time status of the Grant, and retrieve related policy, financial, and procurement information. For more information about the website and registration arrangements, or if you have any queries in relation to the above, please contact the World Bank by email at AskLoans.)WorldBank.or using the above reference. Yours sincerely, P.. Cl ra Ana Coutinho de Sousa Country Director for Republic of Chad Africa Region Attachments 1. Form of Authorized Signatory Letter. 2. Form of Statement of Expenditure (SOE). 3. SOE for PBF. N N N ° у � R" О � � aoi й �r о Г-¢г. � °� '� с�б с�б о и U ° о °� ; � � � � о s.a�, о � � � С� � � �'' 4"� �г� �' � �' ° а-. гл Q� N Q,' N СС о о N (Ч ¢ У � +"С-' � +"о-' 'L� N О О Я ' � � � � .� 'б � 'б � р" 'б N ° О р �� О У О � О U,� > � о.., .� :.. '� н 'о ° и � у � р Q" N Я" N О О Rч О � и � Lт� U сб t1, � �. И �(г� О � � � � к м С7 оо � О.7t о н о �., .� Gгr Гт., у,� � N �' `-- 4"' 40у �+.' Ч� ° Q� д Q V U +' � l� ь ch � у ° N к Г1ч Гir о..С � с�б ;; �А�.,� уд: � � � � Г�U U � 3и й А � а� о ° � .'�с ^ � ^ "� � '_" °° i� � °'' � W й W aoi � � aoi с о �, ::+ о м р г,. р р. r о, ° о ��,а `,,,,° ta �r и к и к ti� ° и� �, ... W � W о, � � U А А гл � а°i д_ � ш ч., ,...а и ч-, ,�.� U U д '"�' � и � о � о w � о w м � � � � �' � t' .о о °° � о р о д � � д о '> д�� р., �'� д., �'� р й пt .'�' �' °�' �' R ,о • а оигл W й о W йwо ,n й й и А" +'' О N у �;, v О ..� � � � � � О � 'б еС 'б Q Q . 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L с�.� � ,S �U �+ � N � �, ti 3 � � �, � � , � � � U � � � о � .� о .о �, � �3 и О � й � О О � � '� 3 и �� b � ���� � эЁ � � �й .� � О ,S� * А -о � •� � о `''� � о a�i � � � й . � � оод о � ci .� � � ^' � t' � � ..б Q о�. м � � � '� . ° � � s�. � 'S � й � _й U � й О .., � �..� Г�G U � V сб 'б � � U .,�''� � � V р � � р � �O �~ 3��'� � о й �� � �'�^'� � � �� Е-� с� Z Q ° � � о � � � � � г�.. °л �? ¢ о � w � � � � � 3 .о � � � о � �ёв � '� •С.> о � .� 3 � � Q й д U -5- Attachment 1 Form of Authorized Signatory Letter [Letterhead] Ministry of Finance [Street address] [City] [Country] [DATE] International Development Association 1818 H Street, N.W. Washington, D.C. 20433 United States of America Re: GFF Grant No. TFOB5488 (Health System Performance Strengthening Project) Attention: Ms Clara Ana Coutinho de Sousa, Country Director I refer to the Grant Agreement ("Agreement") between the International Development Association (the "Association") and the Republic of Chad (the "Recipient"), dated -. providing the above Grant. For the purposes of Section 2.03 of the General Conditions as defined in the Agreement, any '[one] of the persons whose authenticated specimen signatures appear below is authorized on behalf of the Recipient to sign applications for withdrawal [and applications for a special commitment] under this Grant. For the purpose of delivering Applications to the Association, including by electronic means, 2[each] of the persons whose authenticated specimen signatures appears below is authorized on behalf of the Recipient, acting 3[individually] 4[jointly], to deliver Applications, and evidence in support thereof on the terms and conditions specified by the Association. I Instruction to the Recipient: stipulate if more than one person needs to sign Applications, and how many or which positions, and if any thresholds apply. Please delete thisfootnote infinal letter that is sent to the Association. I Instruction to the Recipient: stipulate if more than one person needs tojointly sign Applications, if so, please indicate the actual number. Please delete thisfootnote infinal letter that is sent to the Association. ' Instruction to the Recipient: use this bracket if any one of the authorized persons may sign; if this is not applicable, please delete. Please delete thisfoolnote infinal letter that is sent to the Association. I Instruction to the Recipient: use this bracket only if several individuals must jointly sign each Application; if this is not applicable, please delete. Please delete thisfootnote infinal letter that is sent to the Association. -6- This Authorization replaces and supersedes any Authorization currently in the Association records with respect to this Agreement. [Name], [position] Specimen Signature: [Name], [position] Specimen Signature: [Name], [position] Specimen Signature: Yours truly, / signed / N а+ 3 ы N � 7 С � .�.� С �" � t" .ч 7о = р� � � Яу"'.в '_' ." 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L"�ч И а� �О О о � 3 3 а R а, cs � � о о иZ � о � `о `о � � о � Р. � � ~ ы z � � U] И � -8- Attachment 3 Customized Statement of Expenditure Category 2 IDA Grant No. GFF Grant No. Customized Statement of Expenditures for PBF Payments of the Project Category - Period: DD/MN4/YY to DD/MM/YY The World Bank APPLICATION FOR WITHDRAWAL STATEMENT OF EXPENDITURES - CUSTOMIZED (SOE), 1 2 3 4 5 6 7 8 9 10 0 0 7 4. .2 g 0 Amount Name and Agreement No. & Brief Amount Payment Z Paid from 675 overed by bb request Eligible Address of Date (or other Description of c a. Designated Beneficiary ref. Activities t Cd application for Financing Account :Z PL4 U TOTALS Supporting documents for this Customized SOE retained at:(insert location)