THE WORLD B NK ONILAL * '4 ~;~r1''DOCUMENTS1 q v. Stefan G. Koeberle Country Director, Indonesia Letter No. CD-191/PNPM/VI/2012 June 20, 2012 Mr. Wicaksono Sarosa Kemitraan bagi Pembaruan Tata Pemerintahan (Kemitraan) 1. Wolter Monginsidi No. 3 Jakarta Selatan 12110 Indonesia Dear Mr. Sarosa: Re: PSF Grant No. TF099554-ID (PNPM Peduli Executing Organization: Kem itraan Project) Additional Instructions: Disbursement I refer to the Letter Agreement ("Agreement") between the Kemitraan bagi Pembaruan Tata Pemerintahan (the "Recipient") and the International Bank for Reconstruction and Development ("World Bank"), acting as administrator of grant funds provided by donors under the Support Facility for National Program for Community Empowerment (TF070967) ("PSF"), for the above-referenced project, dated June 30, 2011. The Agreement provides that the World Bank may issue additional instructions regarding the withdrawal of the proceeds of Grant No. TF099554-ID ("Grant"). This letter ("Disbursement Letter"), as revised from time to time, constitutes the additional instructions and amends the Disbursement Letters dated June 30, 2011 and December 9, 201 1by modifying the Supporting Documentation requirements, set out in Paragraph III i) below, to shift to Interim Financial Report based disbursement. The World Bank Dishursement Guidelines fir Projects, dated May 1, 2006, ("Disbursement Guidelines") (Attachment 1) are an integral part of the Disbursement 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 (i) Disbursement Methods (section 2). The following Disbursement Methods may be used under the Grant: * Reimbursement * Advance ISEB Tower 2. JI. Jend. Sudirman Kay. 52-53, Jakata 12190 * Telephone: (62-21) 5299 3000 * Facsimile: (62-21) 5299 3110 P.O. Box 1324/JKT Jakarta 10013 * Telex: IBRDIA 60086 * Headquarters: The World Bank, Washington DC, USA Mr. Wicaksono Sarosa 2 of 4 June 20. 2012 Kemitraan bagi Pembaruan Tata Pemerintahan (ii) Disbursement Deadline Date (subsection 3.7). The Disbursement Deadline Date is four (4) months after the Closing Date specified in the Grant Agreement. Any changes to this date will be notified by the World Bank. (iii) Disbursement Conditions (subsection 3.8). Please refer to the Disbursement Condition(s) in the Grant Agreement. II. Withdrawal of Grant Proceeds (i) Authorized Signatures (subsection 3.1). A letter in the Form attached (Attachment 2) should be furnished to the World Bank at the acdress indicated below providing the name(s) and specimen signature(s) of the official(s) authorized to sign Applications: The World Bank Office Jakarta (WBOJ) Jakarta Stock Exchange Building, Tower 2, 1 2th Floor JI. Jenderal Sudirman Kay. 52-53, Jakarta 12190, Indonesia Attention: Country Director (i) Applications (subsections 3.2 - 3.3). Please provide completed and signed applications for withdrawal, together with supporting doc aments, to the address indicated below: The World Bank Office Jakarta (WBOJ) Jakarta Stock Exchange Building. Tower 2, 12th Floor A1. Jenderal Sudirman Kay. 52-53, Jakarta 12190, Indonesia Attention: Disbursement Team (iii) Electronic Delivery (subsection 3.4) The World Bank may permit the Recipient to electronically deliver to the World Batik Applications (with supporting documents) through the World Bank's Client Connection, web-ba.sed portal. The option to deliver Applications to the World Bank by electronic means may be effected if: (a) the Recipient has designated in writing, pursuant to the terms of subparagraph (i) of this Section, its officials who are authorized to sign and deliver Applications and to receive secure identification devices ("Tokens") from the World Bank for the purpose of delivering such Applications by electronic means; and (b) all such officials designated by the Recipient have registered as users of Client Connection. If the World Bank agrees, the World Bank will provide the Recipient with Tokens for the designated officials. Following which, the designated officials may deliver Applications electronically by completing Form 2380, which is accessible through Client Connection (https::/clientconnection.worldbank.org). The Recipient may continue to exercise the option of preparing and delivering Applications in paper form. The World Bank reserves the right and may, in its sole discretion, temporarily or permanently disallow the electronic delivery of Applications by the Recipient. ISEB Tower 2, JI. Jend. Sudirman Kay. 52-53. Jakarta 12190 * Telephone: (62-21) 5299 3000 * Facsimile: (62-21) 5299 3110 P.O. Box 1324/JKT Jakarta 10013 * Telex: IERDIA 60086 * Headquarters: The World Bank. Washington DC, USA Mr. Wicaksono Sarosa 3 of 4 June 20. 2012 Kemitraan bagi Pembaruan Tata Pemerintahan (iv) Terms and Conditions of Use of Tokens to Process Applications. By designating officials to accept Tokens and by choosing to deliver the Applications electronically, the Recipient confirms through the authorized signatory letter its agreement to: (a) abide by the Terms and Conditions of Use of Secure Identification Devices ii connection with Use of Electronic Means to Process Applications and Supporting Documentation ("Terms and Conditions of Use of Tokens") provided in Attachment 3; and (b) to deliver the Ternts and Conditions of Use of Tokens to each such official and to cause such official to abide by those terms and conditions. (v) Minimum Value of Applications (subsection 3.5). The Minimum Value of Applications for reimbursement is 20% of advance to the designated account. (vi) Advances (sections 5 and 6). * Type of Designated Account (subsection 5.3).: Segregated. * Currency of Designated 4ccount (subsection 5.4). Indonesian Rupiah (IDR). * Financial Institution at which the Designated Account Will Be Opened (subsection 5.5): Bank Rakyat Indonesia or a commercial bank/financial institution acceptable to the World Bank. * Ceiling (subsection 6.1): Forecast for 2 quarters as provided in the quarterly Interim Financial Report. III. Reporting on Use of Grant Proceeds (i) Supporting Documentation (section 4). Supporting documentation should be provided with each application for withdrawal as set out below: * For requests for Reimbursement. o Interim Financial Report n the form attached (Attachment 4) * For reporting eligible expenditures paid from the Designated Account: o Interim Financial Report .n the form attached (Attachment 4). (ii) Frequency of Reporting Eligible Expenditures Paid from the Designated Account (subsection 6.3): The period set out in the Grant Agreement for provision of Interim Financial Reports, i.e. quarterly. (iii) Other Supporting Documentation Instructions: Copies of bank statement of the designated account should be attached to the application for withdrawal for replenishment of the designated account. ISEB Tower 2, JL Jend Sudirman Kay. 52-53, Jakat-a 12190 * Telephone: (62-21) 5299 3000 * Facsimile: (62-21) 5299 3110 PO. Box 1324/JKT Jakarta 10013 * Telex: IBRDIA 60086 * Headquarters: The World Bank. Washington DC, USA Mr. Wicaksono Sarosa 4 of 4 June 20, 2012 Kemitraan bagi Pembaruan Tata Pemerintahan IV. Other Important Information For additional information on disbursement arrangements, please refer to the Disbursement Handbook available on the World Bank's public website at https://www.worldbank.ore and its secure website "Client Connection" at https.//clientconnection.worldbank. oro. Print copies are available upon request. If you have not already done so, the World Bank recommends that you register as a user of the Client Connection website (https://clientconnection.worldbank.org). From this website you will be able to download Applications, monitor the near real-time status of the Grant, and retrieve related policy, financial, and procurement information. All Recipient officials authorized to sign and deliver Applications by electronic means are required to register with Client Connection before electronic delivery can be effected. For more information about the website and registration arrangements, please contact the World Bank by email at . If you have any queries in relaton to the above, please contact Chau-Ching Shen, Senior Finance Officer at loaeap(a worldbank.rg or the Disbursement Team in WBOJ using the above reference. Yours sincerely, Stefan G. Koeberle Country Director, Indonesia Attachments 1. World Bank Disbursement Guidelines. fbr Projects, dated May 1, 2006 04, (2. Form for Authorized Signatures )6. Terms and Conditions of Use of Secure Identification Devices in connection with Use of Electronic Means to Process Applications and Supporting Documentation, dated January 20, 2010 4. Interim Financial Report ISEB Tower 2. J. Jend. Sudirman Kay. 52-53, Jakarta 12190 * Telephone: (62-21) 5299 3000 * Facsimile. (62-21) 5299 3110 P.O. Box 1324/JKT Jakarta 10013 * Telex: IERDIA 60086 * Headquarters: The World Bank, Washington DC, USA Attachment 2 [Letterhead] Kemitraan bagi Pembaruan Tata Pemerintahan [Street address] [City] [Country] [DATE] The World Bank Office Jakarta Jakarta Stock Exchange Building, Tower 2, 1 2th Floor Jl. Jenderal Sudirman Kay. 52-53, Jakarta 12190, Indonesia Attention: [Country Director] Dear [Country Director]: Re: PSF Grant No. TF099554-ID (PNPM Peduli Executing Organization: Kemitraan Project) I refer to the Letter Agreement ("Agreement") between the Kemitraan bagi Pembaruan Tata Pemerintahan (the "Recipient") and the International Bank for Reconstruction and Development ("World Bank"), acting as administrator of grant funds provided by donors under the Support Facility for National Program for Community Empowerment (TF070967) ("PSF"), dated June 30, 2011, providing the above Grant. For the purposes of Section 3.04 (b) of the Standard 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 under this Grant. For the purpose of delivering Applications to the World Bank, '[each] of the persons whose authenticated specimen signatures appears below is authorized on behalf of the Recipient, acting 3[individually] 4ointly], to deliver Applications, and evidence in support thereof on the terms and conditions specified by the World Bank. Instruction to the Recipient when sending this lettei to the World Bank: Stipulate if more than one person needs to sign Applications, and how many or which positions, and if any thresholds apply. Please delete this.footnote in final letter that is sent to the World Bank. Instruction to the Recipient: Stipulate if more than one person needs to jointlY sign Applications, if so, please indicate the actual number. Please delete this footnote in final letter tha, is sent to the World Bank. 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 this,footnote in final letter that is sent to the World Bank. Instruction to the Recipient: Use this bracket only f several individuals must jointly sign each Application; if this is not applicable, please delete. Please delete this footnote in final letter that is sent to the World Bank. '[This confirms that the Recipien is authorizing such persons to accept Tokens and to deliver the Applications and supporting documents to the World Bank by electronic means. In full recognition that the World Bank shall rely upon such representations and warranties, including without limitation, the representations and warranties contained in the Terms and Conditions qf Use of Secure Identification Devices in connection with Use of Electronic Means to Process Applications and Supporting Documentation ("Terms and Conditions of Use of Tokens"), the Recipient represents and warrants to the World Bank that it will deliver to each such person a copy of the Terms and Conditions of Use of Tokens and will cause such persons to abide by those terms and conditions.] This Authorization replaces and supersedes any Authorization currently in the World Bank records with respect to this Agreement. [Name], [position] Specimen Signature: [Name], [position] Specimen Signature: [Name], [position] Specimen Signature: Yours truly, / signed / [Position] Instruction to the Recipient: Add this paragraph if the Recipient wishes to authorize the listed persons to accept Tokens and to deliver Applications by electronic means, if this is nt applicable, please delete the paragraph. Please delete this footnote in final letter that is sent to the World Bank. Attachment 3 Terms and Conditions of Use of Secure Identification Devices in connection with Use of Electronic Means to Process Applications and Supporting Documentation January 20, 2010 The World Bank (Bank)6 will provide secure identification devices (Tokens) to permit the Borrower to deliver applications for withdrawal and applications for special commitments under the Agreement(s) and supporting documentation (such applications and supporting documentation together referred to in these Terms and Conditions of Use as Applications) to the Bank electronically, on the terms and conditions of use specified herein. A. Identification of Users. 1. The Borrower will be required to identify in a completed Authorized Signatory Letter (ASL) duly delivered to and received by the Bank each person who will be authorized to deliver Applications. The Bank will provide Tokens to each person identified in the ASL (Signatory), as provided below. The Borrower shall also immediately notify the Bank if a Signatory is no longer authorized by the Borrower to act as a Signatory. 2. Each Signatory must register as a user on the Bank's Client Connection (CC) website (https://clientconnection.worldbaik.org ) prior to delivery of Tokens. Registration on CC will require that the Signatory establish a CC password (CC Password). The Signatory shall not reveal his/her CC Password :o anyone or store or record the CC Password in written or other form. Upon registration as a CC user, the Signatory will be assigned a unique identifying account name. B. Distribution, Initialization and Return of Tokens. 1. The Bank will physically deliver a Token to each Signatory in a manner to be determined by and satisfactory to the Bank. 2. At the time of delivery of a Token to a Signatory, the Signatory will receive a copy of these Terms and Conditions of Use for purposes of initializing the Token. 3. The Bank will verify that the Token, Temporary Password and Terms and Conditions of Use have been duly delivered to and received by the CC User. 4. Promptly upon receipt of the Token and Terms and Conditions of Use, the Signatory will access CC using his/her account name and CC Password and register his/her Token and set a 6 "Bank" includes IBRD and IDA. '"Borrower" includes the borrower of an IBRD loan, IDA credit. or Project Preparation Facility advance and the recipient of a grant. personal identification number (PIN) to be used in connection with the use of his/her Token, after which the Token will be iniialized for use by the Signatory exclusively for purposes of delivering Applications. Upon initialization of the Token, the Signatory will be a "Token User". The Bank will maintain in its database a user account (Account) for each Token User for purposes of managing the Token of the Token User. Neither the Borrower nor the Token User will have any access to the Account. 5. Prior to first use of the Token by the Token User for delivering Applications, the Borrower shall ensure that the Token User has received training materials provided by the Bank in use of the Token. 6. Tokens shall be promptly returned to the Bank upon request of the Bank. C. Management of Tokens. 1 . Tokens will remain the property of the Bank. 2. Use of the Token is strictly limited to use in the delivery of Applications by the Token User in the manner prescribed by the Bank in the Agreement(s) and these Terms and Conditions. Any other use of the Token is prohibited. 3. The Bank assumes no responsibility or liability whatsoever for any misuse of the Token by the Token User, other representatives of the Borrower, or third parties. 4. The Borrower undertakes to ensure, and represents and warrants to the Bank (such representation and warranty being expressly relied upon by the Bank in delivery of a Token to each Token User) that each Token User is provided, understands and will abide by, these Terms and Conditions of Use, including without limitation the following: Security 4.1. The Token User shall no reveal his/her PIN to anyone or store or record the PIN in written or other form. 4.2. The Token User shall -ot allow anyone else to utilize a Token to deliver an Application to the Bank. 4.3. The Token User shall always logout from CC when not using the system. Failure to logout properly can create a route into the system that is unprotected. 4.4. If the Token User believes a third party has learned his/her PIN or has lost his/her Token he/she shall immediately notify clientconnection( worldbank.org. 4.5. The Borrower shall immediately notify the Bank at clientconnectiona/wodbank.org of any lost, stolen or compromised Tokens, and take other reasonable steps to ensure such Tokens are disabled immediately. Care of Tokens 4.6. Tokens contain delicate and sophisticated instrumentation and therefore should be handled with due care, and should not be immersed in liquids, exposed to extreme temperatures, crushed or bent. Also, Tokens should be kept more than five (5) cm from devices that generate electromagnetic radiation (EMR), such as mobile phones, phone- enabled PDAs, smart phones and other similar devices. Tokens should be carried and stored separate from any EMR device. At close range (less than 5 cm), these devices can output high levels of EMR that can in:erfere with the proper operation of electronic equipment, including the Token. 4.7 Without derogating from these Terms and Conditions of Use, other technical instructions on the proper use and care Tokens are available at http://www.rsa.com. 5. Replacement 5.1. Lost, damaged, compromised (in terms of 4.5, above) or destroyed Tokens will be replaced at the expense of the BorTower. 5.2. The Bank reserves the right, in its sole discretion, not to replace any Token in the case of misuse, or not to reactivate a Token User's Account 6. Reservation of Right to disable Token 6.1. The Borrower shall reserve the right to revoke the authorization of a Token User to use a Token for any reason. 6.2. The Bank reserves the right, in its sole discretion, to temporarily or permanently disable a Token, de-activate a Token User's Account or both.