OFFICIAL DOCUMENTS THE WORLD BANK IBRD*IDA I WORLDBANKGROUP December 5, 2017 Mr. Le Minh Hung Governor State Bank of Vietnam Hanoi, Vietnam Excellency, Re: PHRD Grant No. TF0A5252 MARD M&E Capacity Building for Agricultural Restructuring Plan Implementation Project Additional Instructions: Disbursement I refer to the Letter Agreement ("Agreement") between Socialist Republic of Vietnam ("Recipient"), and the International Bank for Reconstruction and Development ("World Bank"), acting as administrator of grant funds provided by Japan ("Donor") under the Japan Policy and Human Resources Development Fund, dated December 5, 2017. The Agreement provides that the World Bank may issue additional instructions regarding the withdrawal of the proceeds of Grant TF0A5252 ("Grant"). This letter ("Disbursement Letter"), as revised from time to time, constitutes the additional instructions. The attached World Bank Disbursement Guidelines for Investment Project Financing, dated February 2017, ("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 * Advances * Direct Payment * Special Commitments (ii) Disbursement Deadline Date (subsection 3.7). The Disbursement Deadline Date is 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 Withdrawal Condition(s) in Section 3.02 of 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 address indicated below providing the name(s) and specimen signature(s) of the official(s) authorized to submit Applications: The World Bank 8th Floor 63 Ly Thai To Street Ha Noi, Vietnam Attention: Country Director-Vietnam (ii) Applications (subsections 3.2- 3.3). Please provide completed (a) applications for withdrawal, together with supporting documents, (b) applications for special commitments, together with a copy of the commercial bank letter of credit through the World Bank's Client Connection, web-based portal, following the instructions for electronic delivery. In the case the recipient does not have internet access, the World Bank may permit the delivery of applications for withdrawal, together with supporting documents and applications for special commitments, together with a copy of the commercial bank letter of credit, in accordance with subsection 3.3, to the following address: The World Bank, 26th Floor, One Global Place 5h Avenue Corner, 25h Street, Bonifacio Global City Taguig City, Philippines Attention: Loan Department, (iii) Electronic Delivery (subsection 3.4) The World Bank may permit the Recipient to electronically deliver to the Association Applications (with supporting documents) through the Association's Client Connection, web-based 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 credentials ("SIDC") 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 SIDC 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.or). 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. (iv) Terms and Conditions of Use of SIDC to Process Applications. By designating officials to accept SIDC 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 Credentials in connection with Use of Electronic Means to Process Applications and Supporting Documentation ("Terms and Conditions of Use of SIDC") provided in Attachment [3]; and (b) to deliver the Terms and Conditions of Use of SIDC to each such official and to cause such official to abide by those terms and conditions. 2 (v) Minimum Value of Applications (subsection 3.5). The Minimum Value of Applications for Reimbursements and Direct Payments is USD 50,000 (vi) Advances (sections 5 and 6) * Type ofDesignated Account[s] (Subsection 5.3): Segregated, * Currency of DesignatedAccount[s] (subsection 5.4): USD * Financial Institution at which the Designated Account[s] Will Be Opened (subsection 5.5): Financial institution acceptable to the World Bank Ceiling (subsection 6.1): USD 200,000 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 List of payments against contracts that are subject to the World Bank's prior review, in the form attached (Attachment 5); o Records evidencing eligible expenditures (e.g., copies of receipts, supplier invoices) for payments against contracts subject to the World Bank's prior review; and o Statement of Expenditure in the form attached for all other payments/ contracts (Attachment 4). * For reporting eligible expenditures paid from the Designated Account o Statement of Expenditure in the form attached (Attachment 4) o Records evidencing eligible expenditures (e.g., copies of receipts, supplier invoices) for payments against contracts subject to The World Bank's Prior review; o List of payments against contracts that are subject to the World Bank's prior review, in the form attached (Attachment 5); and, o A reconciliation of the Designated Account, in the form attached (Attachment 6), with a copy of the bank statement. * For requess for Direct Payment: records evidencing eligible expenditures(e.g., copies of receipts, supplier invoices) for amounts above the Minimum Value of Applications. * For requests for Special Commitment: Letter of credit and a copy of Pro-forma invoice (ii) Frequency of Reporting Eligible Expenditures Paid from the Designated Account (subsection 6.3): Quarterly 3 IV. Other Disbursement Instructions: NIL V. 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.org and its secure website "Client Connection" at https://clientconnection.worldbank.org. Print copies are available upon request. From the Client Connection 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. 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.or). 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 affected. For more information about the website and registration arrangements, please contact the World Bank by email at . If you have any queries in relation to the above, please contact WFALD-TF by sending an email to WFALD-tf@worldbank.org and using the trust fund number as a reference. Very truly yours, INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT/INTERNATIONAL DEVELOPMENT ASSOCIATION By Ousmane Dione Country Director, Vietnam East Asia and Pacific Region Attachments 1. World Bank Disbursement Guidelines for Investment Project Financing, dated February, 2017 2. Form for Authorized Signatures 3. Terms and Conditions of Use ofSecure Identification Credentials in connection with Use of Electronic Means to Process Applications and Supporting Documentation, dated March 1, 2013 4. Form of Statement of Expenditures 5. Form of Payments Against Contracts Subject to the World Bank's Prior Review 6. Designated Account Reconciliation Statement 4 Attachment [11 Disbursement Guidelines for Investment Project Financing February 2017 WORLD BANK GROUP 5 CONTENTS PAGE 1. Purpose 1 2. Disbursement Methods 1 3. Withdrawal of Funds from Financing Accoast 2 4. Supporting Documentation Requirements 3 5. Designated Accounts 4 6. Terms and Conditions Applicable to Advances 6 7. Ineligible Expenditures 7 8. Refunds 8 6 dit 3041111111ii 1a l11 (a) R oimbnrem~nt The Wad Bak may renn wrse the bmuower far expenditures fil bfe for =ning pusuant to the Financing Ageent (eh~le expendtenes) thet the boower has prehn~ared from its own resouce. (b) Adewncr- The Wod Bak my advane funds from ihe Finming Accout into a Deiaed Accmt of the boarower to flmnce eligib pendihus fhey me ned and fr which supportng docknents will be provided at a l dete (see sectio 5, Desipaed Acou~ts). (c) Dir~e Pkyment The Wad Bak may make payns e at the borrower's request directly to a ~hird pry (for ~apie, spher, contactor, or conultat) fir egie epMdihues. (d) Spcial Condenmt The Wad Bak may pay amns to a third paty for eigible epeedä~mes under special commioms e~tred into. in wring, at he borowr's request md on t dm conditions agreed between fhe Wofd Bak and he boaowu . 3. Wilthdrawal of F~mds fro the F-ma~ng Accouat 3.1 A nrzed Signaturs. Befare fd frm the Financing Account may be withdiawn or commna the authoaied aeesenheive of the borro er (as deignae~d in the Finaning Agree ent) most himi to dhe Wodd Bak, electronically through the Cient Connection website (httpJ/elienromecinmwnriOaa R) or through an authozed ignatary ä ~ eignatinn lete, fr ane(s) of the ofcial(s) antiäd (a) to sign and uit applications fr widåawal amd applications for a special eomm ent (coectively, Applicatiom), d (b) to receive Secure Ideubficition Credehte (SIDC) from fe Wodd Bmnk. The bonow ms noify fhe World Bak of any change n sigature ant~enty, ewerectrnicaly n Cient Conection or drough an updated authouized signatry *esignatinn letr 3.2 Tems and Cmditions of Use of Se~ure Identficaden Credentidh (SDC) to Process .pplicadons. By desigatng oficials to use SIDC and by choosmg to sub~it the applications electricaly, the bo~ower cnlnfis its apeem~ to abide by fr tes a nditios of use of SIDC. 3.3 Appications. Applicens t be povided to the Wodd Bak n sudh form as is reqmred to access frm tr Fimming Accont and mst melude mc infoamation as the World Bank may rehsonaly request. 3.4 Applications ad necessary supporting docamn s (see section 4 Supporing Docuanentaton Requerments) should be subifm to the Word Bank electronically, in a T=ns d cm&diios fme of SIDC m puan då Disnhme t LÉer. 8 ~jI J! 'ijJi~jiii iiCi I I I ~ f ~iii tL a 4.2 For special comena the coninecial bank povides its cm m~tim directly to the Wodd Bank that conditions for the reease of p ~ets coum=iited for withdrawal have been met 43 TIpes of Sä~prdng Dornmenation. The Woffd Bu keqmres eidber copies of he nigi-t dc-nes evidecing eligible ezpEmdi~ues (Recors) or y reports of expenit - (SEnuy Repors) in soch fom and mnce s the Wmdd Bak may specify. Record in-ude wch docn~ as inmvoices and receipts. A Stanny Report may be either (a) Ih ietu~m unfudited r~ini report reqmred under the Fmecng Agreenant (Interin Flwncia Report) or (b) a s.aet of expendit m nwiz-ng eligible expenditures p dming a stated period (Stamnen of Expenditure). la aU cases, the bosrow is respoble fr retaimng the origina docenents eviAencing eigible expenditures andm.ring dem mvuilable for audit or inpedco 4.4 The Word Buk desems the types of suppftfg docuxnestinn that the boBwer Eust pvIlde, takig into consideration the disbuew~mt nefod sed. mhe suplporing docaene i may be the folowing: (a) For ~pp~caimns for Reimburseen~t (i) lemn Fin~rial Reports, (n) Sante=~ ofExpenditure, or (iii) Records (b) For r~prring m the use of diancem: (i) item Finanrial R~epors, (i) Statmenuts ofEpmnditure, or (iii) Records (c) For ppf~catins for Dirmct PapNemti: (i) Records smch as cpies of supplier avoies; (ii) a bank guarantee fr adve or retention payem~t (d) For apicadens for SecaI Comitment Copy of fh Letter of Credit (with vahd epiy date) that te cumercial bak, known as the opemng baik, has issued. For paynt, a SWF (Society fr Woddwide hInerbask T-1-elo nnication) messge sut be sen by the com cial bk;and (e) Any o~her supporting drKmentatin that the Word Bank may mest by notice to the borower or as specifed in the Disburement 1~tler. 4.5 Faihre te Pénde.4mndr Fjancial Sgatements. If the borrower fils to provide acy of the andted fnammsate ans reqered in accordance with, and within th period of tim specifled in the Finemcing Agrement the Wodd Bank may, at its discretion, decide not to accept application fr withdrawal supported by Sumnary Rnports, even if suchreports me acco.nm e by Records. 5. Desigated Accomats 10 . &＇·’〕’〕“〕〕’〕〕〕〕〕〕〕〕〕’〕〕！〕〕‘〕〕〕！〕〕〕〕〕 計J 勵‘ い 価 へ 『り 1H ----,--------------;---------------，・ 們〕 州 〕〕！〕〕〕〕〕〕―〕〕〕〕〕〕〕；！〕！―〕〕〕〕〕〕，〕！.1！〕l- . 72 Inofigiblé Expoidiftwes Poidftom the D~ WAccmnt If the Wodd Bwk "PIP ~ ~ any pay~ cot of du Deå~ Ac~ was not ~ by the en~ finn~ to die Wodd Bwk ar was ~ fer m m~ expendam the WaM Bwk may, at ib duc~ m~ Ihe bcaoww to Ww om cf the foflowff (a) ft~ Ihe add~ mdmm m~ by ihe WmW Bak (b) De~ m equiv~ oma= into the Deå~ Acc~ (c) Refund an «~ am~ to the WaM Buk (d) Excep~ p~ =~ doc=co~ ev~ ogend~ Tbc bcaower ~ peffmm tbc act~ ~ed pmipdy ~ mmmmg ~akm kom the WmW Buk dat it do so. & I~ds 8.1 B~ w DocHom ta JL*nd The bmmw ~ q= a~ to the Wodd r~ aU m any ammat of Ihe km an de~ m die Den~ Acconet to the WcM Bwk for amM to the Fmum=g Am~ 82 Consegnence of RefinK The Wodd Dwk wh~ refon& to the Wodd Bwk in wroubmcc wilk sw~ 6 =d 7 =d s*s~ 8. 1 of ~ wiff be c~ to the F~cmg Acc~ Re~ of ~ ~ the ~cing Acc~ may ~ m (a) uff tenn=t~ fees (b) ~~ cmU for ammaft fir Ihe mterest nk bam at ca~ bes been con~ at h~ (c) both. 83 Other JUgknand O~ ons Vmoff~ bi- ReftiNK Rdnäh of km ana~ do = a~ odw legg ägtk =d obhp~ of die pa~ the Fåowing Apeement- 14 Attachment 121 [Letterhead] [Street address] [City] [Country] [DATE] The World Bank 8th Floor 63 Ly Thai To Street Ha Noi, Vietnam Attention: [Country Director] Dear [Country Director]: Re: PHRD Grant No. TF05252 MARD M&E Capacity Building for Agricultutral Restructuring Plan Implementation Project Additional Instructions: Disbursement I refer to the Letter Agreement ("Agreement") between Socialist Republic of Vietnam ("Recipient"), and the International Bank for Reconstruction and Development ("World Bank"), acting as administrator of grant funds provided by Japan ("Donor") under the Japan Policy and Human Resources Development Fund, dated December 5, 2017. The Agreement provides that the World Bank may issue additional instructions regarding the withdrawal of the proceeds of Grant TF05252 ("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, 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 World Bank. 5[This confirms that the Recipient is authorizing such persons to accept Secure Identification Credentials (SIDC) and to deliver the Applications and supporting documents to the World Bank by 1 Instruction to the Recipient when sending this letter 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. 2 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 that 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. 4 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 this footnote in final letter that is sent to the World Bank. s 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 not applicable, please delete the paragraph. Please delete this footnote in final letter that is sent to the World Bank. 15 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 of Use of Secure Identification Credentials in connection with Use of Electronic Means to Process Applications and Supporting Documentation ("Terms and Conditions of Use of SIDC"), the Recipient represents and warrants to the World Bank that it 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] 16 Attachment [3] Terms and Conditions of Use of Secure Identification Credentials in connection with Use of Electronic Means to Process Applications and Supporting Documentation March 1, 2013 The World Bank (Bank)' will provide secure identification credentials (SIDC) to permit the Borrowere 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. SIDC can be either: (a) hardware-based (Physical Token), or (b) software-based (Soft Token). The Bank reserves the right to determine which type of SIDC is most appropriate. 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 SIDC 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.worldbank.org) prior to receipt of his/her SIDC. Registration on CC will require that the Signatory establish a CC password (CC Password). The Signatory shall not reveal his/her CC Password to 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. Initialization of SIDC. 1. Prior to initialization of SIDC by a Signatory, the Signatory will acknowledge having read, understood and agreed to be bound by these Terms and Conditions of Use. 2. Where a Physical Token is to be used, promptly upon receipt of the Physical Token, the Signatory will access CC using his/her account name and CC Password and register his/her Physical Token and set a personal identification number (PIN) to be used in connection with the use of his/her Physical Token, after which the Physical Token will be initialized for use by the Signatory exclusively for purposes of delivering Applications. Where a Soft Token is to be used, the Signatory will access CC using his/her account name and CC Password and set a personal identification number (PIN) to be used in connection with the use of his/her Soft Token, after which the Soft Token will be initialized for use by the Signatory exclusively for purposes of delivering Applications. Upon initialization 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. 17 of the SIDC, the Signatory will be a "SIDC User". The Bank will maintain in its database a user account (Account) for each SIDC User for purposes of managing the SIDC of the SIDC User. Neither the Borrower nor the SIDC User will have any access to the Account. 3. Prior to first use of the SIDC by the SIDC User, the Borrower shall ensure that the SIDC User has received training materials provided by the Bank in use of the SIDC. 3. Use of SIDC. Use of the SIDC is strictly limited to use in the delivery of Applications by the SIDC User in the manner prescribed by the Bank in the Agreement(s) and these Terms and Conditions. Any other use of the SIDC is prohibited. The Bank assumes no responsibility or liability whatsoever for any misuse of the SIDC by the SIDC User, other representatives of the Borrower, or third parties. The Borrower undertakes to ensure, and represents and warrants to the Bank (such representation and warranty being expressly relied upon by the Bank in granting SIDC) that each SIDC User understands and will abide by, these Terms and Conditions of Use, including without limitation the following: 4. Security 4.1. The SIDC User shall not reveal his/her PIN to anyone or store or record the PIN in written or other form. 4.2. The SIDC User shall not allow anyone else to utilize his/her SIDC to deliver an Application to the Bank. 4.3. The SIDC 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 SIDC User believes a third party has learned his/her PIN or has lost his/her Physical Token he/she shall immediately notify clientconnection@worldbank.or. 4.5. The Borrower shall immediately notify the Bank at clientconnection@worldbank.org of any lost, stolen or compromised SIDC, and take other reasonable steps to ensure such SIDC are disabled immediately. 5. Reservation of Right to Disable SIDC 5.1. The Borrower shall reserve the right to revoke the authorization of a SIDC User to use a SIDC for any reason. 5.2. The Bank reserves the right, in its sole discretion, to temporarily or permanently disable a SIDC, de-activate a SIDC User's Account or both. 6. Care of Physical Tokens 6.1. Physical Tokens will remain the property of the Bank. 6.2. The Bank will physically deliver a Physical Token to each Signatory designated to receive one in a manner to be determined by and satisfactory to the Bank. 18 6.3. Physical 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, Physical 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. Physical 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 interfere with the proper operation of electronic equipment, including the Physical Token. 6.4. Without derogating from these Terms and Conditions of Use, other technical instructions on the proper use and care of Physical Tokens are available at http://www.rsa.com. 7. Replacement 7.1. Lost, damaged, compromised (in terms of 4.5, above) or destroyed Physical Tokens will be replaced at the expense of the Borrower. 7.2. The Bank reserves the right, in its sole discretion, not to replace any Physical Token in the case of misuse, or not to reactivate a SIDC User's Account. 19 [Attachment 4] Statement of Expenditures (SOE) Payments made during the period from to Date: Application No.: TF No.: SOE No.: 1 2 3 4 5 6 7 8 9 10 11 o Total amountV Name and o oa mutAmount ares ad Contract, Invoice Brief Description of 5 of expenditure Expenditure Aiduntom o Address of Paid From C a or Purchase order Goods, Works, a covered by Amount D Contractor,C O.t Designated S i No. & Date (or Services or other < application Eligible for A 0 Serieror other ref.) Expenditure = -d (net of Financing An) Service Provider at . any) +Cl retention) TOTALS_ Supporting documents for this SOE retained at:(insert location) 20 Attachment [51 Payments Made during Reporting Period Against Contracts Subject to the World Bank's Prior Review 21 Attachment [61 DESIGNATED ACCOUNT RECONCILIATION STATEMENT TRUST FUND NUMBER ACCOUNT NUMBER WITH (BANK) 1. TOTAL ADVANCED BY WORLD BANK (OR COFINANCIER) $ 2 LESS: TOTAL AMOUNT RECOVERED BY WORLD BANK -$ 3. EQUALS PRESENT OUTSTANDING AMOUNT ADVANCED TO THE DESIGNATED ACCOUNT (NUMBER 1 LESS NUMBER 2) = $ 4. BALANCE OF DESIGNATED ACCOUNT PER ATTACHED BANK STATEMENT AS OF DATE $ 5. PLUS: TOTAL AMOUNT CLAIMED IN THIS APPLICATION NO. +$ * 6. PLUS: TOTAL AMOUNT WITHDRAWN AND NOT YET CLAIMED REASON: +$ * 7. PLUS: AMOUNTS CLAIMED IN PREVIOUS APPLICATIONS NOT YET CREDITED AT DATE OF BANK STATEMENTS APPLICATION NO. AMOUNT * SUBTOTAL OF PREVIOUS APPLICATIONS NOT YET CREDITED + $ 8. MINUS: INTEREST EARNED - $ * 9. TOTAL ADVANCE ACCOUNTED FOR (NO. 4 THROUGH NO. 9) = $ 10. EXPLANATION OF ANY DIFFERENCE BETWEEN THE TOTALS APPEARING ON LINES 3 AND 9: 11. DATE: SIGNATURE: TITLE: * ALL ITEMS SHOULD BE INDICATED ON THE BANK STATEMENT 22