ANNEX D.

3
Page 1 of 3

Deadline of Submission:
On or before end-September of each year

<Name of Borrower>
MEDIUM AND LONG-TERMa/ FOREIGN/FOREIGN CURRENCY BORROWINGS PLAN
For the period __________

Part I Loan Particulars

PROSPECTIVE CREDITOR INDICATIVE ESTIMATED

INDICATIVE PROJECTED SCHEDULE
ORIG. GRACE INTEREST
LOAN MATURITY PROJECT/PURPOSE OF LOAN NEGOTIATION
NAME TYPE* CURR** PERIOD RATE
AMOUNT*** (IN YEARS)b/ (MM-YYYY)
(IN YEARS) (% P.A.)c/

a/ Those with original maturity of more than one (1) year

CERTIFIED CORRECT:
b/ Inclusive of grace period
c/ For floating interest rate, please indicate interest base and spread
_________________________________________
* Please indicate the letter corresponding to the type of creditor Name and Signature of Authorized Official
A- Multilateral/International Financial Institutions
B- Bilateral Institutions Designation: _______________________________
C- Foreign Banks and Other Financial Institutions
D- Bond/Noteholders Tel. No. ____________ Fax No. _______________
E- Suppliers/Exporters
F- Foreign Parent/Subsidiary/Affiliate/Shareholders Email address: _____________________________
G- Others
** e.g., USD, JPY, PHP, GBP, EUR, CHF, AUD, CNY
*** In millions with three (3) decimal places

IOD Form 01-001-01A* Version 6 * Updated 27 Nov 2013

 ANNEX D.3
Page 2 of 3

<Name of Borrower>
MEDIUM AND LONG-TERM FOREIGN/FOREIGN CURRENCY LOAN REQUIREMENTS
For the period __________

Part II Estimated Drawdowns (In Original Currency)*

20__ 20__ 20__ 20__ BEYOND

PROSPECTIVE CREDITOR TOTAL ND ST ND ST ND ST ND
2 SEM 1 SEM 2 SEM 1 SEM 2 SEM 1 SEM 2 SEM 20__

*In millions with three (3) decimal places

CERTIFIED CORRECT:

_________________________________________
Name and Signature of Authorized Official

Designation: _______________________________

Tel. No.: ____________ Fax No. ___________

Email address: _____________________________

IOD Form 01-001-01A* Version 6 * Updated 27 Nov 2013

 ANNEX D.3
Page 3 of 3
<Name of Borrower>
MEDIUM AND LONG-TERM FOREIGN/FOREIGN CURRENCY LOAN REQUIREMENTS
For the period __________

Part III Projects/Costs to be Financed

COST
FOREIGN COST* LOCAL COST** TOTAL
PROJECT (IN ORIGINAL (IN ORIGINAL (IN ORIGINAL DETAILSa/
(IN ORIGINAL (IN PHILIPPINE
CURRENCY OF CURRENCY OF CURRENCY OF THE
CURRENCY) PESOS)
THE LOAN) THE LOAN) LOAN)

a/ Indicate, where possible, cost categories to be financed such as: CERTIFIED CORRECT:
a) Importation/procurement of capital equipment/machinery, technology, etc.
b) Civil works/construction of plant, building, facilities, etc. _____________________________________
c) Services such as consultancy/management services Name and Signature of Authorized Official
d) Refinancing of existing/maturing obligations (please indicate if peso
or foreign currency denominated)
e) Others (please specify) Designation: ___________________________
* Costs payable to non-residents and FCDUs of banks
** Costs payable to Philippine residents excluding FCDUs of banks Tel. No.: ___________ Fax No. ____________

Email address: _________________________

IOD Form 01-001-01A* Version 6 * Updated 27 Nov 2013