Introduction

A 1 2 3 4 5 6 In order to provide us with a complete picture of your institution, please fill out each page of this questionnaire with the most details possible. The list below is an index that links to the different parts of the questionnaire, which has been divided into small sections for your convenience. The final section includes a list of potential errors or inconsistencies that your data may have generated, as well as an opportunity for you to write any explanatory notes as needed. General Information Income Statement Balance Sheet Infrastructure Products and Clients Portfolio Report Liabilities Analysis In-kind subsidies Final check Thank you for pariticipating in an international movement towards standardization, transparency and relevant benchmarks for the microfinance sector. Please select your language: English English

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

MIX Monitor Data Collection Tool

General Information

A 1 2 3 4 5 6 7 8 9 10 11 12 13 Name of MFI
Fiscal Year to be analyzed Start (dd/mm/yyyy) End (dd/mm/yyyy)

E
Back to index

Currency

Unit of currency

Exchange rate

INSTITUTIONAL CONTACT INFORMATION

Name and title of person filling out questionnaire Name and title of head of MFI (CEO, ED, etc.)

Address City, State/Province, Postal Code Country

Fax Email Web site

14 Phone 15 16 INSTITUTIONAL PRESENTATION 17 Year microfinance operations began (yyyy) 18 19 20 21 22 23 24 25 26 27 28 29 ACCOUNTING METHODS 30 Does your institution use cash or accrual accounting? Which accounts are treated on each basis? 31 32 33 34 35 36 37 38 39
Can your institution break out total assets between short term assets and long term assets? Can your institution break out outstanding liabilities between short term and long term? Describe any reserve accounts listed under equity on the Balance Sheet Describe the main challenges of the institution Describe the mission of the institution Institutional charter Year of transformation to current institutional charter (if applicable) Is the institution regulated?

Profit Status

Select Alliances

Strategic alliances (please select all that apply, and specify any other affiliations) If 'other', please specify Ownership composition

Please describe the type, frequency and extent of supervision received by the institution, if any

Ye s

No

If yes, by whom is it regulated?

Does your institution adjust for the effects of inflation in its audited financial statements and/or in the financial information which you have presented to us, and if so, how?

Does your institution adjust accounts for the effects of translation/conversion of foreign currencies (including disposition of exchange gains/loss) in its audited financial statements and/or in the financial information which you have presented to us, and if so, how?

Yes Yes

No No

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Income Statement

A 1 2 3 4 5 6 7 8 9 10 11 12 13 14
5a

D
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FINANCIAL STATEMENTS - Please list in Income Statement Period starting Period ending Item 5 Account Financial Revenue Description 0 Total of revenue from loan portfolio and other financial assets, as well as other financial revenue from financial services. (sum of 5) Financial Revenue from Loan Portfolio (sum of 5a) 5a1 5a2 5b 5c Interest on Loan Portfolio Fees and Commissions on Loan Portfolio Financial Revenue from Other Financial Assets Other Revenue Related to Financial Services Interest earned on loan portfolio. Penalties, commissions and other fees charged on loan portfolio. Net gains on other financial assets. Other revenue from provision of financial services, including revenue from insurance or transfer services or non-financial revenue from the provision of financial services, such as the sale of passbooks or SmartCards. This account also includes net exchange gain. 0 Total interest, fees and commission on loan portfolio. Notes

15

16 17 18 19 20 21 22 23 24 25 26 27
6d (sum of 6b) 6b1 6b2 6c Inflation Adjustment Expense Inflation Adjustment Revenue Subsidized Cost-of-Funds Adjustment Expense Cost of maintaining the value of the institution's equity. Gain on the value of fixed assets due to inflation. Adjustment expense for difference between market rate and concessional rate on funding liabilities (reserved for MIX use). 6 Financial Expense (sum of 6) 6a 6a1 6a2 6b Financial Expense on Liabilities (sum of 6a) Interest and Fee Expense on Deposits Interest and Fee Expense on Borrowings Net Inflation Adjustment Expense Interest and fees paid on demand or term deposits. Interest and fees paid on borrowings. 0 Reserved for institutions that use inflation based accounting. Net amount of inflation adjustment. 0 Total of interest and fees paid on deposits and borrowings. 0 Total of financial expense on liabilities, net inflation adjustment, cost-of-funds adjustment and other expenses from financial services.

Other Financial Expenses

28 29 30 31 32

Other expenses from provision of financial services, including non-financial expenses on financial products, as well as net exchange depreciation.

NET FINANCIAL INCOME (5 less 6)

0 Financial Revenue minus Financial Expense.

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Income Statement

A
8

B
Net Loan Loss Provision Expense

D
0 Sum of loan loss provision expense and recovery on loan loss provision.

33 34
8a Loan Loss Provision Expense (sum of 8)

Accts Irrecouvrable

Loan Loss Provision Expense for the period.

35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51
12 Net Non-Operating Income 0 Non-operating Revenue less Non-operating Expense. 11 NET OPERATING INCOME (7 less 8 less 10) 0 Financial Revenue less Financial Expense, Net Loan Loss Provision Expense and Operating Expense. 10b Administrative Expense (sum of 10b) 10b1 10b2 10b3 10b4 10b5 Rent and Utilities Transportation Office Supplies Depreciation and Amortization Other Administrative Expenses Rent and utility charges. Transportation of staff to attend to clients and to manage operations. Printed matter, supplies, photocopies, books, etc. Allowance for deterioration, eventual replacement of equipment. Other non-personnel administrative expenses. 8b 10 10a Recovery on Loans Written-off Operating Expense (sum of 10) Personnel Expense Salaries, withholdings, fringe benefits and personnel taxes paid on all those who work for the institution. 0 Total of Rent and Utilities, Transportation, Office Supplies, Depreciation and Other Administrative Expenses. Total recovery on loans written off. 0 Total of Personnel Expense and Administrative Expense.

52 53
12a Non-Operating Revenue (sum of 12) Revenue from activity unrelated to the MFI's core activity of providing financial services. This could include consulting income, sale of IT products, or fees for BDS.

54
12b Non-Operating Expense

55 56 57 58 59 60 61 62 63 64 65 66 67 68 69
17 NET INCOME (AFTER TAXES AND DONATIONS) (15+16) 16 15 NET INCOME (AFTER TAXES AND BEFORE DONATIONS) (13 less 14) Donations to Subsidize Financial Services 14 Taxes 13 NET INCOME (BEFORE TAXES AND DONATIONS) (11+12)

Expenses from activity unrelated to the MFIs core activity of providing financial services, such as BDS development costs or consulting expenses.

0 Net Operating Income plus Net Non-operating Income.

Includes all taxes paid on Net Income or other measure of profits as defined by local tax authorities. 0 Net Income (before Taxes and Donations) less Taxes. (13-14) Donations made to the MFI to subsidize its operations.

0 Net Income (after Taxes and before Donations) plus Donations. Back to index

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Balance Sheet

A 2 3 4 5 6 7 8 9 10 11
1d2 1d 1d1 Balance Sheet Item 1a 1b 1c

FINANCIAL STATEMENTS - Please list in As of Account Assets Description Cash, petty cash, balances in banks, including non-interest bearing deposits. Cash reserves in a central bank. Treasury bills and other short term investments, including interestbearing deposits, convertible to cash within 12 months. Usually used in liquidity management. 0 Gross Loan Portfolio minus Loan Loss Reserve. (sum of 1d) All outstanding principal for all outstanding client loans, including current, delinquent and restructured loans, but not loans that have been written off. It does not include interest receivable. It does not include employee loans. The portion of the gross loan portfolio that has been expensed (provisioned for) in anticipation of losses due to default. This item represents the cumulative value of the loan loss provision expense, less the cumulative value of loans written off. Notes

Cash and Due from Banks Reserves in Central Bank Short Term Financial Assets

Net Loan Portfolio Gross Loan Portfolio

Loan Loss Reserve

12
1e Interest Receivable

13 14 15 16 17 18 19
1 TOTAL ASSETS (sum of 1) 1f 1g 1h Accounts Receivable and Other Assets Long Term Financial Assets Net Fixed Assets

Interest receivable on all asset accounts. Recorded by institutions using accrual accounting. Accounts receivable, notes receivables and other receivables. This includes all receivables other than client loan accounts, including employee loans. Long term investments not convertible to cash within 12 months. The purchase value of property, plant and equipment, less accumulated depreciation. This includes intangibles, such as MIS development or goodwill, less accumulated amortization. 0 Total of all net asset accounts.

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Balance Sheet

A 20 21 22 23 24 25 26 27 28 29 30
2e 2c1 2c2 2d 2a2 2b 2c 2a 2a1

B
Demand Deposits

C
Liabilities

D
0 Total of Voluntary and Compulsory Savings.

(sum of 2a) Voluntary Savings Demand deposits from the general public and members that are not maintained as a condition for accessing a current or future loan and are held with the institution. Client savings accounts that are maintained as a condition for a current or future loan and are held with the institution. Certificates of deposit or other fixed term deposits. 0 Total of Commercial and Concessional Borrowings. (sum of 2c) Borrowings at Concessional Interest Rates Borrowings at Commercial Interest Rates Interest Payable Principal balance of all borrowings, including overdraft accounts, for which the institution pays a nominal rate of interest that is less than the local commercial interest rate. Principal balance of all borrowings, including overdraft accounts, for which the institution pays a nominal rate of interest that is greater than to or equal to the local commercial interest rate. Interest payable on all liability accounts. Recorded by institutions using accrual accounting. Other liabilities including tax and salary liabilities, social withholdings, deferred income, other accounts payable, including liabilities that do not fund the portfolio, such as mortgages on real estate.

Compulsory Savings Time Deposits Total Borrowings

31 32 33 34
2

Accounts Payable and Other Liabilities

TOTAL LIABILITIES (sum of 2)

0 Total of all liability accounts.

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Balance Sheet

A 35 36 37 38
3b1 Prior Years 3a 3b Paid-in Capital Donated Equity

D
Equity Capital paid by shareholders or members. 0 Accumulated donations.

(sum of 3b) Accumulated donations from prior periods.

39 40 41 42 43
3c1 Prior Years 3c 3b2 Current Year (line 16 from IS) Retained Earnings (sum of 3c) Accumulated net income after taxes and before donations from prior periods. 0 Accumulated net income after taxes and before donations. 0 Accumulated donations from the current year.

44
3c2 Current Year 0 Accumulated net income after taxes and before donations from the current year.

45
(line 15 from IS) 3d 3d1 Adjustments (sum of 3d) Inflation Adjustment

46 47 48 49
3d2

0 Value of all adjustments, including inflation adjustment. Value of inflation adjustment expense (reserved for institutions practicing inflation-based accounting).

50 51 52 53 54 55 56 57 58
3d3 3e 3f 3

Subsidized Cost of Funds Adjustment In-Kind Subsidy Adjustment Reserves Other Equity Accounts TOTAL EQUITY (sum of 3)

Value of subsidized cost of funds adjustment expense (reserved for MIX use). Value in-kind subsidy adjustment (reserved for MIX use). Reserves such as those imposed by law or statute. Explain any reserves used by the institution. Other equity accounts not included elsewhere. 0 Total of all equity accounts.

TOTAL LIABILITIES AND EQUITY (2+3)

0 Total of Total Liabilities and Total Equity.

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Balance Sheet

A 59 65 66 67 68 69 70 71

D
Back to index

Please provide the following account balances for the previous fiscal year TOTAL ASSETS, as of Net fixed assets, as of Gross Loan Portfolio, as of TOTAL EQUITY, as of

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Infrastructure

A 1 2 3 4 5 6 7 8 Name of MFI
Fiscal Year to be analyzed Start (dd/mm/yyyy) End (dd/mm/yyyy)

E
Back to index

Currency 0

Unit of currency 0

Exchange rate 0

Structure
How many staff does the MFI have at each level Head office of infrastructure? Regional office level Branch office Sub-branch (unit level)

9 10 How many offices? 11 Large cities 12 Percentage of total clients in each location 13 14 15 Please provide information on staffing and personnel 16 17
Number of staff, year-end

Small cities/Towns

Rural

Total 0.0%

All staff should be listed in full-time equivalence (i.e. hours of part-time staff should be aggregated and you should calculate the equivalent of full-time staff that would be required for those hours)

18
Number of front-office staff (staff who have direct contact with clients), year-end

Percentage of (annual budget for staff training/operating expenses)

19
Number of staff who have left during year

Average annual salary and benefits per staff member - all staff (expressed in currency described in General Information)

20
Number of staff hired during the year

Do these figures represent all the people who contribute to your operations, including volunteers, part time, and full time staff?

Yes

No
Back to index

21

22

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Products and Clients A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 35 36 37 38 55 56 57 58 59 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

a) b) c) Other microfinance products Description of terms and conditions of product (all products defined as 'other' should be described in particular detail) If applicable, balance outstanding at year-end (in currency and unit listed above)

E
Back to index

Name of MFI
Fiscal Year to be analyzed Start (dd/mm/yyyy) End (dd/mm/yyyy) Total number of active clients (all services combined) Total number of loan products offered Lending methodologies used Total number of savings products offered Is the institution able to track numbers of clients in addition to number of accounts (i.e., savers as well as savings accounts)? Does the institution offer non financial services? Currency 0 Unit of currency 0 Exchange rate 0

Individual

Solidarity Group

Village Banking/SHG

Y es Y es

N o N o

Please list, describe and provide a balance for each financial product offered by the institution (ranked in order of importance to institution) Description of loan terms and conditions (include description of loan terms, Balance outstanding at year-end (in Loan products payment frequency, grace periods, guarantee requirements, conditions required to currency and unit listed above) access loans, etc.) a) b) c) Savings products Description of terms and conditions of savings product (include description of terms, whether account is voluntary or compulsory, whether deposits are fixed term, whether MFI or third party mobilizes deposits, etc.) Balance outstanding at year-end (in currency and unit listed above)

Please provide information as of Loans and borrowers Total Number of loans outstanding Number of active borrowers Number of accumulated borrowers Number of accumulated loans disbursed Number of new borrowers Number of women borrowers Total Please provide information as of

Total Savings and savers Compulsory Number of active savings accounts Number of active savers Number of women savers Voluntary

Ye s Ye s

No No

Clients, by other product Number of active clients Number of new clients Number of women clients

Other products

Does the institution specifically target very poor clients (clients earning less than US$1/day or population in the bottom half living under the poverty line)? Does the institution use any targeting tools such as Means Test, Participatory Wealth Ranking, Housing Index, etc.? Percentage of clients in households earning less than US$1/day per household member

Ye s Ye s

N o N o
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Portfolio Report

A 1 2 3 4 5 6 7 8 9 Name of MFI
Fiscal Year to be analyzed Start (dd/mm/yyyy) End (dd/mm/yyyy)

E
Back to index

Currency 0

Unit of currency 0

Exchange rate 0

Repayment performance of outstanding Loan Portfolio Please provide information as of

Were there any renegotiated loans on this year's Balance Sheet?

10 Does the MFI track renegotiated loans separate from non-renegotiated loans? 11 Aging/Status of portfolio 12 13 Current portfolio, on-time (< 30 Days, non-renegotiated loans) 14
Portfolio balance affected by overdue payments (non-renegotiated loans) 30-90 Days 91-180 Days 181-365 Days 366+ Days

Y e Y s es
Number of loans Amount - listed in

N N o o
Percent

15 16 17 18 19 All renegotiated loans 20 Gross Loan Portfolio 21 22 23

0%

Please explain how your institution calculates delinquency (portfolio balance affected by overdue payments) as given in the above table

24 Please describe precisely your institution's policy regarding provisioning and write-offs 25 26 27 28 29 30 31
Loan Loss Reserve for FY ended Loan Loss Reserve for FY ended Loan Loss Provision Expense for FY ended Loans written off in FY ended Back to index

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Liabilities Analysis

A 1 2 3 4 5 6 7 8 9 10 Name of MFI
Fiscal Year to be analyzed Start (dd/mm/yyyy) End (dd/mm/yyyy)

E
Back to index

Currency 0

Unit of currency 0 17

Exchange rate 0

How many individual borrowings (either commercial or concessional) appear on the current year's Balance Sheet? Description of institutional borrowings Source, including name and description (if possible)

Nominal interest rate paid on this borrowing

Would you classify this as a liability from Amount of this liability a public or private source? on Balance Sheet

11 a) 12 13
b) c)

Total borrowings, as of

14 d) 15 e) 16 f) 48 49 50
Total borrowings, current year (Line 2c of Balance Sheet)

public public public

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In-kind subsidies

A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Rent and utilities Transportation Office supplies Other

F
Back to index

Name of MFI
Fiscal Year to be analyzed Start (dd/mm/yyyy) End (dd/mm/yyyy) 0 0 0 Currency Unit of currency Exchange rate

Operational subsidy analysis

Please read through the following questions to determine if your institution received any operational (in-kind) subsidy this fiscal year Were any managerial or operational personnel paid by donor funds that are not included in your Income Yes Statement? If 'yes', please explain to us what function they performed and how they contributed to your operations

No

What was the amount of their salaries during the fiscal year ended

30/12/1899

Does your institution use any property or equipment that belongs to another party and is not accounted for on your financial statements (i.e. office space, computer equipment, vehicles, etc.)?

Yes

No

If yes, please explain what category this property/equipment would fall under, its value to the institution, and how it was used Category Value of subsidy/donation to the institution How it was used

Check this box if the institution receives no in-kind subsidies Back to index

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Final check

A 1 2 3 4 5 6
The number of outstanding loans listed in 'Portfolio Report' is different from the number of outstanding loans listed in 'Products and Clients' The LLR listed on the Portfolio Report is different from LLR on the Balance Sheet

The following is a list of potential inconsistencies your data has generated. This does not necessarily mean that the data is incorrect, only that it differs for some reason from what is submitted by the majority of users. Please do not erase or change any data if it is correct - instead, explain, where necessary, the reason for this inconsistency in the 'Notes' field. Potential Inconsistency The GLP listed on the Portfolio Report is different from GLP on the Balance Sheet Check or not? No problem Notes [Please write here]

No problem

[Please write here]

No problem

[Please write here]

7
The LLPE listed on the Portfolio Report is different from the LLPE on the Income Statement No problem [Please write here]

8
The write-offs listed on the Portfolio Report do not equal [last year's loan loss reserve + current year's loan loss provision expense - current year's loan loss reserve] No problem [Please write here]

10 11 12 13 14 15 16 17

The number of total clients exceeds the sum of savers, borrowers and other product clients The difference between current and previous years' personnel is not consistent with personnel who have been hired and who have left The average staff salary is not consistent with the number of personnel listed in Infrastructure and the personnel expense listed on the Income Statement Total Assets do not equal Total Liabilities and Equity on Balance Sheet Voluntary savings appear on the Balance Sheet but no voluntary savings clients have been listed in 'Products and Clients' Voluntary savings clients have been listed but no voluntary savings appears on the Balance Sheet

No problem No problem

[Please write here] [Please write here]

No problem

[Please write here]

No problem No problem No problem

[Please write here] [Please write here] [Please write here]

The total borrowings listed on Liabilities Analysis is different from the total borrowings listed on the Balance Sheet

No problem

[Please write here]

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A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
GI39 GI40 No. GI1 GI2 GI3 GI4 GI5 GI6 GI7

B English Name of MFI Fiscal Year to be analyzed Start (dd/mm/yyyy) End (dd/mm/yyyy) Currency Unit of currency Exchange rate Yes No

Label data (language)

Page 15

INSTITUTIONAL CONTACT INFORMATION

GI8 GI9 GI10 GI11 GI12 GI13 GI14 GI15 GI16

Name and title of person filling out questionnaire

Name and title of head of MFI (CEO, ED, etc.) Address City, State/Province, Postal Code Country Phone Fax Email Web site INSTITUTIONAL PRESENTATION Year microfinance operations began (yyyy) Year of transformation to current institutional charter (if applicable) Profit Status -Select oneProfit Non-profit Institutional charter -Please selectBank Credit Union/Cooperative Non-Bank Financial Intermediary Non Governmental Organization (NGO) Rural Bank Other Ownership composition Strategic alliances (please select all that apply, and specify any other affiliations) Select Alliances If 'other', please specify Is the institution regulated? If yes, by whom is it regulated? Yes No Please describe the type, frequency and extent of supervision received by the institution, if any Describe the mission of the institution Describe the main challenges of the institution ACCOUNTING METHODS Does your institution use cash or accrual accounting? Which accounts are treated on each basis?

GI17 GI19 GI20

GI24

GI32 GI33

GI34 GI35

GI38

GI40

A
GI41

53

GI42

54

Label data (language) B Does your institution adjust for the effects of inflation in its audited financial statements and/or in the financial information which you have presented to us, and if so, how? Does your institution adjust accounts for the effects of translation/conversion of foreign currencies (including disposition of exchange gains/loss) in its audited financial statements and/or in the financial information which you have presented to us, and if so, how? Describe any reserve accounts listed under equity on the Balance Sheet Can your institution break out total assets between short term assets and long term assets? Can your institution break out outstanding liabilities between short term and long term?
FINANCIAL STATEMENTS - Please list in

Page 16

55 56

GI43 GI44

Separation of all asset accounts between amounts maturing within and beyond 12 months Separation of all liability accounts between amounts payable within and beyond 12 months

GI45

57 58 59 60 61 62 63 64 65 66 67 68 69 70
FS1d1 FS1d FS1a FS1b FS1c

Balance Sheet Item Account As of Description

Assets Cash and Due from Banks Reserves in Central Bank Short Term Financial Assets Cash, petty cash, balances in banks, including non-interest bearing deposits. Cash reserves in a central bank. Treasury bills and other short term investments, including interestbearing deposits, convertible to cash within 12 months. Usually used in liquidity management. Gross Loan Portfolio minus Loan Loss Reserve.

Net Loan Portfolio (sum of 1d) Gross Loan Portfolio

71
FS1d2 Loan Loss Reserve

All outstanding principal for all outstanding client loans, including current, delinquent and restructured loans, but not loans that have been written off. It does not include interest receivable. It does not include employee loans. The portion of the gross loan portfolio that has been expensed (provisioned for) in anticipation of losses due to default. This item represents the cumulative value of the loan loss provision expense, less the cumulative value of loans written off. Interest receivable on all asset accounts. Recorded by institutions using accrual accounting. Accounts receivable, notes receivables and other receivables. This includes all receivables other than client loan accounts, including employee loans. Long term investments not convertible to cash within 12 months. The purchase value of property, plant and equipment, less accumulated depreciation. This includes intangibles, such as MIS development or goodwill, less accumulated amortization. Total of all net asset accounts.

72
FS1e FS1f Interest Receivable Accounts Receivable and Other Assets

73 74 75 76 77 78 79 80 81 82 83 84

FS1g FS1h

Long Term Financial Assets Net Fixed Assets

FS1

TOTAL ASSETS (sum of 1) Liabilities

FS2a FS2a1 FS2a2 FS2b

Demand Deposits (sum of 2a) Voluntary Savings Compulsory Savings Time Deposits

Total of Voluntary and Compulsory Savings. Demand deposits from the general public and members that are not maintained as a condition for accessing a current or future loan and are held with the institution. Client savings accounts that are maintained as a condition for a current or future loan and are held with the institution. Certificates of deposit or other fixed term deposits.

A 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128
BS5 BS6 BS7 BS8 BS1 BS2 BS3 BS4 FS3d1 FS3d2 FS3d3 FS3e FS3f FS3 FS4 FS3c1 FS3c2 FS3d FS3b1 FS3b2 FS3c FS2 TOTAL LIABILITIES (sum of 2) Equity FS3a FS3b Paid-in Capital Donated Equity (sum of 3b) Prior Years Current Year Retained Earnings (sum of 3c) Prior Years Current Year Adjustments (line 15 from IS) (line 16 from IS) (sum of 3d) Inflation Adjustment FS2c1 FS2c2 FS2d FS2e FS2c Total Borrowings (sum of 2c)

Label data (language)

Page 17

Total of Commercial and Concessional Borrowings.

Borrowings at Concessional Interest Rates Borrowings at Commercial Interest Rates Interest Payable Accounts Payable and Other Liabilities

Principal balance of all borrowings, including overdraft accounts, for which the institution pays a nominal rate of interest that is less than the local commercial interest rate. Principal balance of all borrowings, including overdraft accounts, for which the institution pays a nominal rate of interest that is greater than to or equal to the local commercial interest rate. Interest payable on all liability accounts. Recorded by institutions using accrual accounting. Other liabilities including tax and salary liabilities, social withholdings, deferred income, other accounts payable, including liabilities that do not fund the portfolio, such as mortgages on real estate. Total of all liability accounts.

Capital paid by shareholders or members. Accumulated donations.

Accumulated donations from prior periods. Accumulated donations from the current year. Accumulated net income after taxes and before donations.

Accumulated net income after taxes and before donations from prior periods. Accumulated net income after taxes and before donations from the current year. Value of all adjustments, including inflation adjustment.

Subsidized Cost of Funds Adjustment In-Kind Subsidy Adjustment Reserves Other Equity Accounts TOTAL EQUITY (sum of 3) TOTAL LIABILITIES AND EQUITY Please provide the following account balances for the previous fiscal year Gross Loan Portfolio, as of TOTAL ASSETS, as of Net fixed assets, as of TOTAL EQUITY, as of

Value of inflation adjustment expense (reserved for institutions practicing inflation-based accounting). Value of subsidized cost of funds adjustment expense (reserved for MIX use). Value in-kind subsidy adjustment (reserved for MIX use). Reserves such as those imposed by law or statute. Explain any reserves used by the institution. Other equity accounts not included elsewhere. Total of all equity accounts. Total of Total Liabilities and Total Equity.

Please provide us with the short and long-term breakout of Total Assets and Total Liabilities Total of all asset accounts maturing at or within 12 Total of all asset accounts (including gross loan portfolio) maturing months at or within 12 months Total of all asset accounts maturing in more than 12 months Total of all asset accounts (including gross loan portfolio) maturing in more than 12 months

Total balance on all liability accounts payable at or Total balance on all liability accounts payable within 12 months within 12 months Total balance on all liability accounts payable Total balance on all liability accounts payable beyond 12 month beyond 12 month horizon horizon Income Statement

A 129 130
FS5 Period starting Period ending Financial Revenue

Label data (language)

Page 18

131 132 133 134 135 136 137 138

Financial Expense FS6a (sum of 6) Financial Expense on Liabilities (sum of 6a) FS6a1 FS6a2 FS6b Interest and Fee Expense on Deposits Interest and Fee Expense on Borrowings Net Inflation Adjustment Expense (sum of 6b) FS6b1 FS6b2 FS6c FS6d Inflation Adjustment Expense Inflation Adjustment Revenue Subsidized Cost-of-Funds Adjustment Expense Other Financial Expenses FS5a FS5a1 FS5a2 FS5b FS5c FS6 (sum of 5) Financial Revenue from Loan Portfolio (sum of 5a) Interest on Loan Portfolio Fees and Commissions on Loan Portfolio Financial Revenue from Other Financial Assets Other Revenue Related to Financial Services

Total of revenue from loan portfolio and other financial assets, as well as other financial revenue from financial services.

Total interest, fees and commission on loan portfolio.

Interest earned on loan portfolio. Penalties, commissions and other fees charged on loan portfolio. Net gains on other financial assets. Other revenue from provision of financial services, including revenue from insurance or transfer services or non-financial revenue from the provision of financial services, such as the sale of passbooks or SmartCards. This account also includes net exchange gain. Total of financial expense on liabilities, net inflation adjustment, cost-of-funds adjustment and other expenses from financial services. Total of interest and fees paid on deposits and borrowings.

139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158
FS10a FS8a FS8b FS10 FS7 FS8

Interest and fees paid on demand or term deposits. Interest and fees paid on borrowings. Reserved for institutions that use inflation based accounting. Net amount of inflation adjustment.

Cost of maintaining the value of the institution's equity. Gain on the value of fixed assets due to inflation. Adjustment expense for difference between market rate and concessional rate on funding liabilities (reserved for MIX use). Other expenses from provision of financial services, including nonfinancial expenses on financial products, as well as net exchange depreciation. Financial Revenue minus Financial Expense. Sum of loan loss provision expense and recovery on loan loss provision. Loan Loss Provision Expense for the period. Total recovery on loans written off. Total of Personnel Expense and Administrative Expense.

NET FINANCIAL INCOME (5 less 6) Net Loan Loss Provision Expense (sum of 8) Loan Loss Provision Expense Recovery on Loans Written-off Operating Expense (sum of 10) Personnel Expense

159 160 161 162 163 164 165 166 167 168 169 170
FS12 FS10b Administrative Expense (sum of 10b) FS10b1 Rent and Utilities FS10b2 Transportation FS10b3 Office Supplies FS10b4 Depreciation and Amortization FS10b5 Other Administrative Expenses FS11 NET OPERATING INCOME (7 less 8 less 10) Net Non-Operating Income (sum of 12)

Salaries, withholdings, fringe benefits and personnel taxes paid on all those who work for the institution. Total of Rent and Utilities, Transportation, Office Supplies, Depreciation and Other Administrative Expenses.

Rent and utility charges. Transportation of staff to attend to clients and to manage operations. Printed matter, supplies, photocopies, books, etc. Allowance for deterioration, eventual replacement of equipment. Other non-personnel administrative expenses. Financial Revenue less Financial Expense, Net Loan Loss Provision Expense and Operating Expense.

Non-operating Revenue less Non-operating Expense.

A
FS12a Non-Operating Revenue

Label data (language)

Page 19

171
FS12b Non-Operating Expense

Revenue from activity unrelated to the MFI's core activity of providing financial services. This could include consulting income, sale of IT products, or fees for BDS.

172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215
PC1 PC2 PC3 PC4 PC5 PC6 Total number of active clients (all services combined) Total number of loan products offered Lending methodologies used Total number of savings products offered Is the institution able to track numbers of clients in addition to number of accounts (i.e., savers as well as savings accounts)? Does the institution offer non financial services? In12 In13 In14 In15 In16 In17 In18 In19 In20 In21 In23 In1 In2 In3 In4 In5 In6 In7 In8 In9 In10 In11 FS16 FS17 FS13 FS14 FS15 NET INCOME (BEFORE TAXES AND DONATIONS) Taxes NET INCOME (AFTER TAXES AND BEFORE DONATIONS) (13 less 14) Donations to Subsidize Financial Services NET INCOME (AFTER TAXES AND DONATIONS) Structure How many staff does the MFI have at each level of infrastructure? Head office Regional office level Branch office Sub-branch (unit level) How many offices? Head office Regional office level Branch office Sub-branch (unit level) Percentage of total clients in each location Large cities Small cities/Towns Rural Please provide information on staffing and personnel All staff should be listed in full-time equivalence (i.e. hours of part-time staff should be aggregated and you should calculate the equivalent of full-time staff that would be required for those hours) Number of staff, year-end Number of front-office staff (staff who have direct contact with clients), year-end Number of staff who have left during year Number of staff hired during the year Number of staff, year-end Number of front-office staff (staff who have direct contact with clients), year-end Number of staff who have left during year Number of staff hired during the year Percentage of (annual budget for staff training/operating expenses) Average annual salary and benefits per staff member - all staff (expressed in currency described in General Information) Do these figures represent all the people who contribute to your operations, including volunteers, part time, and full time staff?

Expenses from activity unrelated to the MFIs core activity of providing financial services, such as BDS development costs or consulting expenses. Net Operating Income plus Net Non-operating Income. Includes all taxes paid on Net Income or other measure of profits as defined by local tax authorities. Net Income (before Taxes and Donations) less Taxes.

Donations made to the MFI to subsidize its operations. Net Income (after Taxes and before Donations) plus Donations.

A 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264
PC43 PC12 PC13 PC14 PC15 PC9 PC10 PC11 PC7 PC8

Label data (language)

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Please list, describe and provide a balance for each financial product offered by the institution (ranked in order of importance to institution) Loan products Description of loan terms and conditions (include description of loan terms, payment frequency, grace periods, guarantee requirements, conditions required to access loans, etc.) Balance outstanding at year-end (in currency and unit listed above) Savings products Description of terms and conditions of savings product (include description of terms, whether account is voluntary or compulsory, whether deposits are fixed term, whether MFI or third party mobilizes deposits, etc.) Balance outstanding at year-end (in currency and unit listed above) Other microfinance products Description of terms and conditions of product (all products defined as 'other' should at year-end (in If applicable, balance outstanding be described in particularand unit listed above) currency detail) Non-financial services Describe individually each non-financial service Non-financial service Number of participants Related operational expenses Related operational income Operational profit (loss) from non-financial service Total How do the non-financial services offered by the institution enhance its core savings and loan business? Can this effect be clearly and efficiently measured due to the separation of accounts? Do the expenses, income and profit amounts given above appear on your audited financial statements? If 'yes', please enter these amounts in lines 12a and 12b of the Income Statement. Loans and borrowers Total Please provide information as of

PC16 PC17 PC18 PC19 PC20 PC21 PC22 PC23

PC25 PC26 PC27 PC28 PC29 PC30 PC31 PC32

Number of loans outstanding Number of active borrowers Number of loans outstanding Number of active borrowers Number of accumulated borrowers Number of accumulated loans disbursed Number of new borrowers Number of women borrowers Savings and savers Total Compulsory

PC33 PC34 PC35 PC36 PC37 PC38

Number of active savings accounts Number of active savers Number of women savers Voluntary Number of active savings accounts Number of active savers Number of women savers Clients, by other product Other products

[See 'Products and Clients' clients Number of active [See 'Products and Clients' Number of new clients [See 'Products and Clients' clients Number of women PC42 Does the institution specifically target very poor clients (clients earning less than US$1/day or population in the bottom half living under the poverty line)? Does the institution use any targeting tools such as Means Test, Participatory Wealth Ranking, Housing Index, etc.?

A 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312
IK1 IK2 IK3 IK4 PR1 PR2 PC44

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Percentage of clients in households earning less than US$1/day per household member Repayment performance of outstanding Loan Portfolio Were there any renegotiated loans on this year's Balance Sheet? Does the MFI track renegotiated loans separate from non-renegotiated loans? Amount - listed in Number of loans Percent Aging/Status of portfolio

[See 'Portfolio Report'] Current portfolio, on-time (< 30 Days, nonrenegotiated loans) [See 'Portfolio Report'] Portfolio balance affected by overdue payments (non-renegotiated loans) [See 'Portfolio Report'] 30-90 Days [See 'Portfolio Report'] 91-180 Days [See 'Portfolio Report'] 181-365 Days [See 'Portfolio Report'] 366+ Days [See 'Portfolio Report'] loans All renegotiated Gross Loan Portfolio PR10 PR11 PR12 PR13 PR14 PR15 LA1 Please explain how your institution calculates delinquency (portfolio balance affected by overdue payments) as given in the above table Please describe precisely your institution's policy regarding provisioning and write-offs Loan Loss Reserve for FY ended Loan Loss Reserve for FY ended Loan Loss Provision Expense for FY ended Loans written off in FY ended How many individual borrowings (either commercial or concessional) appear on the current year's Balance Sheet? Description of institutional borrowings

[See 'Liabilities Analysis'] name and description (if Source, including possible) [See 'Liabilities Analysis'] rate paid on this borrowing Nominal interest [See 'Liabilities Analysis'] Would you classify this as a liability from a public or private source? public private cannot be classified [See 'Liabilities Analysis'] Amount of this liability on Balance Sheet LA5 LA6 Total borrowings, current year (Line 2c of Balance Sheet) Total borrowings, as of Operational subsidy analysis Please read through the following questions to determine if your institution received any operational (in-kind) subsidy this fiscal year Were any managerial or operational personnel paid by donor funds that are not included in your If 'yes', please explain to us what function they Income Statement? performed and how they contributed to your operations What was the amount of their salaries during the fiscal year ended Does your institution use any property or equipment that belongs to another party and is not accounted for on your financial statements (i.e. office space, computer equipment, vehicles, etc.)? If yes, please explain what category this property/equipment would fall under, its value to the institution, and how it was used Category

[See In-kind subsidies] Value of subsidy/donation to the institution [See In-kind subsidies] How it was used [See In-kind subsidies] Rent and utilities [See In-kind subsidies] Transportation [See In-kind subsidies] Office supplies [See In-kind subsidies] Other IK9 Check this box if the institution receives no in-kind subsidies

A 313 314 315 316

Potential Inconsistency Check or not? Notes

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317

318 319 320 321 322 323 324 325 326

The following is a list of potential inconsistencies your data has generated. This does not necessarily mean that the data is incorrect, only that it differs for some reason from what is submitted by the majority of users. Please do not erase or change any data if it is correct - instead, explain, where necessary, the reason for this inconsistency in the 'Notes' field. Please check - this is different from GLP on Balance Sheet Please check - the number of loans does not equal that listed in the 'Products and Clients' section Please check - this does not equal the LLR on the Balance Sheet Please check - this does not equal the LLPE on the Income Statement Please check - this is not entirely consistent with above information

The GLP listed on the Portfolio Report is different from GLP on the Balance Sheet The number of outstanding loans listed in 'Portfolio Report' is different from the number of outstanding loans listed in 'Products and Clients' The LLR listed on the Portfolio Report is different from LLR on the Balance Sheet The LLPE listed on the Portfolio Report is different from the LLPE on the Income Statement The write-offs listed on the Portfolio Report do not equal [last year's loan loss reserve + current year's loan loss provision expense - current year's loan loss reserve] The number of total clients exceeds the sum of savers, borrowers and other product clients The difference between current and previous years' personnel is not consistent with personnel who have been hired and who have left The average staff salary is not consistent with the number of personnel listed in Infrastructure and the personnel expense listed on the Income Statement

Please check - your total clients exceed the sum of savers, borrowers and other product clients Please check - this is not entirely consistent with above information Please check - this information is not consistent with the difference in personnel between this year and last Please check - this information is not consistent with the personnel information entered in the Income Statement Please check - Total Assets do not equal Total Liabilities and Equity

Total Assets do not equal Total Liabilities and Equity on Balance Sheet

327
Please check - voluntary savings appear on the Balance Sheet but you have not listed voluntary savings clients Please check - you have listed voluntary savings clients but no voluntary savings appears on the Balance Sheet Please check - this does not equal the borrowings listed on your Balance Sheet Voluntary savings appear on the Balance Sheet but no voluntary savings clients have been listed in 'Products and Clients' Voluntary savings clients have been listed but no voluntary savings appears on the Balance Sheet The total borrowings listed on Liabilities Analysis is different from the total borrowings listed on the Balance Sheet

328 329 330