OFFICIAL DOCUMENTS THE WORLD BANK IBRD*IDA I wo.BANROUP Date:1u.qi, A,2018 H.E. Hadizatou Rosine Coulibaly Sori Minister of Economy Finance and Development Ministry of Economy, Finance and Development Ouagadougou, Burkina Faso Re: Grant D354-BF (BF-Health Services Reinforcement Project) Additional Instructions: Disbursement and Financial Information Letter. Excellency, I refer to the Financing Agreement between Burkina Faso (the "Borrower") and the International Development Association (the "Association") for the above-referenced Project. The General Conditions, as defined in the Financing Agreement, provide that the Recipient may from time to time request withdrawals of Grant amounts from the Grant Account in accordance with the Disbursement and Financial Information Letter, and such additional instructions as the Association may specify from time to time by notice to the Recipient. The General Conditions also provide that the Disbursement and Financial Information Letter may set out Project specific financial reporting requirements. This letter constitutes such Disbursement and Financial Information Letter ("DFIL"), and may be revised from time to time. I. Disbursement Arrangements, Withdrawal of Grant Funds, and Reporting of Uses of Grant Funds. The Disbursement Guidelines for Investment Project Financing, dated February 2017, ("Disbursement Guidelines") are available in the Association's public website at https://www.worldbank.or and its secure website "Client Connection" at https://clientconnection.worldbank.or . The Disbursement Guidelines are an integral part of the DFIL, and the manner in which the provisions in the guidelines apply to the Credit is specified below. (i) Disbursement Arrangements General Provisions (Schedule 1). The table in Schedule I sets out the disbursement methods which may be used by the Borrower, information on registration of authorized signatures, processing of withdrawal applications (including minimum value of applications and processing of advances), instructions on supporting documentation, and frequency of reporting on the Designated Account. (ii) Electronic Delivery. Section 11.01 (c) of the General Conditions. The Association may permit the Recipient to electronically deliver applications (with supporting documents) through the Association's web-based portal (https://clientconnection.worldbank.or) "Client Connection". This option may be effected if the officials designated in writing by the Recipient who are authorized to sign and deliver Applications have registered as users of "Client Connection". The designated officials may deliver Applications electronically by completing the Form 2380, which is accessible through "Client Connection". By signing the Authorized Signatory Letter, the Recipient confirms that it is authorizing such persons to accept Secure Identification Credentials (SIDC) and to deliver the Applications and supporting documents to the Association by electronic means. The Recipient may continue to exercise the option of preparing and delivering Applications in paper form. The Association reserves the right and may, in its sole discretion, temporarily or permanently disallow the electronic delivery of Applications by THE WORLD BANK IBRD * IDA I WORLDBNKmGROUP the Recipient. By designating officials to use 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, available in the Association's public website at https://worldbank.org and "Client Connection"; and (b) to cause such official to abide by those terms and conditions. II. Financial Reports and Audits. (i) Financial Reports. The Recipient must prepare and furnish to the Association not later than forty-five (45) days after the end of each calendar quarter, interim unaudited financial reports ("IFR") for the Project covering the quarter. (ii) Audits. Each audit of the Financial Statements must cover the period of one fiscal year of the Borrower, commencing with the fiscal year in which the first withdrawal was made. The audited Financial Statements for each such period must be furnished to the Association not later than six (6) months after the end of such period. III. Other Information. For additional information on disbursement arrangements, please refer to the Loan Handbook available on the Association's website (http://www.worldbank.org/) and "Client Connection". The Association recommends that you register as a user of "Client Connection". From this website you will be able to prepare and deliver Applications, monitor the near real-time status of the [Grant] [Credit], and retrieve related policy, financial, and procurement information. For more information about the website and registration arrangements, please contact the Association by email at clientconnection(@bworldbank.org. If you have any queries in relation to the above, please contact Issa Thiam, Finance Officer at ithiam@worldbank.org, with copy to Felix Lawson, Finance Analyst at llawsonl@worldbank.org using the above reference. Yours sincerely, Hafez M. H. Ghanem Vice President Africa Region (AFRVP) World Bank Group Attachments 1. Form of the Authorized Signatory Letter 2. Statement of Expenditure (SOE) 3. Customized of Statement of Expenditure With copies: The Minister of Health: Professor Nicolas Meda: Minist&re de la Santd Building Lamizana, 03 BP 7009 Ouagadougou 03. Phone +226 25326340 THE WORLD BANK IBRD* IDA I WORLDBANwOUP The Minister of Economy, Finance and Development: Mrs Hadizatou Rosine Coulibaly Sori: 395, Avenue du 11 D6cembre, Ministre de l'tconomie, des Finances et du D6veloppement, 03 BP 7050 Ouagadougou 03, BURKINA FASO, phone : +226 25 33 30 95, Email : cab mef(yahoo.fr, Schedule 1: Disbursement Provisions -Country Burkina Faso Closing Date Section [III.B.2.] of Schedule [2] to Grant Borrower Burkina Faso the Loan Agreement. Number D354-BF Name of the Project Health Services Reinforcement Disbursement Four months after the closing date. Project Deadline Date Subsection 37 ** Disbursement Methods Methods Supporting Documentation Section 2 (**) Subsections 4.3 and 4.4 (**) Direct Payment [Yes] Copy of records Reimbursement [Yes] Statement of Expenditure (SOE) in the format provided in Attachment 2 of the DFIL Designated Account [Yes] Statement of Expenditure and Customized Statement of Expenditures in the format provided in Attachment 2 and 3 of the DFIL Slecial Commitments [Yes Cop of Letter of Credit Type Segregated Ceiling Fixed Financial Institution - BCEAO - BF FCFA Name Frequency of Reporting Monthly Amount 2,500,000,000 Subsections (**) The minimumITI vaIlue of applications, fo(r Reimibuirsement, Direct Payment and Special Commnitment is ten percent of the Designated Account C'eiling. Authorized Signatures (subsection 3.1 and 3.2). Applications for this Financing will be signed by the official(s) authorized to sign Applications as indicated in your letter of May 2, 2017 and signed by H.E. Hadizatou Rosine Coulibaly Sori, Ministre de l'Economie, des Finances et du Ddveloppement. Applications (subsections 3.3 - 3.4). Please provide completed and signed (a) applications for withdrawal, together with supporting documents, and (b) applications for special commitments, together with a copy of the commercial bank letter of credit, to the address indicated below: The World Bank, Loan Department Delta Center, 13th Floor, Menegai Road, Upper Hill Nairobi, Kenya Attention: Loan Oerations & Trust Funds Unit ** Sections and subsections relate to the "Disbursement Guidelines for Investment Project Financing", dated February 2017 [Attachment 1 - Form of Authorized Signatory Letter] [Letterhead] Ministry of Finance [Street address] [City] [Country] [DATE] The World Bank 1818 H Street, N.W. Washington, D.C. 20433 United States of America Attention: Mr. Laporte Re: Grant - (BF-Health Services Reinforcement Project) I refer to the Financing Agreement ("Agreement") Agreement between Burkina Faso (the "Recipient") and the International Development Association (the "Association"), dated providing the above Grant. For the purposes of Section 2.02 of the General Conditions as defined in the Agreement, any Jone] of the persons whose authenticated specimen signatures appear below is authorized on behalf of the Borrower to sign applications for withdrawal [and applications for a special commitment] under this Loan. For the purpose of delivering Applications to the Bank, 2[each] of the persons whose authenticated specimen signatures appears below is authorized on behalf of the Borrower, acting 3[individually] 4Uointly], to deliver Applications, and evidence in support thereof on the terms and conditions specified by the Bank. 5[This confirms that the Borrower is authorizing such persons to accept Secure Identification Credentials (SIDC) and to deliver the Applications and supporting documents to the Bank by electronic means. In full recognition that the Bank shall rely upon such I Instruction to the Borrower: 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 Bank 2 Instruction to the Borrower: 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 Bank I Instruction to the Borrower: 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 Bank 4 Instruction to the Borrower: 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 Bank s Instruction to the Borrower: Add this paragraph if the Borrower wishes to authorize the listed persons to accept Secure Identification Credentials 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 Bank 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 Borrower represents and warrants to the Bank that it will cause such persons to abide by those terms and conditions.] This Authorization replaces and supersedes any Authorization currently in the Bank records with respect to this Agreement. [Name], [position] Specimen Signature: [Name], [position] Specimen Signature: [Name], [position] Specimen Signature: Yours truly, / signed / [Position] AttachmentZ一Statement of Expenditures 主抓 ATTACHMENT 3 The World Bank APPLICATION FOR WITHDRAWAL Data CUSTOMIZED STATEMENT OF EXPENDITURES6 (SOE) Category No. 1 3 4 5 6 7 8 9 10 11 Amou Amount 1 Paid Name and Amount nt References Total From Z Address of of Eligible per Amount tb Eligibl Designa Payment Beneficiar e for Agency Beneficiary y Paid W Financ ted Account ing I (if any) TOTAL S Certification The Recipient hereby certifies that the Beneficiaries paid were selected in line with the Procedures and Eligibility Criteria specified in the in Section I.C. I of Schedule 2 to the Agreement Name and Title of Authorized Representative Supporting documents for this SOE retained at:(insert location) FOR INTERNAL DISTRIBUTION ONLY Drafted by Issa Thiam, (WFACS FO) Cleared with and cc: Saba M. Gheshan (Lawyer) Paul Jacob Robyn (TTL) Cc: Jean Charles Amon Kra (FMS)