OFFICIAL DOCUMENTS THEWORLD BANK IBRD* IDA I WORLDBANKGROUP t'-PP 13,2019 Mr. Faiziddin Qahhorzoda Minister of Finance Ministry of Finance 3, Akademikov Rajabovykh Ave. Dushanbe, 734025 Republic of Tajikistan Re: Grant No. TF0A9568 (CASA 1000 Community Support Project) Additional Instructions: Disbursement Letter (DL) Dear Mr. Qahhorzoda: I refer to the Grant Agreement ("Agreement") between the International Bank for Reconstruction and Development/International Development Association ("World Bank"), acting as administrator of the CASA-1000 Multi Donor Trust Fund, and Republic of Tajikistan (the "Recipient") for the above-referenced project, dated Nove her /3 , 2019. The Agreement provides that the World Bank may issue additional instructions regarding the withdrawal of the proceeds of Grant TF0A9568 ("Grant"). This letter ("Disbursement Letter" or "DL"), as revised from time to time, constitutes the additional instructions. I. Disbursement Arrangements, Withdrawal of Grant Proceeds and Reporting on Uses of Grant Proceeds The Disbursement Guidelines for Investment Project Financing, dated February 2017, ("Disbursement Guidelines") are available in the World Bank's public website at https://www.worldbank.org and its secure website "Client Connection" at https://clientconnection.worldbank.org. The Disbursement Guidelines are an integral part of the DL, and the manner in which the provisions in the guidelines apply to the Grant is specified below. (i) Disbursement Arrangements The table in Schedule 1 sets out the disbursement methods which may be used by the Recipient, 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. 1 (ii) Electronic Delivery The Recipient will electronically deliver applications (with supporting documents) through the World Bank's web-based portal (https://clientconnection.worldbank.org) "Client Connection". This facility will become available once: (a) the Recipient has designated in writing, 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". The designated officials will 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 World Bank by electronic means. The Recipient may exercise the option of preparing and delivering Applications in paper form on an exceptional basis (including when encountering legislative limitations), and when pre-agreed with the World Bank. The World Bank reserves the right and may, in its sole discretion, temporarily or permanently disallow the electronic delivery of Applications by 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 World Bank's public website at https://worldbank.org and "Client Connection"; and (b) to cause such official to abide by those terms and conditions. II. Other Information For additional information on disbursement arrangements, please refer to the Loan Handbook available on the World Bank's website (http://www.worldbank.or /) and "Client Connection". The World Bank 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, and retrieve related policy, financial, and procurement information. For more information about the website and registration arrangements, or if you have any queries in relation to the above, please contact the World Bank by email at askloans(iworldbank.org. o sincerely, Jan-Peters 01ters Country Manager for Taji stan 2 Attachments 1. Form of Authorized Signatory Letter 2. Form of Statement of Expenditure (SOE) 3. Form of Designated Account Reconciliation Statement Cc with copies: National Social Investment Fund for Tajikistan (NSIFT) 3 Schedule 1: Disbursement Provisions Country Republic of Tajikistan Closing Date Section IV.B.2. of Schedule 2 to Grant Recipient Republic of Tajikistan the Grant Agreement Number TF0A9568 Name of the Project CASA 1000 Community Support Project Disbursement Four months after the Closing Deadline Date Date (Subsection 3.7 *) Disbursement Methods and Supporting Documentation Disbursement Methods Methods Supporting Documentation (Section 2 *(Subsections 4.3 and 4.4 ** Direct Payment Yes Copy of records (e.g. suppliers' invoices, guarantees for advance and retention payments, etc.) Reimbursement Yes Statement of Expenditure (SOE) in the format provided in Attachment 2 of the DL Designated Account* Yes* Statement of Expenditure (SOE) in the format provided in Attachment 2 of the DL; Designated iAccount Reconciliation Statement in the format provided in Attachment 3 of the DL Special Commitments No_N/A Designated4Account,(Sections 5 and 6** __._. Type Segregated - one new, separate Designated Account (DA) to be Ceiling Fixed opened for the MDTF and to be managed by NSIFT Financial Institution - To be established at a financial institution acceptable to the World Currency USD Name Bank Frequency of Reporting Quarterly, or more frequently if needed. Amount Up to 100,000* (Subsection 6.3 *i The minimum value of applications for Reimbursement and Direct Payment is USD 20,000 equivalent. Authorized Signatures (Subsection 3.1 and 3.2 *) The form for Authorized SignaioriesLetter is providedinAttachmet 1jfthiletter Withdrawal and Documentation Applications (Subsection 3.3 and34 * The World Bank Radnicka cesta 80, 9th floor Zagreb, HR-10000, Croatia Attention: Loan Department (WFACS) Note: All Withdrawal and Documentation Applications will be electronically delivered to the World Bank, via the World Bank's website Client Connection. lAditiftalif6r lA rcOu ....... . . .. ..... * Condition for the Designated Account: In accordance with the subsection 5.2 of the Disbursement Guidelines, usage of the Designated Account may not be permitted in case the Recipient has failed to refund undocumented advances in the Designated Account of any other Grant or Credit to, or guaranteed by, the Recipient within two months after the Disbursement Deadline Date for that Grant or Credit. In such case, the advance/Designated Account method will become available only after the undocumented advance under the relevant lapsed Grant or Credit has been refunded to and received by the World Bank. ** Sections and subsections relate to the "Disbursement Guidelines for Investment Project Financing", dated February 2017. Attachment 1 - Form of Authorized Signatory Letter Form of Authorized Signatory Letter [Letterhead] [Recipient] [Street address] [City] [Country] [DATE] The World Bank 1818 H Street, N.W. Washington, D.C. 20433 United States of America Attention: [Country Director] Re: Grant (CASA 1000 Community Support Project) I refer to the Grant Agreement ("Agreement") between the International Bank for Reconstruction and Development/International Development Association ("World Bank"), acting as administrator of the CASA-1000 Multi Donor Trust Fund, and Republic of Tajikistan (the "Recipient"), dated , providing the above Grant. For the purposes of Section 3.04 (b) of the Standard Conditions, as defined in the Agreement, any [lone] of the persons whose authenticated specimen signatures appear below is authorized on behalf of the Recipient to sign applications for withdrawal [and applications for a special commitment] 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. 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 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 I 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 3 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 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] Attachment 2 - Form of Statement of Expenditure Statement of Expenditure (SOE) For Goods, non-CS, CS, Training, IOC Payments made during the period from to Grant No.: Application No.: Category No.: SOE No.: 1 2 3 4 5 6 7 8 9 10 11 Supplier's WB Type of Good or Currency and Total Currency and % Financed Amount Currency and Exchange Date of Remarks Name Contract Service Amount, and Date of Total Amount by Eligible Amount Paid Rate Payment Number in (CW/GO/CS/OP/TR) Contract of Invoice IBRD/IDA/TF for from Client / Brief Description Covered by Financing Designated Connection Application (5 x 6) Account (if (for Prior Applicable) Review Contracts) TOTALS Supporting documents for this SOE retained at (location) Attachment 3 - Form of Designated Account Reconciliation Statement DESIGNATED ACCOUNT RECONCILIATION STATEMENT LOAN/CREDIT/PPF/COFINANCIER NUMBER ACCOUNT NUMBER WITH (BANK) I. TOTAL ADVANCED BY WORLD BANK (OR COFINANCIER) US$/EUR 2 LESS: TOTAL AMOUNT RECOVERED BY WORLD BANK - US$/EUR 3. EQUALS PRESENT OUTSTANDING AMOUNT ADVANCED TO THE DESIGNATED ACCOUNT (NUMBER I LESS NUMBER 2) = US$/EUR 4. BALANCE OF DESIGNATED ACCOUNT PER ATTACHED BANK STATEMENT AS OF DATE US$/EUR 5. PLUS: TOTAL AMOUNT CLAIMED IN THIS APPLICATION NO. + US$/EUR 6. PLUS: TOTAL AMOUNT WITHDRAWN AND NOT YET CLAIMED REASON: + US$/EUR 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 + US$/EUR 8. MINUS: INTEREST EARNED - US$/EUR 9. TOTAL ADVANCE ACCOUNTED FOR (NO.4 THROUGH NO. 9) = US$/EUR 10. EXPLANATION OF ANY DIFFERENCE BETWEEN THE TOTALS APPEARING ON LINES 3 AND 9: 11. DATE: SIGNATURE: TITLE: FOR INTERNAL DISTRIBUTION ONLY Prepared by: Jasna Mestnik, Finance Officer - WFACS Cleared with and cc: Pilar GonzalezlRuxandra Costache, Country Lawyer - LEGLE Janelle Plummer, Task Team Leader - GSU03 Cc: Niso Bazidova, Financial Management Analyst - GGOEE