mix mbb questionnaire

8/2/2019 MIX MBB Questionnaire

http://slidepdf.com/reader/full/mix-mbb-questionnaire 1/22

Introduction

MIX Monitor Data Collection Tool

Please select your language: English

Thank you for pariticipating in an international movement towards standardization, transparency andrelevant benchmarks for the microfinance sector.

In order to provide us with a complete picture of your institution, please fill out each page of thisquestionnaire 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 sectionincludes a list of potential errors or inconsistencies that your data may have generated, as well as anopportunity 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

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General Information

Name of MFI

Fiscal Year to be analyzed

Currency Unit of currency Exchange raStart (dd/mm/yyyy)

End (dd/mm/yyyy)

INSTITUTIONAL CONTACT INFORMATION

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

Address Fax

City, State/Province, Postal Code Email

Country Web site

Phone

INSTITUTIONAL PRESENTATION

Year microfinance operations began (yyyy) Profit Status

Institutional charter

If 'other', please specify

Ownership composition

Is the institution regulated?If yes, by whom is it regulated?

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?

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?

Back

Strategic alliances (please select all that apply, and specify anyother affiliations)

Year of transformation to current institutionalcharter (if applicable)

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 uif so, how?

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

Yes No

Yes No

No

Select Allia

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Income Statement

FINANCIAL STATEMENTS - Please list in

Income Statement

Item Account

Period starting

Description

Period ending

5 Financial Revenue 0

(sum of 5)

5a 0 Total interest, fees and commission on loan portfolio.

(sum of 5a)

5a1 Interest on Loan Portfolio Interest earned on loan portfolio.

5a2

5b Net gains on other financial assets.

5c

6 Financial Expense 0

(sum of 6)

6a Financial Expense on Liabilities 0 Total of interest and fees paid on deposits and borrowings.

(sum of 6a)

6a1 Interest and fees paid on demand or term deposits.

6a2 Interest and fees paid on borrowings.

6b Net Inflation Adjustment Expense 0

(sum of 6b)

6b1 Inflation Adjustment Expense Cost of maintaining the value of the institution's equity.

6b2 Inflation Adjustment Revenue Gain on the value of fixed assets due to inflation.

6c

6d Other Financial Expenses

7 NET FINANCIAL INCOME 0 Financial Revenue minus Financial Expense.

(5 less 6)

Back to

Total of revenue from loan portfolio and other financialassets, as well as other financial revenue from financialservices.

Financial Revenue from LoanPortfolio

Fees and Commissions on LoanPortfolio

Penalties, commissions and other fees charged on loanportfolio.

Financial Revenue from Other Financial Assets

Other Revenue Related to FinancialServices

Other revenue from provision of financial services, includingrevenue from insurance or transfer services or non-financialrevenue from the provision of financial services, such as thesale of passbooks or SmartCards. This account alsoincludes net exchange gain.

Total of financial expense on liabilities, net inflationadjustment, cost-of-funds adjustment and other expensesfrom financial services.

Interest and Fee Expense onDeposits

Interest and Fee Expense onBorrowings

Reserved for institutions that use inflation based accounting.Net amount of inflation adjustment.

Subsidized Cost-of-FundsAdjustment Expense

Adjustment expense for difference between market rate andconcessional rate on funding liabilities (reserved for MIXuse).

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

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Income Statement

8 Net Loan Loss Provision Expense 0

(sum of 8)

8a Loan Loss Provision Expense Loan Loss Provision Expense for the period.

8b Recovery on Loans Written-off Total recovery on loans written off.

10 Operating Expense 0 Total of Personnel Expense and Administrative Expense.

(sum of 10)

10a Personnel Expense

10b Administrative Expense 0

(sum of 10b)10b1 Rent and Utilities Rent and utility charges.

10b2 Transportation

10b3 Office Supplies Printed matter, supplies, photocopies, books, etc.

10b4 Depreciation and Amortization

10b5 Other Administrative Expenses Other non-personnel administrative expenses.

11 NET OPERATING INCOME 0

(7 less 8 less 10)

12 Net Non-Operating Income 0 Non-operating Revenue less Non-operating Expense.

(sum of 12)

12a Non-Operating Revenue

12b Non-Operating Expense

13 0 Net Operating Income plus Net Non-operating Income.

(11+12)

14 Taxes

15 0 Net Income (before Taxes and Donations) less Taxes.

(13 less 14) (13-14)

16 Donations made to the MFI to subsidize its operations.

17 0

(15+16)

Sum of loan loss provision expense and recovery on loanloss provision.

Salaries, withholdings, fringe benefits and personnel taxespaid on all those who work for the institution.

Total of Rent and Utilities, Transportation, Office Supplies,Depreciation and Other Administrative Expenses.

Transportation of staff to attend to clients and to manageoperations.

Allowance for deterioration, eventual replacement of equipment.

Financial Revenue less Financial Expense, Net Loan LossProvision Expense and Operating Expense.

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

Expenses from activity unrelated to the MFIs core activity of providing financial services, such as BDS development

costs or consulting expenses.

NET INCOME (BEFORE TAXESAND DONATIONS)

Includes all taxes paid on Net Income or other measure of profits as defined by local tax authorities.

NET INCOME (AFTER TAXES ANDBEFORE DONATIONS)

Donations to Subsidize FinancialServices

NET INCOME (AFTER TAXES ANDDONATIONS)

Net Income (after Taxes and before Donations) plusDonations.

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ccts Irrecouvrabl

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Balance Sheet



Balance Sheet As of

Item Account Description

Assets

1a Cash and Due from Banks

1b Reserves in Central Bank Cash reserves in a central bank.

1c Short Term Financial Assets

1d Net Loan Portfolio 0 Gross Loan Portfolio minus Loan Loss Reserve.

(sum of 1d)

1d1 Gross Loan Portfolio

1d2 Loan Loss Reserve

1e Interest Receivable

1f

1g Long Term Financial Assets Long term investments not convertible to cash within 12 months.

1h Net Fixed Assets

1 TOTAL ASSETS 0 Total of all net asset accounts.

(sum of 1)

Cash, petty cash, balances in banks, including non-interest bearingdeposits.

Treasury bills and other short term investments, including interest-bearing deposits, convertible to cash within 12 months. Usually used inliquidity management.

All outstanding principal for all outstanding client loans, includingcurrent, delinquent and restructured loans, but not loans that have beenwritten off. It does not include interest receivable. It does not includeemployee loans.

The portion of the gross loan portfolio that has been expensed(provisioned for) in anticipation of losses due to default. This itemrepresents the cumulative value of the loan loss provision expense, lessthe cumulative value of loans written off.

Interest receivable on all asset accounts. Recorded by institutionsusing accrual accounting.

Accounts Receivable and Other Assets

Accounts receivable, notes receivables and other receivables. Thisincludes all receivables other than client loan accounts, includingemployee loans.

The purchase value of property, plant and equipment, less accumulateddepreciation. This includes intangibles, such as MIS development or

goodwill, less accumulated amortization.

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Balance Sheet


Liabilities

2a Demand Deposits 0 Total of Voluntary and Compulsory Savings.

(sum of 2a)

2a1 Voluntary Savings

2a2 Compulsory Savings

2b Time Deposits Certificates of deposit or other fixed term deposits.

2c Total Borrowings 0 Total of Commercial and Concessional Borrowings.

(sum of 2c)

2c1

2c2

2d Interest Payable

2e

2 TOTAL LIABILITIES 0 Total of all liability accounts.

(sum of 2)

Demand deposits from the general public and members that are notmaintained as a condition for accessing a current or future loan and areheld with the institution.

Client savings accounts that are maintained as a condition for a currentor future loan and are held with the institution.

Borrowings at Concessional Interest Rates

Principal balance of all borrowings, including overdraft accounts, for which the institution pays a nominal rate of interest that is less than thelocal commercial interest rate.

Borrowings at Commercial Interest Rates

Principal balance of all borrowings, including overdraft accounts, for which the institution pays a nominal rate of interest that is greater thanto or equal to the local commercial interest rate.Interest payable on all liability accounts. Recorded by institutions usingaccrual accounting.

Accounts Payable and Other Liabilities

Other liabilities including tax and salary liabilities, social withholdings,deferred income, other accounts payable, including liabilities that do notfund the portfolio, such as mortgages on real estate.

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Balance Sheet


Equity

3a Paid-in Capital Capital paid by shareholders or members.

3b Donated Equity 0 Accumulated donations.

(sum of 3b)

3b1 Prior Years Accumulated donations from prior periods.

3b2 Current Year 0 Accumulated donations from the current year.

(line 16 from IS)

3c Retained Earnings 0 Accumulated net income after taxes and before donations.

(sum of 3c)

3c1 Prior Years

3c2 Current Year 0

(line 15 from IS)

3d Adjustments 0 Value of all adjustments, including inflation adjustment.

(sum of 3d)

3d1 Inflation Adjustment

3d2

3d3 In-Kind Subsidy Adjustment Value in-kind subsidy adjustment (reserved for MIX use).

3e Reserves

3f Other Equity Accounts Other equity accounts not included elsewhere.

3 TOTAL EQUITY 0 Total of all equity accounts.

(sum of 3)

4 TOTAL LIABILITIES AND EQUITY 0 Total of Total Liabilities and Total Equity.

(2+3)

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

Accumulated net income after taxes and before donations from thecurrent year.

Value of inflation adjustment expense (reserved for institutionspracticing inflation-based accounting).

Subsidized Cost of Funds Adjustment

Value of subsidized cost of funds adjustment expense (reserved for MIX use).

Reserves such as those imposed by law or statute. Explain anyreserves used by the institution.

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Balance Sheet


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

Back to index

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Infrastructure


Name of MFI


Currency Unit of currency ExchangStart (dd/mm/yyyy)

End (dd/mm/yyyy) 0 0

StructureHead office Regional office level Branch office Sub-branch (un

How many offices?

Percentage of total clients in each location Large cities Small cities/Towns Rural Total

Please provide information on staffing and personnel

Number of staff, year-end

Number of staff who have left during year

Number of staff hired during the year

How many staff does the MFI have at each levelof infrastructure?

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 woulfor those hours)

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

Number of front-office staff (staff who have directcontact with clients), year-end

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

Do these figures represent all the peoplewho contribute to your operations, includingvolunteers, part time, and full time staff? Yes

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Products and Clients

Name of MFI


Currency Unit of currencyStart (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

Does the institution offer non financial services?

Please list, describe and provide a balance for each financial product offered by the institution (ranked in order of importance to institu

Loan products

a)

b)

c)

Savings products

a)

b)

c)

Other microfinance products

Loans and borrowers

Please provide information as of Please provide

Total T

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 VoluntaryNumber of active savings accounts

Number of active savers

Number of women savers

Clients, by other productOther products

Number of active clients

Is the institution able to track numbers of clients in addition to number of accounts (i.e., savers as well as savings accounts)?

Description of loan terms and conditions (include description of loan terms,payment frequency, grace periods, guarantee requirements, conditions required toaccess loans, etc.)

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Description of terms and conditions of savings product (include description of terms, whether account is voluntary or compulsory, whether deposits are fixedterm, whether MFI or third party mobilizes deposits, etc.)

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Description of terms and conditions of product (all products defined as 'other'should be described in particular detail)

If yeab

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Portfolio Report

Name of MFI


Currency Unit of currency ExchangStart (dd/mm/yyyy)


Repayment performance of outstanding Loan Portfolio

Please provide information as of Were there any renegotiated loans on this year's Balance Sheet?

Does the MFI track renegotiated loans separate from non-renegotiated loans?

Aging/Status of portfolio Number of loans Amount - listed in

Current portfolio, on-time (< 30 Days, non-renegotiated loans)

Portfolio balance affected by overdue payments (non-renegotiated loans)

30-90 Days

91-180 Days

181-365 Days

366+ Days

All renegotiated loans

Gross Loan Portfolio - -

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

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Liabilities Analysis


Name of MFI


Currency Unit of currency Exchange rateStart (dd/mm/yyyy)

End (dd/mm/yyyy) 0 0 0

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Description of institutional borrowings

a)

b)

c)

d)

e)

f)

Total borrowings, current year (Line 2c of Balance Sheet) 0

Total borrowings, as of

Back to index

How many individual borrowings (either commercial or concessional)appear on the current year's Balance Sheet?

Source, including name and description (if possible)

Nominal interest ratepaid on this borrowing

Would you classify this as a liability froma public or private source?

Amount of this liabilityon Balance Sheet

Back to index

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In-kind subsidies


Name of MFI

Fiscal Year to be analyzed Currency Unit of currency Exchange rate

Start (dd/mm/yyyy)

End (dd/mm/yyyy) 0 0 0

Operational subsidy analysis

Please read through the following questions to determine if your institution received any operational (in-kind) subsidy this fiscal year

If 'yes', please explain to us what function they performed and how they contributed to your operations

What was the amount of their salaries during the fiscal year ended 30/12/1899

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

Category How it was used

Rent and utilities

Transportation

Office supplies

Other

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

Back to index

Were any managerial or operational personnel paid by donor funds that are not included in your IncomeStatement?

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

Value of subsidy/donation tothe institution

Back to index

Yes No

Yes No

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Final check

Potential Inconsistency Check or not?

The GLP listed on the Portfolio Report is different from GLP on the Balance Sheet No problem [Please write here]

No problem [Please write here]

The LLR listed on the Portfolio Report is different from LLR on the Balance Sheet No problem [Please write here]

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


The number of total clients exceeds the sum of savers, borrowers and other product clients No problem [Please write here]



Total Assets do not equal Total Liabilities and Equity on Balance Sheet No problem [Please write here]


Voluntary savings clients have been listed but no voluntary savings appears on the Balance Sheet No problem [Please write here]


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 disubmitted 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 i

The number of outstanding loans listed in 'Portfolio Report' is different from the number of outstanding loans listed in 'Products and Clients'

The write-offs listed on the Portfolio Report do not equal [last year's loan loss reserve + currentyear's loan loss provision expense - current year's loan loss reserve]

The difference between current and previous years' personnel is not consistent with personnel whohave 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

Voluntary savings appear on the Balance Sheet but no voluntary savings clients have been listed in'Products and Clients'

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

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Label data (language) No. English

GI1 Name of MFIGI2 Fiscal Year to be analyzedGI3 Start (dd/mm/yyyy)GI4 End (dd/mm/yyyy)GI5 CurrencyGI6 Unit of currencyGI7 Exchange rate

YesNo

INSTITUTIONAL CONTACT INFORMATIONGI8 Name and title of person filling out questionnaireGI9 Name and title of head of MFI (CEO, ED, etc.)GI10 AddressGI11 City, State/Province, Postal CodeGI12 CountryGI13 PhoneGI14 FaxGI15 Email

GI16 Web site

INSTITUTIONAL PRESENTATIONGI17 Year microfinance operations began (yyyy)GI19

GI20 Profit Status-Select one-ProfitNon-profit

GI24 Institutional charter -Please select-

BankCredit Union/CooperativeNon-Bank Financial IntermediaryNon Governmental Organization (NGO)Rural BankOther

GI32 Ownership compositionGI33

Select Alliances

If 'other', please specifyGI34 Is the institution regulated?GI35 If yes, by whom is it regulated?

YesNo

GI38

GI39 Describe the mission of the institutionGI40 Describe the main challenges of the institution

ACCOUNTING METHODSGI40

Year of transformation to currentinstitutional charter (if applicable)

Strategic alliances (please select all thatapply,and specify any other affiliations)

Please describe the type, frequency andextent of supervision received by theinstitution, if any

Does your institution use cash or accrual accounting? Which accounts aretreated on each basis?

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Label data (language) GI41

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Balance SheetItem Account As of Description Assets

FS1a Cash and Due from Banks

FS1b Reserves in Central Bank Cash reserves in a central bank.

FS1c Short Term Financial Assets

FS1d Net Loan Portfolio Gross Loan Portfolio minus Loan Loss Reserve.

(sum of 1d)

FS1d1 Gross Loan Portfolio

FS1d2 Loan Loss Reserve

FS1e Interest Receivable

FS1f Accounts Receivable and Other Assets

FS1g Long Term Financial Assets Long term investments not convertible to cash within 12 months.

FS1h Net Fixed Assets

FS1 TOTAL ASSETS Total of all net asset accounts.

(sum of 1)

Liabilities

FS2a Demand Deposits Total of Voluntary and Compulsory Savings.

(sum of 2a)

FS2a1 Voluntary Savings

FS2a2 Compulsory Savings

FS2b Time Deposits Certificates of deposit or other fixed term deposits.

Does your institution adjust for theeffects of inflation in its audited financialstatements and/or in the financialinformation which you have presented tous, and if so, how?

Does your institution adjust accounts for the effects of translation/conversion of foreign currencies (including dispositionof exchange gains/loss) in its auditedfinancial statements and/or in thefinancial information which you havepresented to us, and if so, how?

Describe any reserve accounts listedunder equity on the Balance Sheet

Can your institution break out totalassets between short term assets andlong term assets?

Separation of all asset accounts between amountsmaturing within and beyond 12 months

Can your institution break outoutstanding liabilities between shortterm and long term?

Separation of all liability accounts between amountspayable within and beyond 12 months

Cash, petty cash, balances in banks, including non-interest bearingdeposits.

Treasury bills and other short term investments, including interest-bearing deposits, convertible to cash within 12 months. Usuallyused in liquidity management.

All outstanding principal for all outstanding client loans, includingcurrent, delinquent and restructured loans, but not loans that havebeen written off. It does not include interest receivable. It doesnot include employee loans.

The portion of the gross loan portfolio that has been expensed(provisioned for) in anticipation of losses due to default. This itemrepresents the cumulative value of the loan loss provisionexpense, less the cumulative value of loans written off.

Interest receivable on all asset accounts. Recorded by institutionsusing accrual accounting.

Accounts receivable, notes receivables and other receivables.This includes all receivables other than client loan accounts,including employee loans.

The purchase value of property, plant and equipment, lessaccumulated depreciation. This includes intangibles, such as MISdevelopment or goodwill, less accumulated amortization.

Demand deposits from the general public and members that arenot maintained as a condition for accessing a current or future loanand are held with the institution.Client savings accounts that are maintained as a condition for acurrent or future loan and are held with the institution.

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Label data (language) FS2c Total Borrowings Total of Commercial and Concessional Borrowings.

(sum of 2c)

FS2c1 Borrowings at Concessional Interest Rates

FS2c2 Borrowings at Commercial Interest Rates

FS2d Interest Payable

FS2e Accounts Payable and Other Liabilities

FS2 TOTAL LIABILITIES Total of all liability accounts.

(sum of 2)

Equity

FS3a Paid-in Capital Capital paid by shareholders or members.

FS3b Donated Equity Accumulated donations.

(sum of 3b)

FS3b1 Prior Years Accumulated donations from prior periods.

FS3b2 Current Year Accumulated donations from the current year.

FS3c Retained Earnings Accumulated net income after taxes and before donations.

(sum of 3c)

FS3c1 Prior Years

FS3c2 Current Year

FS3d Adjustments Value of all adjustments, including inflation adjustment.

(line 15 from IS)

(line 16 from IS)(sum of 3d)

FS3d1 Inflation Adjustment

FS3d2 Subsidized Cost of Funds Adjustment

FS3d3 In-Kind Subsidy Adjustment Value in-kind subsidy adjustment (reserved for MIX use).

FS3e Reserves

FS3f Other Equity Accounts Other equity accounts not included elsewhere.

FS3 TOTAL EQUITY Total of all equity accounts.

(sum of 3)

FS4 TOTAL LIABILITIES AND EQUITY Total of Total Liabilities and Total Equity.

BS1 Gross Loan Portfolio, as of

BS2 TOTAL ASSETS, as of

BS3 Net fixed assets, as of

BS4 TOTAL EQUITY, as of

BS5

BS6

BS7 Total balance on all liability accounts payable within 12 months

BS8

Income Statement

Principal balance of all borrowings, including overdraft accounts,for which the institution pays a nominal rate of interest that is lessthan the local commercial interest rate.Principal balance of all borrowings, including overdraft accounts,for which the institution pays a nominal rate of interest that isgreater than to or equal to the local commercial interest rate.Interest payable on all liability accounts. Recorded by institutionsusing accrual accounting.

Other liabilities including tax and salary liabilities, socialwithholdings, deferred income, other accounts payable, includingliabilities that do not fund the portfolio, such as mortgages on realestate.

Accumulated net income after taxes and before donations fromprior periods.

Accumulated net income after taxes and before donations from thecurrent year.

Value of inflation adjustment expense (reserved for institutionspracticing inflation-based accounting).Value of subsidized cost of funds adjustment expense (reservedfor MIX use).

Reserves such as those imposed by law or statute. Explain anyreserves used by the institution.

Please provide the following account balances for the previous fiscal year

Please provide us with the short and long-termbreakout of Total Assets and Total LiabilitiesTotal of all asset accounts maturing at or within 12months

Total of all asset accounts (including gross loan portfolio) maturingat or within 12 months

Total of all asset accounts maturing in more than12 months

Total of all asset accounts (including gross loan portfolio) maturingin more than 12 months

Total balance on all liability accounts payable at or within 12 monthsTotal balance on all liability accounts payablebeyond 12 month horizon

Total balance on all liability accounts payable beyond 12 monthhorizon

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Label data (language) Period starting

Period ending

FS5 Financial Revenue

(sum of 5)

FS5a Financial Revenue from Loan Portfolio Total interest, fees and commission on loan portfol io.

FS5a1 (sum of 5a)

FS5a2 Interest on Loan Portfolio Interest earned on loan portfolio.

FS5b Fees and Commissions on Loan Portfolio Penalties, commissions and other fees charged on loan portfolio.

FS5c Financial Revenue from Other Financial Assets Net gains on other financial assets.

FS6 Other Revenue Related to Financial Services

Financial Expense

FS6a (sum of 6)

Financial Expense on Liabilities Total of interest and fees paid on deposits and borrowings.

(sum of 6a)FS6a1 Interest and Fee Expense on Deposits Interest and fees paid on demand or term deposits.

FS6a2 Interest and Fee Expense on Borrowings Interest and fees paid on borrowings.

FS6b Net Inflation Adjustment Expense

(sum of 6b)

FS6b1 Inflation Adjustment Expense Cost of maintaining the value of the institution's equity.

FS6b2 Inflation Adjustment Revenue Gain on the value of fixed assets due to inflation.

FS6c Subsidized Cost-of-Funds Adjustment Expense

FS6d Other Financial Expenses

FS7 NET FINANCIAL INCOME Financial Revenue minus Financial Expense.

(5 less 6)

FS8 Net Loan Loss Provision Expense

(sum of 8)

FS8a Loan Loss Provision Expense Loan Loss Provision Expense for the period.

FS8b Recovery on Loans Written-off Total recovery on loans written off.

FS10 Operating Expense Total of Personnel Expense and Administrative Expense.

(sum of 10)

FS10a Personnel Expense

FS10b Administrative Expense

(sum of 10b)

FS10b1 Rent and Utilities Rent and utility charges.

FS10b2 Transportation

FS10b3 Office Supplies Printed matter, supplies, photocopies, books, etc.

FS10b4 Depreciation and Amortization Allowance for deterioration, eventual replacement of equipment.

FS10b5 Other Administrative Expenses Other non-personnel administrative expenses.

FS11 NET OPERATING INCOME

(7 less 8 less 10)

FS12 Net Non-Operating Income Non-operating Revenue less Non-operating Expense.

(sum of 12)

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

Other revenue from provision of financial services, includingrevenue from insurance or transfer services or non-financialrevenue from the provision of financial services, such as the saleof passbooks or SmartCards. This account also includes netexchange gain.

Total of financial expense on liabilities, net inflation adjustment,cost-of-funds adjustment and other expenses from financialservices.

Reserved for institutions that use inflation based accounting. Netamount of inflation adjustment.

Adjustment expense for difference between market rate andconcessional rate on funding liabilities (reserved for MIX use).

Other expenses from provision of financial services, including non-

financial expenses on financial products, as well as net exchangedepreciation.

Sum of loan loss provision expense and recovery on loan lossprovision.

Salaries, withholdings, fringe benefits and personnel taxes paid onall those who work for the institution.

Total of Rent and Utilities, Transportation, Office Supplies,Depreciation and Other Administrative Expenses.

Transportation of staff to attend to clients and to manageoperations.

Financial Revenue less Financial Expense, Net Loan LossProvision Expense and Operating Expense.

A B C

129130

131

132

133

134135

136

137

138

139

140

141

142143

144

145

146147

148

149

150

151152

153

154

155

156

157

158

159

160

161162

163

164

165

166

167

168

169

170



Label data (language) FS12a Non-Operating Revenue

FS12b Non-Operating Expense

FS13 Net Operating Income plus Net Non-operating Income.

FS14 Taxes

FS15 Net Income (before Taxes and Donations) less Taxes.

(13 less 14)

FS16 Donations to Subsidize Financial Services Donations made to the MFI to subsidize its operations.

FS17 Net Income (after Taxes and before Donations) plus Donations.

Structure

In1 Head office

In2 Regional office levelIn3 Branch office

In4 Sub-branch (unit level)

How many offices?

In5 Head office

In6 Regional office level

In7 Branch office

In8 Sub-branch (unit level)

Percentage of total clients in each location

In9 Large cities

In10 Small cities/Towns

In11 Rural

In12 Number of staff, year-end

In13

In14 Number of staff who have left during year

In15 Number of staff hired during the year

In16 Number of staff, year-end

In17

In18 Number of staff who have left during year

In19 Number of staff hired during the year

In20

In21

In23

PC1

PC2 Total number of loan products offered

PC3 Lending methodologies used

PC4 Total number of savings products offered

PC5

PC6 Does the institution offer non financial services?

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.

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

NET INCOME (BEFORE TAXES ANDDONATIONS)

Includes all taxes paid on Net Income or other measure of profitsas defined by local tax authorities.

NET INCOME (AFTER TAXES AND BEFOREDONATIONS)

NET INCOME (AFTER TAXES ANDDONATIONS)

How many staff does the MFI have at each level of infrastructure?

Please provide information on staffing andpersonnel All staff should be listed in full-time equivalence(i.e. hours of part-time staff should be aggregatedand you should calculate the equivalent of full-timestaff that would be required for those hours)



Percentage of (annual budget for staff training/operating expenses) Average annual salary and benefits per staff member - all staff (expressed in currencydescribed in General Information)Do these figures represent all the people whocontribute to your operations, including volunteers,part time, and full time staff?

Total number of active clients (all servicescombined)

Is the institution able to track numbers of clients inaddition to number of accounts (i.e., savers as wellas savings accounts)?

A B C

171

172

173

174

175

176

177

178

179180

181

182

183184185186187188189190191192193194

195196

197

198

199

200

201202

203

204

205

206

207

208

209

210

211212213

214

215



Label data (language)

PC7 Loan products

PC8

PC9

PC10 Savings products

PC11

PC12

PC13 Other microfinance products

PC14

PC15

Non-financial services

Describe individually each non-financial service

PC16 Non-financial service

PC17 Number of participants

PC18 Related operational expenses

PC19 Related operational income

PC20 Operational profit (loss) from non-financial service

Total

PC21

PC22

PC23

Loans and borrowers

Total

Please provide information as of

PC25 Number of loans outstanding

PC26 Number of active borrowers

PC27 Number of loans outstanding

PC28 Number of active borrowers

PC29 Number of accumulated borrowers

PC30 Number of accumulated loans disbursed

PC31 Number of new borrowers

PC32 Number of women borrowers

Savings and savers

Total

Compulsory

PC33 Number of active savings accountsPC34 Number of active savers

PC35 Number of women savers

Voluntary

PC36 Number of active savings accounts

PC37 Number of active savers

PC38 Number of women savers

Clients, by other product

Other products

[See 'ProNumber of active clients

[See 'ProNumber of new clients

[See 'ProNumber of women clients

PC42

PC43

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 (includedescription of loan terms, payment frequency,grace periods, guarantee requirements, conditionsrequired to access loans, etc.)Balance outstanding at year-end (in currency andunit listed above)

Description of terms and conditions of savingsproduct (include description of terms, whether account is voluntary or compulsory, whether deposits are fixed term, whether MFI or third partymobilizes deposits, etc.)Balance outstanding at year-end (in currency andunit listed above)

Description of terms and conditions of product (all' 'If applicable, balance outstanding at year-end (in

How do the non-financial services offered by theinstitution enhance its core savings and loanbusiness?Can this effect be clearly and efficiently measureddue to the separation of accounts?Do the expenses, income and profit amounts givenabove appear on your audited financialstatements? If 'yes', please enter these amounts inlines 12a and 12b of the Income Statement.

Does the institution specifically target very poor clients (clients earning less than US$1/day or population in the bottom half living under thepoverty line)?Does the institution use any targeting tools suchas Means Test, Participatory Wealth Ranking,Housing Index, etc.?

A B C

216

217

218

219

220

221

222

223224225226227228229

230231232233

234

235

236

237238

239240241242243244245246247248249250

251252253254255256257258259

260

261262

263

264



Label data (language) PC44

PR1

PR2

Amount - listed in

Number of loans

Percent

Aging/Status of portfolio[See 'Por

[See 'Por

[See 'Por 30-90 Days



[See 'Por 366+ Days

[See 'Por All renegotiated loans

Gross Loan Portfolio

PR10

PR11

PR12 Loan Loss Reserve for FY ended

PR13 Loan Loss Reserve for FY ended

PR14 Loan Loss Provision Expense for FY ended

PR15 Loans written off in FY ended

LA1

Description of institutional borrowings

[See 'Lia

[See 'Lia Nominal interest rate paid on this borrowing

[See 'Lia

public

private

cannot be classified

[See 'Lia Amount of this liability on Balance Sheet

LA5

LA6 Total borrowings, as of

Operational subsidy analysis

IK1IK2

IK3

IK4

Category

[See In-kiValue of subsidy/donation to the institution

[See In-kiHow it was used[See In-kiRent and utilities

[See In-kiTransportation

[See In-kiOffice supplies

[See In-kiOther

IK9

Percentage of clients in households earning lessthan US$1/day per household member Repayment performance of outstanding LoanPortfolioWere there any renegotiated loans on this year'sBalance Sheet?Does the MFI track renegotiated loans separatefrom non-renegotiated loans?

Current portfolio, on-time (< 30 Days, non-renegotiated loans)Portfolio balance affected by overdue payments(non-renegotiated loans)

Please explain how your institution calculatesdelinquency (portfolio balance affected by overduepayments) as given in the above table

Please describe precisely your institution's policyregarding provisioning and write-offs

How many individual borrowings (either commercial or concessional) appear on the currentyear's Balance Sheet?

Source, including name and description (if possible)

Would you classify this as a liability from a publicor private source?

Total borrowings, current year (Line 2c of BalanceSheet)

Please read through the following questions todetermine if your institution received anyoperational (in-kind) subsidy this fiscal year

Were any managerial or operational personnelIf 'yes', please explain to us what function theyperformed and how they contributed to your operationsWhat was the amount of their salaries during thefiscal year endedDoes your institution use any property or equipment that belongs to another party and is notaccounted for on your financial statements (i.e.office space, computer equipment, vehicles, etc.)?If yes, please explain what category thisproperty/equipment would fall under, its value tothe institution, and how it was used

Check this box if the institution receives no in-kind

A B C

265

266

267

268

269270271

272273

274

275276277278279280

281

282

283284285

286

287

288

289

290291

292293294295

296

297298

299

300

301

302

303

304

305306

307308309310311

312



Label data (language)

Potential Inconsistency

Check or not?

Notes

The following is a list of potential inconsistenciesyour data has generated. This does notnecessarily mean that the data is incorrect, onlythat it differs for some reason from what issubmitted by the majority of users. Please do noterase 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 onBalance Sheet

The GLP listed on the Portfolio Report is different from GLP on theBalance Sheet

Please check - the number of loans does notequal that listed in the 'Products and Clients'section

The number of outstanding loans listed in 'Portfolio Report' isdifferent from the number of outstanding loans listed in 'Productsand Clients'

Please check - this does not equal the LLR on theBalance Sheet

The LLR listed on the Portfolio Report is different from LLR on theBalance Sheet

Please check - this does not equal the LLPE onthe Income Statement

The LLPE listed on the Portfolio Report is different from the LLPEon the Income Statement

Please check - this is not entirely consistent withabove information

The write-offs listed on the Portfolio Report do not equal [lastyear's loan loss reserve + current year's loan loss provisionexpense - current year's loan loss reserve]

Please check - your total clients exceed the sumof savers, borrowers and other product clients

The number of total clients exceeds the sum of savers, borrowersand other product clients

Please check - this is not entirely consistent withabove information

The difference between current and previous years' personnel isnot consistent with personnel who have been hired and who haveleft

Please check - this information is not consistentwith the difference in personnel between this year and last

The average staff salary is not consistent with the number of personnel listed in Infrastructure and the personnel expense listedon the Income Statement

Please check - this information is not consistentwith the personnel information entered in theIncome StatementPlease check - Total Assets do not equal TotalLiabilities and Equity

Total Assets do not equal Total Liabilities and Equity on BalanceSheet

Please check - voluntary savings appear on theBalance Sheet but you have not listed voluntarysavings clients

Voluntary savings appear on the Balance Sheet but no voluntarysavings clients have been listed in 'Products and Clients'

Please check - you have listed voluntary savingsclients but no voluntary savings appears on theBalance Sheet

Voluntary savings clients have been listed but no voluntary savingsappears on the Balance Sheet

Please check - this does not equal the borrowingslisted on your Balance Sheet

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

A B C

313314315316

317

318

319

320

321

322

323

324

325

326

327

328

329

330

mix mbb questionnaire

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