IFADPROCEDURE I, II and

IVFORM 100

APPLICATION FOR WITHDRAWAL

1. IFAD Loan No.: 2. Application No.:

To: International Fund for Agricultural Development107 Via del Serafico00142 Rome, ItalyAttention: Country Programme Manager

3. Please Pay ___________________________________________ (Currency Name) (Amount to be paid in Figures)

We hereby apply for withdrawal from the Loan Account opened under the IFAD Loan Agreement and hereby certify as follows:

A. The undersigned has not previously withdrawn from the Loan Account to meet these expenditures and has not and does not intend to obtain funds for this purpose out of the proceeds of any other loan or grant.

B. The goods, works and services covered by this application have been or are being purchased in accordance with the terms of the agreement.

C. The expenditures have been or are being made only for goods or services from member states of IFAD.

Details of Expenditure(Use Summary Sheets if additional space is required or if expenditure relate, to more than one supplier, category)

4. Name and address of the contractor or supplier

(If different from payee)

5. Procurement Detailsa) Contract or purchase order no. and date:

b) Description of goods, works or services:

c) Currency and total amount of contract:

d) Invoice numbers and net amount of invoice covered by this application:

Payment Instruction

7. Payee's BankName:

Address:

Account No:

8. Payee's Name and Address:

6. Withdrawal Detailsa) Category no.

b) Percentage of expenditures to be financed by IFAD

9. Correspondent Bank:If the currency claimed is not the currency of

the country of the payee's bank, enter the name and address of their banks' correspondent in the country whose currency is to be paid.

10. Special Payment Instructions and References:

11. __ 13.

____________________________________________________(Name of Borrower) Signature(s) of Authorized

Representative(s)

12. ____ 14. ___________________________________________________

Date Print Name(s) and Title(s)