Stephen N. Ndegwa Country Director Papua New Guinea & Pacific Islands East Asia and Pacific Region 17-Apr-2023 _____________________ Hon. Mulipola Anarosa Ale Molio’o Minister of Finance Ministry of Finance Private Bag Apia Independent State of Samoa Re: Grant No. TF0C0742 (Samoa Health System Strengthening Program Additional Financing) Additional Instructions: Disbursement and Financial Information Letter Excellency: I refer to the Grant Agreement (“Agreement”) between the Independent State of Samoa (“Recipient”) and the International Development Association (“Association”), acting as an administrator of the Papua New Guinea and Pacific Islands Umbrella Facility Multi-Donor Trust fund for the above-referenced Program. The Standard Conditions, as defined in the Grant Agreement, provide that the Recipient may from time-to-time request withdrawals of Grant amounts from the Grant TF0C0742 (“Grant”) in accordance with the Disbursement and Financial Information Letter (“DFIL”), and such additional instructions as the Association may specify from time to time by notice to the Recipient. The Standard Conditions also provide that the Disbursement and Financial Information Letter may set out Program specific financial reporting requirements. This letter constitutes such Disbursement and Financial Information Letter and may be revised from time to time. I. Disbursement Arrangements, Withdrawal of Grant Funds, and Reporting of Uses of Grant Funds (i) Disbursement Arrangements The table in Schedule 1 sets out the disbursement methods which may be used by the Recipient, conditions, information on registration of authorized signatories, processing of Withdrawal Applications (including the processing of advances), instructions on supporting documentation, and reporting of advances. (ii) Withdrawal Applications (Electronic Delivery) 1 The Recipient will deliver Withdrawal Applications (with supporting documents, “Applications”) electronically through the Association’s web-based portal “Client Connection” at https://clientconnection.worldbank.org. This option will be effected after the officials designated in writing by the Recipient who are authorized to sign and deliver Applications have registered as users of “Client 1 Section 10.01 (c) of the General Conditions Connection.” The designated officials will deliver Applications electronically by completing 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 exercise the option of preparing and delivering Applications in paper form on exceptional cases (including those where the Recipient encounters legal limitations) and which were previously agreed with the Association. 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://www.worldbank.org and “Client Connection” at https://clientconnection.worldbank.org; and (b) to cause such officials to abide by those terms and conditions. (iii) Disbursement Linked Results (DLRs) The Recipient shall deliver Applications for amounts of the Grant allocated to individual Disbursement Linked Results (“DLRs”), pursuant to the provisions of Section IV A.2 of Schedule 2 of the Grant Agreement. The Applications may be submitted to the Bank at any time after the Bank has notified the Recipient in writing that it has accepted evidence of achievement of the specific DLRs. (iv) Withdrawal Amount for the Program The Applications may be for an amount not to exceed the amount of the Grant confirmed by the Association for the specific DLRs in respect of which the withdrawal is requested, as specified in the Association’s notice to the Recipient. (v) Advances and Recovery of Advances The Recipient may, in accordance with provisions of the Grant Agreement, request advances of amounts of the Grant allocated to DLIs/DLRs that have not yet been achieved using the Form attached (Attachment 2). The Association records an amount of the advance as disbursed for an achieved DLRs (“recovered”) after it has notified the Recipient of its acceptance of the evidence of achievement of the DLR for which the advance was provided. The amount so reclassified becomes available for further advances in accordance with the preceding paragraph. II. Financial Reports and Audits 1 (i) Financial Reports The interim unaudited financial reports (“IFRs”) for the Program are not required. (ii) Audits Each audit of the Financial Statements shall cover the period of one (1) fiscal year of the Recipient, commencing with the fiscal year in which the first withdrawal was made. The audited Financial Statements 1 Section 5.09 of the General Conditions for each such period shall be furnished to the Association not later than nine (9) months after the end of such period. III. Other Important Information For additional information on disbursement arrangements, please refer to the Loan Handbook available on the Association’s public website at https://www.worldbank.org and “Client Connection” at https://clientconnection.worldbank.org the Association recommends that you register as a user of “Client Connection.” From this website, you will be able to prepare and deliver Authorized Signatory Letters and Withdrawal 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 Association by email at askloans@worldbank.org using the above reference. Yours sincerely, ______________________________ Paul Vallely Acting Country Director Papua New Guinea & Pacific Islands East Asia and Pacific Region Attachments 1. Form of Authorized Signatory Letter 2. Sample Form for Advances Schedule 1: Disbursement Provisions Basic Information Country Independent State of Samoa Section B.3 (c).Section IV of Recipient Ministry of Finance Schedule 2 of the Grant Closing Date Grant No. Agreement. TF0C0742 Name of the Samoa Health System Strengthening Disbursement Six (6) months after the closing Program Program Additional Financing Deadline Date date. Disbursement Methods and Supporting Documentation Disbursement Methods Methods Supporting Documentation Reimbursement (DLI payment Yes Confirmation issued by the Association for achieved results) Advance (DLI Advance) Yes Request in the format provided in Attachment 2 of the DFIL Advances Amount / 323,493 Financial Institution - Name Central Bank of Samoa Limit Currency USD Authorized Signatures The form for Authorized Signatories Letter is provided in Attachment 1 of this letter. Withdrawal and Documentation Applications The form for Authorized Signatory Letter is provided in Attachment 1 of this letter. The ASL and all Withdrawal Applications with their supporting documentation will be submitted electronically via the Bank’s “Client Connection” system. If the ASL will be submitted manually, please send it to the following address: The World Bank Level 19, 14 Martin Place CML Building Sydney NSW 2000, Australia Attention: Country Director If the withdrawal applications will be submitted manually, please submit them together with supporting document to the address indicated below: The World Bank 26th Floor, One Global Place 5th Avenue cor 25th Street, Bonifacio Global City Taguig City, Philippines 1634 Attention: Loan Department Additional Information N/A Attachment 1 – Form of Authorized Signatory Letter Form of Authorized Signatory Letter [Letterhead] Ministry of Finance [Street address] [City] [Country] [DATE] International Development Association Level 19, 14 Martin Place CML Building Sydney NSW 2000 Australia Attention: Country Director Re: Grant No. TF0C0742 (Samoa Health System Strengthening Program Additional Financing) I refer to the Grant Agreement (“Agreement”) between the International Development Association (“Association”), acting as an administrator of the Papua New Guinea and Pacific Islands Umbrella Facility Multi-Donor Trust fund, and the Independent State of Samoa (the “Recipient”), providing the above Grant. For the purposes of Section 3.04 (b) of the Standard Conditions, as defined in the Agreement, any [1one] 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 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 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 Bank by electronic means. In full recognition that the 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 Means to Process Applications and Supporting Documentation (“Terms and Conditions of Use of SIDC”), the Recipient represents and warrants to the Bank that it will cause such persons to abide by those terms and conditions.] 1 Instruction to the Recipient when sending this letter to the 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 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 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 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 Bank. 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]1 1 Instruction to Bank staff: please forward this letter to the Country Lawyer for further processing (Recipient: please do not delete this note). Attachment 2 - Sample Form for Advances [Ministry/Implementing Agency Letterhead] [Date] The World Bank 26th Floor, One Global Place 5th Avenue cor 25th Street, Bonifacio Global City Taguig City, Philippines 1634 Attention: Loan Department Subject: Re: IDA Grant ______-___ (Samoa Health System Strengthening Program Additional Financing) -Request for Advance Dear Sir/Madam, We refer to the Financing Agreement between the Association (the “Association”) and Independent State of Samoa (the “Recipient”) providing for the above Grant. In accordance with the provisions of the Disbursement Letter and Schedule ___, Section __________ of the Financing Agreement, to support the implementation of the above Program and to facilitate the achievement of the planned results, we request an Advance in the amount of [insert amount]1. [We request that the Advance be disbursed in [currency requested for disbursement] equivalent to the Total Advance Requested above.]2 We acknowledge that the amount disbursed will be charged to the [Grant][Credit] Account in the currency of the Financing at the rate of exchange in effect at the time of disbursement. Sincerely, [insert Name and Position]3 1 The Proposed Advance should be in the currency of the DLI/DLR as set out in the disbursement table in the [Grant][Financing] Agreement, and in accordance with provisions in the Disbursement and Financial Information Letter. Normally, this is the currency of commitment of the [Grant][Credit]. 2 Use this text to designate the currency of the Advance if it should be different from the currency set out in the disbursement table in the [Grant][Financing] Agreement. 3 To be signed by a representative of the implementing/coordinating agency of the Recipient, OR by the person(s) authorized on behalf of the Recipient to sign applications for withdrawal under the Credit/Grant as set out in the applicable Authorized Signatory Letter.