THE WORLD BANK IBRD • IDA I WORLD BANK GROUP Robert J. Saum Regional Country Director Europe and Central Asia Region H.E. Sergii Marchenko Minister of Finance Ministry of Finance of Ukraine 12/2 Hrushevskoho Kyiv 01008 Ukraine Re: IDA Credit No. 7659-UA (Transforming Healthcare through Reform and Investments in Efficiency Program) Additional Instructions: Disbursement and Financial Information Letter Excellency: I refer to the Financing Agreement between Ukraine ("Recipient") and the International Development Association ("Association") for the above-referenced Program. The General Conditions, as defined in the Financing Agreement, provide that the Recipient may from time-to-time request withdrawals of Credit Financing' amounts from the Credit Account 1 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 General 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 Credit Funds, and Reporting of Uses of Credit Funds (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 signatories, processing of Withdrawal Applications (including the processing of advances), instructions on supporting documentation, and reporting of advances. (ii) Withdrawal Applications (Electronic Delivery) z The Recipient shall 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 effective after the officials designated in writing by the Recipient, who are authorized to sign and deliver Applications, have registered as users of "Client 1 "Financing Account" means: (a) the Credit Account if the Financing Agreement provides for a Credit only; (b) the Grant Account if the Financing Agreement provides for a Grant only; or (c) the Credit Account in respect of the Credit and the Grant Account in respect of the Grant if the Financing Agreement provides for a Credit and a Grant. 2 Section 2.01 (b) of the General Conditions 1818 H Street NW • Washington, DC 20433 USA -2- Connection." The designated officials shall deliver Applications electronically by completing Form 2380, which is accessible through "Client Connection." By signing the Authorized Signatory Letter, which can be delivered manually or electronically, 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 these 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 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 the 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. ,; orl dbank.org; and (b) to cause such officials to abide by those terms and conditions. (iii) Disbursement Linked Results (DLRs) The Recipient shall deliver applications of amounts of the Credit allocated to individual Disbursement Linked Results ("DLRs") may, pursuant to the provisions of Section IV.A.2 of Schedule 2 of the Financing Agreement, be submitted to the Association at any time after the Association has notified the Recipient in writing that it has accepted evidence of achievement of the specific DLRs. (iv) Withdrawal Amount for the Program The Application may be for an amount not to exceed the amount of the Credit 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 ofAdvances for the Program The Recipient may, in accordance with provisions of the Financing Agreement, request advances of amounts of the Credit 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 DLR ("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 • Financial Reports The Recipient shall prepare and furnish to the Association not later than forty-five (45) days after the end of fiscal year interim unaudited financial reports ("IFRs") for the Program covering the fiscal year. 1 Section 5.09 of the General Conditions -3- • 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 for each such period shall be furnished to the Association by the Recipient, 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 htt s://clientconnection.worldbank.or,,.. 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 Credit 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 askJoans@worldbank.org using the above reference. Yours sincerely, INTERNATIONAL DEVELOPMENT ASSOCIATION /~ i (JUvvv\ Regional Country Director Europe and Central Asia Region Attachments 1. Form of Authorized Signatory Letter 2. Sample Form for Advances With copies: Ministry of Finance of Ukraine 11 Mezhyhirska Street, Kyiv, Ukraine, 04071 Ministry of Health of Ukraine 7, Hrushevsky Street Kyiv, Ukraine, 01601 -4- Schedule 1: Disbursement Provisions A. .Qasic Information Countrv Ukraine Section IV.B.5 of Schedule 2 to Closing Date Recipient Ministry of Finance the Financing Agreement. IDA Credit 7659-UA Transforming Healthcare through No. Name of the Disbursement Six (6) months after the closing Reform and Investments in Efficiency Program Deadline Date date. Program - :B. Disbu~ ement Methods and Sunoortino Documentation Disbursement Methods Methods SuooortinE!: Documentation Reimbursement (DLI payment Yes Confirmation issued by the Association for achieved results) - - .. c. Advance. .. - Amount/ 101,000,000 Financial Institution - Name Treasury Account Limit Currencv USD ··- D. Authorized Sig.-atures The form for Auihorize"(j Signatories Leiter is provit:kd in AttachmeniT ofiliis -,ener. W-llhdrawal mul Doclllflentation :NHJlications 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 Association's "Client Connection" svstem. E. Additional lnstnactions. - The advance amount shall be subiect to the limitation set forth under Section IV.B.2.a of Schedule 2 to the Financing Agreement. -5- Attachment 1 - Form of Authorized Signatory Letter [Letterhead] Ministry of Finance [Street address] [City] [Country] [DATE] International Development Association 1818 H Street, N.W. Washington, D.C. 20433 United States of America 1 Attention: [Country Director] Dear [Country Director]: Re: IDA [Credit] [Grant]2 No. _ _ _- _ (name of Program/Operation) I refer to the [Credit] [Grant] Agreement ("Agreement") between the International Development Association ("Association")[, acting as implementing of the ]3 and [name of recipient] ("Recipient"), providing the above [Credit] [Grant]. For the purposes of Section 2.03 of the General Conditions as defined in the Agreement, any 4 [one] of the persons whose authenticated specimen signatures appear below is authorized on behalf of the Recipient to sign Withdrawal Applications ("Application") [and applications for a special commitment] under this [Credit] [Grant]. For the purpose of delivering Applications to the Association, including by electronic means, 5[each] of the persons whose authenticated specimen signatures appears below is authorized on behalf of the Recipient, acting 6 [individually] 7 [jointly], to deliver Applications and evidence in support thereof on the terms and conditions specified by the Association. 1 Instruction to Association staff: please forward this letter to the Finance Officer for further processing (Recipient: please do not delete this note). 2 Instruction to the Recipient: use "Credit" or "Grant" as applicable. Please delete this footnote in the final letter that is sent to the Association. 3 Instruction to the Recipient: add text in line with the Grant Agreement if applicable, ifnot applicable delete it. Please delete this footnote in the final letter that is sent to the Associations 4 Instruction to the Recipient: stipulate if more than one person needs to sign Applications, how many or which positions, and if any thresholds apply. Please delete this footnote in the final letter that is sent to the Association. 5 Instruction to the Recipient: stipulate if more than one person needs to jointly sign Applications, if so, please indicate lhe acwal number. Please delete this footnote in the final letter that is sent to the Association. 7 Instruction to the Recipient: use this bracket if any one of the authorized persons may sign; if this is not applicable, please delete it. Please delete this footnote in the final letter that is sent to the Association. -6- 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 Association by electronic means. In full recognition that the Association 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 Association that it will cause such persons to abide by those terms and conditions. This Authorization replaces and supersedes any Authorization currently in the Association records with respect to this Agreement. Signatory Details Name Position Email ID fSignatory Namel [Titlel [Emaill Specimen Signatures Signatory Name Signature 1 Signature 2 Signature 3 [User Name] [User Name] Yours truly, /signed/ [Position] 1 1 Instruction to the Recipient: use this bracket only if several individuals must jointly sign each Application; if this is not applicable, please delete it. Please delete this footnote in the final letter that is sent to the Association. 1 Instruction to Bank staff: please forward this letter to the Finance Officer for further processing (Recipient: please do not delete this note). -7- Attachment 2 Sample Form for Advances [Ministry/Implementing Agency Letterhead] [Date] Loan Department- [name of Regional Center] The World Bank [address ofregional center] Attention: [name of regional center team lead] Subject: Re: IDA [Credit] [Grant] [name of Program/Operation] -Request for Advance Dear Sir/Madam, We refer to the Credit Agreement between the International Development Association ("Association") and [insert the name of the Recipient] ("Recipient") providing for the above Credit. In accordance with the provisions of the Disbursement Letter and Schedule _ , Section _____ of the Credit 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 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 Credit Agreement, and in accordance with provisions in the Disbursement and Financial Information Letter. Normally, this is the currency of commitment of the 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 Credit 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 as set out in the applicable Authorized Signatory Letter.