Request for Hedging Products
Currency Swap for a Non-IBRD Hedge
Borrower's Explanatory Statement for the Hedge Request:
The borrower's hedge selection, as requested, and the reasons for this selection, are as follows:

We represent that:(a) we have made our own independent decision to request this hedging transaction;(b) we are not relying on any communication or confirmation from IBRD as a recommendation to request such hedging transaction;(c) unless expressly agreed with IBRD by separate agreement, IBRD is not acting as a fiduciary for, or an advisor to, us in respect of such hedgingtransaction;(d) we are capable of evaluating and understanding, and understand and accept the terms, conditions and risks of such hedging transaction, and weare also capable of assuming,and assume, the financial risks of such hedging transaction;(e) we are undertaking the hedging transaction in order to facilitate prudent debt management as further specified above; and(f) our representative signing this Request is authorized to do so.

Hedge Transaction Details
Maturity Date:

Effective Date (as applicable):
To be paid by the Borrower to the IBRD
Yes

Initial Exchange

To be paid by the IBRD to the Borrower

No

Currency:

Currency:
Complete only one amountAmount:Amount:Notional Amount of the Hedge Transaction
Currency:

Currency:
Complete only one amountAmount:Amount:Business Days
Calendar for Payments:

Calendar for Payments:(e.g., NY, Tokyo)(e.g., NY, Tokyo)

Calendar for Resets

Calendar for Resets(if applicable):(if applicable):Interest Rate
Variable
Day-count:

Fixed Rate
Actual/360

Variable
30/360

Actual/Actual

Day-count:

Request for Hedging Products

Actual/360

30/360

Actual/Actual

OtherOther
Frequency of Interest PaymentsFixed Rate

Frequency of Interest Payments

Interest Payment Dates

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Interest Payment Dates

Currency Swap for a non IBRD Hedge
Updated December 2021

Payment Convention:

Payment Convention:

Modified following

Other

Interest Adjustment:

Other

Modified following

Following

Following
Adjusted:

Unadjusted:

Interest Adjustment:

Adjusted:

Unadjusted:

Variable Interest Rate Index (if applicable):

Variable Interest Rate Index (if applicable):

Optional (complete only 1 of the 4 choices).

Note: If this section is left blank, the variable rate will be the Reference Rate applicable under the loan flat.

Spread over variable rate should be equal
Fixed rate should be equal to:%%

Maturity Schedule (or attach separate sheet if needed)
Currency:
Date:

Spread over variable rate should be equal
Fixed rate should be equal to:%%Complete only one column for notional principal amountCurrency:

Notional Principal Amount:

Date:

Notional Principal Amount:

Special Requests / Instructions (use this space for non-standard requests)(In addition, please contact the IBRD regarding any non-standard requests)

Request for Hedging Products

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Payment Instructions
Name of Beneficiary Bank:
Address:
Account Number:
Swift Code:Name of Beneficiary Entity:
Address:(in case payment currency corresponds to a country different from the beneficiary country):
Name of Beneficiary Bank:
Address:
Account Number:
Swift Code:Special Instructions:

Authorizations:
Specimen signatures of the authorized representatives of the Borrower below must be on file at IBRD before processing of this request may begin.
Name of Borrower:
By:
Authorized Representative

Name:
Title:
Date:

Telephone:
Facsimile:
Email:

Contact Information for Transaction Confirmation:
Name:
Title:
Address1:Address2:

Telephone:
Facsimile:
Email:

This completed form and any related correspondence should be addressed to:
Attn: WFA Trust Fund and Loans Department
International Bank for Reconstruction and Development / International Development Association1818 H Street, N.W.
Washington, D.C. 20433,
USA
Email: askloans@worldbank.org

Request for Hedging Products

3 of 3Currency Swap for a non IBRD Hedge