Request for Hedging ProductsInterest Rate 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
Currency:
Principal Amount:
Effective Date (as applicable):
Maturity:Frequency of Interest Payments:
Fixed Leg:

Interest Payment Date(s):Floating Leg:

Interest Payment Date(s):Calendar for Payments:(e.g., NY, Tokyo)
Calendar for Resets:
Interest Rate

To be paid by the Borrower to the IBRD
Variable Rate
Day-count:

Fixed Rate
Actual/360

To be paid by the IBRD to the Borrower

Variable Rate

30/360

ActualDay-count:

Other

Actual/360

30/360

Actual

Other

Payment Convention:

Payment Convention:

Modified following

Other

Modified following

Following
Interest Adjustment:

Fixed Rate

Other

Following
Adjusted

Unadjusted

Variable Interest Rate Index (if applicable):
Optional (complete only 1 of the 4 choices).

Adjusted

Unadjusted

Variable Interest Rate Index (if applicable):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:

Interest Adjustment:%%

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

For Swaps with Amortizing Principal Repayment Schedules Only:
Maturity Schedule (or attach separate sheet if needed)
Date:

Request for Hedging Products

Principal Amount Outstanding

1 of 2

Interest Rate Swap for a non IBRD Hedge

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

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:

Telephone:Title:

Facsimile:

Date:

Email:

Contact Information for Transaction Confirmation:
Name:
Title:

Telephone:

Address1:

Facsimile:

Address2:

Email:

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

2 of 2Interest Rate Swap for a non IBRD Hedge
Updated December 2021