L1.B (Template 1.B) - Financial Questionnaire.docx

Template 1.B

FINANCIAL QUESTIONNAIRE

USAID SOL XXXXXXXXXXXXX

(To be completed by Financial Institution and submitted by Offeror)

The United States Agency for International Development (USAID) Malawi is currently considering award of a US Government contract to this Prospective Contractor. Prior to award, USAID requests the financial information listed below with regard to this Prospective Contractor. In order to be responsive to USAID’s needs, it is requested that you complete this financial questionnaire with regard to this Prospective Contractor. Upon completion of the questionnaire, it is requested that you place the completed questionnaire in a sealed envelope, showing the return address of the financial institution, and forward it to the Prospective Contractor shown below. The requested information must be received by the Prospective Contractor no later than seven (7) days after the issuance of the RFP.

Prospective Contractor for which information is being requested:

Name:

Address:

Phone Number:

Point of Contact:

Signature of Prospective Contractor or Contractor Representative requesting Financial Information

Name of Financial Institution:

Address:

Phone Number:

Account Number:

Type of Account:

Average Bank Account Balance Figure:

Amount of cash currently available for construction projects:

Does the Contractor have a Line of Credit (LOC) (Yes/No)?

If so, what is the Limitation?

Remaining Balance in the LOC:

Duration the Contractor has been a Client:

Name and Title of Person Providing Above Information:

Signature of Person Providing the Above Information

Please provide any additional comments that may help determine the business and financial reputation and integrity of the Prospective Contractor on a separate document.

Template 1.B – Financial Questionnaire rev.1 02/22 Page of image2.png image1.png