Governmentowned Company And Parastatal Grantee Information Form

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USTDA‐Funded Feasibility Study, Technical Assistance, or Training Grant

Government‐Owned Company and Parastatal

Grantee Information Form

This form is designed to enable the U.S. Trade and Development Agency (“USTDA”) to obtain information about entities and individuals proposed for participation

in USTDA‐funded activities. Information in this form is used to conduct screening of entities and individuals to ensure compliance with legislative and executive

branch prohibitions on providing support or resources to, or engaging in transactions with, certain individuals or entities with which USTDA must comply.

USTDA Activity Number [To be completed by USTDA]

Activity Type [To be completed by USTDA]

Feasibility Study

Technical Assistance

Other

(specify)

Activity Title [To be completed by USTDA]

Full Legal Name of Grantee

Business Address (street address only)

Telephone

Fax

Website