USELF Application Questionnaire: Pellet Production Projects
4th floor, Office 4B, BC Horizon Office Towers
42-44 Shovkovychna Street, 01601 Kyiv
Tel: +38 095 8998 443
Web: www.uself.com.ua E-mail:
USELF Application Questionnaire: Pellet Production Projects
Please fill in this application questionnaire and submit it in an electronic form to , which will guarantee the quickest way to get your application reviewed. Alternatively you can send it by fax or mail to the USELF office.
After receiving the application questionnaire, the USELF Implementation Team will send you a confirmation and review the application. If your project is eligible for USELF financing, you will be contacted for the next steps, which may require a visit to your company and the collection of more detailed information.
For further information on the eligibility review process, please refer to the website at www.uself.com.ua. If you have questions regarding this application form, please contact the USELF helpline at +38 095 8998443.
1. Project Name
Name ______
2. Main Contact Data
Company name
Address
Internet domain
Contact person
Name
Telephone
Email ______
Person responsible for technical information (Technical Director or similar)
Name
Telephone
Email ______
3. Company Profile:
Ownership:
Private ownership %:
Public ownership %:
Year of foundation:
Sector of operation and main products: ______
(Describe main activities of the Company)
Total turnover (in UAH)
2008: ______
2009: ______
Total assets (in UAH)
2008: ______
2009: ______
4. Description of Proposed Project:
(a) Narrative description:
Please provide a brief description of your project with relevant technical data and information on source of wood to be pelletized, technology, type and supplier of equipment, capacity / size, location, etc.
Please state if pellets are for own demand or for national or international market.
(b) Summary of technical data
Start of construction (planned date) /Start of operation (planned date) /
Plant configuration /
Power plant (if applicable) /
Heat only / combined heating plant /
If CHP: water steam cycle or Organic Rankine Cycle? /
Type of fuel for power plant /
Source of fuel for power plant /
Fuel demand (MW) /
Gross electrical capacity (MWel) /
Supplier furnace /
Supplier boiler /
Supplier Turbine / ORC Module /
Operating hours per year /
Pelletizing plant /
Heat demand (max.) MWth /
Heat demand (mean.) MWth /
Electrical demand (MWth) /
Supplier drying equipment /
Supplier pelletizing equipment /
Pellet size /
Operating hours per year /
(c) Input and energy consumption
Biomass consumption (tons/year)Specify biomass type for pelletizing (wood, miscanthus, willow, etc)
Specify source of biomass (forest, plantation, saw mill, etc)
Range of biomass humidity (% water content)
Electricity consumption (MWh/year)
Heat consumption (MWh/year)
Source of heat (specify, if applicable)
(d) Status of project development
yes / noThe project is still in its conceptual phase
(we have only a project idea)?
Technical design has started?
Technical design is completed?
Quotations / proposals from equipment suppliers have been received?
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/ Project Office4th floor, Office 4B, BC Horizon Office Towers
42-44 Shovkovychna Street, 01601 Kyiv
Tel: +38 095 8998 443
Web: www.uself.com.ua E-mail:
5. Project Costs and Financing
(a) Investment budget
Total project investment costs estimate / Foreign Costs (Euro) / Local Costs (UAH) / Total Costs (UAH)Machinery and equipment
Civil structure / buildings
Power interconnection system
Engineering construction supervision
Land
Project development
Financial charges (interest during
construction)
TOTAL
Give breakdown, if available; alternatively give only total investment cost.
(b) Operation and maintenance costs
Operation and maintenance costs / Hrn / yearBiomass costs
Staff
Maintenance and consumables
Electricity costs
Land lease
Taxes
Other
TOTAL (per year)
(c) Target capital structure (apart from EBRD / CTF loan)
Developer's Equity (share in %)Developer’s subordinated loans (share in %)
Commercial loan (share in %)
Currency of commercial loan
Interest rate on commercial loan (%)
Maturity of commercial loan (years)
6. Information on Environmental Impact Assessment
Is Environmental Impact Assessment (EIA) required? (yes/no)If required, has EIA been completed? (yes/no)
If EIA is available, has it observed any adverse environmental impacts? If yes, describe them shortly (on separate sheet).
What are possible mitigation measures of adverse environmental impacts, if any?
If EIA is required but not available, when will it be completed?
Date, ______
......
Signature (if sent by fax or post)
Name: ……………………
Position: ………………….
If you are not sure whether your project is eligible or in case you have additional questions please contact the USELF helpline: ; phone: +38 095 8998 443
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