4th floor, Office 4B, BC HorizonOfficeTowers
42-44 Shovkovychna Street, 01601 Kyiv
Tel: +38 095 8998 443
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USELF Application Questionnaire: Wind Power Plants
Please fill in this applicationquestionnaireand submit itin an electronic form to , which will guarantee the quickest way to get your applicationreviewed. Alternatively you can send it by fax or mail to the USELF office.
After receiving the applicationquestionnaire, the USELF Implementation Team will send you a confirmation and review theapplication. 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 If you have questions regarding this applicationform, please contact the USELF helpline at +38 095 8998443.
1.Project Name
Name ______
2.Main ContactData
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 dataand information on technology, type and supplier of equipment, capacity / size, location, etc.
(b) Summary of Technical Data
Start of construction (planned date)Start of operation (planned date)
Installed total capacity (MW)
Expected annual net electricity generation (MWh/year)
Average wind velocity at 10 m height (m/s):
Average wind velocity at hub height (m/s):
Number / brand / type of wind turbines:
Hub height of wind turbine (meter):
Duration of wind measuring campaign (start-date / end-date)
Wind data from meteorological stations close to site available (yes/no):
Consultant engaged for wind measuring campaign (name):
Energy yield assessment study available (yes/no):
(c) 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?
5.Project Costs and Financing
(a)Investment budget
Total project investment costs estimate / Foreign Costs (Euro) / Local Costs (UAH) / Total Costs (UAH)Site installation / access road
Civil / foundations
Machinery and equipment
Interconnection and transmission system
Engineering and 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 / UAH / yearStaff
Maintenance and consumables
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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