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Oikocredit USA Global Community Notes Individual …oikocreditusa.org/.../gcn+individual.pdf?format=save_to_disk&ext=.pdf · 1. Please complete this form and print in capital letters

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Page 1: Oikocredit USA Global Community Notes Individual …oikocreditusa.org/.../gcn+individual.pdf?format=save_to_disk&ext=.pdf · 1. Please complete this form and print in capital letters

1. Please complete this form and print in capital letters. 2. Mail the completed application to: Oikocredit USA, PO Box 66383, Washington, DC 20035 3. Please make all checks payable to Oikocredit USA. If you prefer to wire the funds, please contact us at (202) 728-4143. 4. Complete the IRS form W-9 (available at www.irs.gov/formspubs) and review the accompanying instructions. 5. Please consult with a professional advisor for tax or legal advice.

SECTION A: DEFINE YOUR NOTE I am investing $_________________ (minimum $250) in a Global Community Note(s). Select one of two options: Option 1: Consolidated note

Select both a term and interest rate: ○ 1 year* ○ 3 years ○ 5 years with an interest rate of ○ 0% ○ 1 % ○ 2% Option 2: Staggered notes I understand that Oikocredit’s partners need long-term capital and would like to create a layered note structure that supports the mission. Please divide my funds:

$__________ (min $250) for 1 year* at ○ 0% ○ 1 % ○ 2% $__________(min $250) for 3 years at ○ 0% ○ 1 % ○ 2%

$__________ (min $250) for 5 years at ○ 0% ○ 1 % ○ 2% * Each investor may hold a maximum of $100,000 in a 1 year termed note.

SECTION B: INVIDUAL OR JOINT INVESTOR (For Trust Accounts, please use the Institutional Investor Application.)

○ Mr. ○ Ms. ○ Mrs.

If joint account:

______________________________________________________________________________ First Middle Initial Last ______________________________________________________________________________

For individual account holders, please note that Oikocredit USA will not transfer accounts to a named beneficiary upon the death of an investor. Assets will be redeemed to the estate or legal representative. Only in the case where a joint investor has been named can we transfer the account solely to that joint investor.

SECTION C: SSN / DOB

_________________________________________________________________________________________________________________ Social Security Number Date of Birth (MM/DD/YY) _________________________________________________________________________________________________________________ Social Security Number (if joint investor) Date of Birth (MM/DD/YY)

SECTION D: CONTACT INFORMATION _________________________________________________________________________________________________________________Address _________________________________________________________________________________________________________________City State Zip

_________________________________________________________________________________________________________________Phone number (please indicate home, work, mobile) Email

SECTION E: Oikocredit Growth Plan Recipient: ONLY for Investing on behalf of individuals under 18 years . See back for instructions. _________________________________________________________________________________________________________________Name of Minor Individual

________________________________________________________________________________________________________________ Address of Minor Individual

________________________________________________________________________________________________________________ City State Zip How did you hear about us? ○ Printed Ad in: ○Sojourners ○Ms. Magazine ○Green American ○The Nation ○Christian Century ○Friends Journal ○Other: ______________________________ ○Internet Search ○ Organization affiliation (Church, school, etc.) Name: ___________________________________________________________________ ○Friend / Relative Name:___________________________________________ News Story /Article in:____________________________________________________ ○Financial Advisor / Broker Name:___________________________ ○ Conference / Event ______________________________________________________________

Other __________________________________________________________________________________________________ Note to All Investors: I acknowledge receipt of information regarding the terms and conditions of my investment in Global Community Notes as set out in the Oikocredit-USA prospectus. I hereby agree to be bound by these terms:

Oikocredit USA Global Community Notes Individual Investor

INSTRUCTIONS:

_______________________________________________________________________________________________________Individual Signature Date _______________________________________________________________________________________________________ Joint signature Date

First Middle Initial Last

Page 2: Oikocredit USA Global Community Notes Individual …oikocreditusa.org/.../gcn+individual.pdf?format=save_to_disk&ext=.pdf · 1. Please complete this form and print in capital letters

OPTIONAL Financial Advisor or Broker Information: __________________________________________________________________________________________________ Financial advisor or Broker Name __________________________________________________________________________________________________ Company __________________________________________________________________________________________________ Address __________________________________________________________________________________________________ City State Zip

THESE SECURITIES ARE EXEMPT FROM FEDERAL REGISTRATION AND HAVE NOT BEEN APPROVED OR DISAPPROVED BY THE SECURITIES AND EXCHANGE COMMISSION OR ANY STATE SECURITIES COMMISSION, NOR HAS THE FEDERAL OR ANY STATE SECURITIES COMMISSION PASSED ON THE ACCURACY OR ADEQUACY OF THIS DISCLOSURE DOCUMENT. ANY REPRESENTATION TO THE CONTRARY IS A CRIMINAL OFFENSE. GLOBAL COMMUNITY NOTES ARE UNSECURED OBLIGATIONS AND ARE NOT DEPOSITS OR OBLIGATIONS OF, OR GUARANTEED OR ENDORSED BY, ANY BANK, AND ARE NOT INSURED BY ANY FEDERAL OR STATE AGENCY. OIKOCREDIT-USA’S EMPLOYEES, PARTNERS, OFFICERS AND DIRECTORS ARE NOT REGISTERED AS INVESTMENT ADVISERS UNDER THE INVESTMENT ADVISERS ACT OF 1940, AS AMENDED OR AS BROKER DEALERS UNDER THE SECURITIES EXCHANGE ACT OF 1934. Oikocredit-USA (Ecumenical Development Corporation, USA) – Global Community Notes are issued by Oikocredit-USA, a Washington DC non-profit corporation established March 01, 1990. Oikocredit-USA is a 501(c)(3) organization dedicated to the mission of mobilizing credit and resources to promote economic growth, social justice and self-reliance among the poor in the underdeveloped areas of the world. The Oikocredit Growth Plan initiative is designed to give current and prospective investors the opportunity to invest on behalf of a minor (child, grandchild, etc.) and generate increasing social impact as the minor grows from childhood to adulthood. Investors must include information for the minor beneficiary in Section E of this application, along with a properly completed W-9. The Oikocredit Global Community Note program was designed in 2004. Investments in Oikocredit Global Community Notes are lent to Oikocredit U.A., Ecumenical Development Cooperative Society U.A., based in Amersfoort, The Netherlands, for the purpose of channeling capital to underdeveloped areas of the world to promote economic growth, social justice and self-reliance among the poor. Oikocredit U.A. utilizes the capital raised to make loans to a wide range of community-based non-governmental organizations, cooperative societies, producer groups, micro-lenders and other grass roots, community controlled enterprises. Oikocredit Global Community Notes are issued to investors who invest for specific terms with the expectation of a fixed rate of return. There are Investment Risks associated with an investment in the Global Community Note program. There are added risks associated with making loans abroad, such as limited availability of information, currency fluctuation, and risks relating to political and economic conditions. While Oikocredit U.A. has established criteria in order to determine which organizations are most likely to benefit from loans and still maintain their repayment obligations, and procedures have been put in place to monitor repayment progress, there can be no guarantee that the organizations will be able to make payments as scheduled. Oikocredit Global Community Notes are senior to the net assets, or reserves, of Oikocredit-USA. However, there remains some risk that defaults or untimely payments of loans may result in Oikocredit-USA having insufficient reserves to satisfy all outstanding notes. An investment in Global Community Notes is speculative and involves a high degree of risk. Before investing you should carefully review the information contained in the section of the Prospectus captioned “RISK FACTORS”. Additional information containing more details about the program may be obtained free of charge by calling 202-728-4143. To purchase an Oikocredit Global Community Note or service existing investments call 202-728-4143. Oikocredit-USA will send you documentation containing information about its structure, including directors, officers, and financial information. The documentation contains details about the due diligence factors Oikocredit U.A. takes into account in connection with the loans it considers.

PO Box 66383 | Washington, DC 20035 | 202 728 4143 | [email protected]