Environment | Environment Procedures and Guidelines

Annex B

Ex-Im Bank Environmental Screening Document

Must Accompany All Applications For Long-Term Financial Support 

The information provided on this form is used to environmentally categorize the application and thereby determine the information needed (if any) for Ex-Im Bank to evaluate the environmental effects of the transaction, a process that is crucial to the appropriate and timely review of your application. Please check the boxes that apply. 

Are the products or services covered in your application destined for an identified physical project?
No, explain  ____________________________________________.
Yes a) identify the project________________________________________________________
            b) Provide a brief description, including output, capacity, size, etc._______________________
            ________________________________________________________________________
            ________________________________________________________________________

            c) Indicate whether this is a new project, a rehabilitation or an expansion in size or output of an
                 existing project___________________________

PROJECT LOCATION
Is the project located in or near an environmentally sensitive site or area? (Check all applicable):
Tropical Forests or Other Areas with High Biological Diversity
Nationally or Internationally Designated Protected Areas, such as Wetlands, Seashores, Wildlands or Refuges, National Parks
Habitat of Endangered Species
Location Affecting Indigenous, Tribal or Other Vulnerable Populations
Location having Historical / Archaeological Significance
Large Scale Resettlement? (Potential Number of People Affected: ________________________)
Properties on the UNESCO World Heritage Site List

PROJECT SECTOR OR INDUSTRY
Check classification(s) describing the project for which the exports are destined:

Large Infrastructure
	Airport  Ports/harbors  Pipelines  Highways  Other Large Infrastructure	Iron & Steel Plant  Smelter  Pulp & Paper Plant  Petroleum Refinery or Petrochemical Plant  Chemical / Pharmaceutical  Natural Gas Liquefaction Plants  Industrial Plants - large scale
Agro-industries - large scale		Transportation (Aircraft, Locomotives, Boats)
Forestry		Telecommunications or Satellites
Mining & Mineral Processing Plant		Air traffic control or navigational aids
Oil & Gas Field Development		Railway Signaling
Hydropower Plant / Water Reservoir  Thermal Power Plant		Hospitals and Medical Equipment
	over 140 MWe under 140 MWe
Nuclear Power Plant		Pre-project Services, Feasibility/Environmental study
Geothermal Power		Consulting services
Waste Management		Other, specify:_____________________________

Name of Applicant____________________________________ Date__________________

For inquiries and information please contact the Engineering & Environment Division at (202)565-3570.