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 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 EXIM 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: _______________________________________________________________


Is the project located in or near an environmentally sensitive site or area? (Check all applicable, if any):

 Tropical Forests or Other Areas with High Biological Diversity
 Nationally or Internationally Designated Protected Areas, such as Wetlands, Seashores, Wilde-lands 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


Check classification(s) describing the project for which the exports are destined:

 Large Infrastructure:
 Other Large Infrastructure

 Agro-industries – large scale
 Mining & Mineral Processing Plant
 Oil & Gas Field Development
 Hydropower Plant / Water Reservoir
 Thermal Power Plant
 over 140 MWe
 under140 MWe
 Nuclear Power Plant
 Geothermal Power 
 Waste Management
 Iron & Steel Plant
 Pulp & Paper Plant
 Petroleum Refinery or Petrochemical Plant
 Chemical / Pharmaceutical
 Natural Gas Liquefaction Plants
 Industrial Plants – large scale 
 Transportation (Aircraft, Locomotives, Boats)
 Telecommunications or Satellites
 Air traffic control or navigational aids
 Railway Signaling 
 Hospitals and Medical Equipment

 Pre-project Services, Feasibility/Environmental study
 Consulting Services 
 Other, specify:_____________________________

Name of Applicant _____________________________________  Date __________________

For inquiries and information please contact the  Engineering & Environment Division at (202)565-3570  or email Enviro.Specialist@exim.gov