Environmental Screening Document

ANNEX B

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 EXIM 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 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: _______________________________________________________________

PROJECT LOCATION

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 

PROJECT SECTOR OR INDUSTRY

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

Name of Applicant _____________________________________  Date __________________

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