EIB 95-10 Application for Long-Term Loan or Guarantee, Attachment

LONG-TERM LOAN OR GUARANTEE APPLICATION
ATTACHMENT B: Environmental Screening Document

OMB No. 3048-0013
Expires 1/31/2005

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 project?

No, explain ___________________________________________________________________
Yes, a) identify the project______________________________________________________ __
b) provide a brief description, including output, capacity, size, etc.____________________ ___
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
c) indicate whether new project, rehabilitation or expansion _____________________________
Project Location
Is the project located in or near an environmentally sensitive site or area? (Check all applicable):
Tropical Forest
Nationally Designated Wetlands or Seashore / Protected Wildlands / Nationally Designated Refuges
National Parks
Coral Reefs or Mangrove Swamps
Habitat of Endangered Species
Location affecting indigenous or tribal populations
Location having Historical / Archaeological Significance
Large Scale Resettlement? (Potential Number of People Affected: ____________________)
Properties on the World Heritage List

Project Sector Or Industry
Check classification(s) describing the project for which the exports are destined:

Large infrastrucure:
Airport
Ports/harbors
Pipelines
Highways
Other large infrastructure

Agro-industries – large scale
Forestry
Mining & Mineral Processing Plant
Oil & gas field development

Hydropower Plant / Water Reservoir
Thermal power plant
over 140 MWe
under 140 MWe
Nuclear power plant
Geothermal Power
Waste management

Iron & Steel Plant
Smelter
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.
Revised 1/05