Ⅰ. Screening Form

Nam e o f P r o je ct ：Nam e o f P r o je ct Pr o p o n en t ：Nam e o f Bo r r o w er ：Please provide the name, department, job title, and contact details for the person who is responsible for fillingout this form.
Name：
Department and job title：
Name of Company or Organization：
Telephone number：Fax number：
E-Mail address：
Date：
Signature：(Matters to be noted)

1.

2.
3.

4.

Please note that JBIC may provide the information concerning the confirmation of environmental and social considerations (includingthat in writing or orally; hereinafter referred to as the “Environmental Information”) provided by the Borrower, etc., in considering thelending, equity participation, or guarantee for a project as part of JBIC’s international financial operations to the financial institutions inJapan, which also consider lending, equity participation, or guarantee for the same project jointly or separately with JBIC (hereinafterreferred to as the “Cofinancing Institutions”), whether or not any confidentiality agreement has been entered into by and between JBIC
and the Borrower, etc. JBIC provides the Environmental Information to the Cofinancing Institutions for their conducting theconfirmation of environmental and social consideration with respect to the project. In providing the Environmental Information, JBIC
requires the Cofinancing Institutions (i) not to use the Environmental Information for any purpose other than the internal confirmation ofenvironmental and social consideration with respect to the project, and (ii) not to disclose the Environmental Information to any thirdparty.
Please note that this Screening Form or the contents thereof may be made public.
If all or part of descriptions of this Screening Form turn out to be false, JBIC may, in accordance with the funding agreement, suspend
the disbursement or declare all the principal outstanding at the time, with interest and any other charges thereon, to be payable
immediately as stated in the clause of 6. Decision-making and Funding Agreements in Part 1 of Japan Bank For International
Cooperation Guidelines For Confirmation Of Environmental And Social Considerations.
In cases where export loans or local buyer’s credit are provided, this Screening Form or the contents thereof may be offered to Nippon
Export and Investment Insurance (hereinafter referred to as “NEXI”). When any description in this Screening Form has been found false
or insufficient due to intent or negligence, NEXI may refuse to pay part or all of the insurance claims or make them refund part or all of
the insurance claims, or cancel the relevant insurance contract, based on the insurance contract.

Questions
Q1.

Please provide the address of the project site.
Address of the project site：

Q2.

Please provide a brief explanation of the project.

Q3. Is it a new project to be implemented or a project that has been implemented? If it has been implemented,
has it received a serious complaint from local residents or a directive for improvement, a stop-work order, aproject suspension order, etc., from a local environmental authority?
□□□□

New project to be implemented
Project that has been implemented (with a complaint)
Project that has been implemented (without a complaint)
Other ()

Q4. Do the laws or regulations of the country where the project will be implemented require the project toconduct environmental and/or social impact assessments (such as an Environmental and Social ImpactAssessment (ESIA) and Environmental Impact Assessment (EIA))? If so, have they been conducted or planned?
□□

Required (Assessments done)
Not Required□□

Required (Assessments in progress or being planned)
Other ()

Q5. If environmental and/or social impact assessments have been conducted, have they been approved inaccordance with the environmental and social impact assessment system of the country where the project will beimplemented? If so, please also specify the date of the approvals and the name of the authorities.
□□

Approved (without condition(s))
Under approval process□□

Approved (with condition(s))
Other ()

Date of Approvals：
Name of Authorities：

Q6. Are there any environmental permits required other than environmental and/or social impact assessments?
If so, have they been obtained? Also, if required, please specify the name of the permits.
□□

Obtained
Not required□□

Required, but not obtained yet
Other ()

Name(s) of required permit(s)：Q7. Will the project be specified after JBIC made a funding commitment (as in the case of a two-step loan,
where sub-projects cannot be specified at the time of a funding commitment)?

(Yes / No)
If “Yes”, please disregard the following questions.
If “No”, please go to Q8.

Q8. Will JBIC’s funding be used to serve as support for international balance of payments or to be used for theprovision of goods or services that does not involve installation or implementation in particular sites or regions,as in the case of export/import or lease of machinery or equipment that is not connected with a particular
project?

(Yes / No)
If “Yes”, please disregard the following questions.
If “No”, please go to Q9.

Are there any environmentally sensitive area(s) shown below in or near the project site(s)?

Q9.

(Yes / No)
If “Yes”, please mark the applicable items and go to Q10.
If “No”, please go to Q10.

 (1) National parks, nationally-designated protected areas (coastal areas, wetlands, areas for ethnic
 (2)
 (3)
 (4)
 (5)
 (6)
 (7)
 (8)

minorities or indigenous peoples, and cultural heritage, etc., designated by national
governments)
Forests with important ecological value (including primary forests and natural forests in tropicalareas)
Habitats with important ecological value (including coral reefs, mangrove wetlands, and tidalflats)
Habitats of rare species requiring protection under domestic legislation, international treaties,etc.
Areas in danger of large-scale salt accumulation or soil erosion
Areas with a remarkable tendency towards desertification
Areas with unique archaeological, historical or cultural value
Areas inhabited by ethnic minorities, indigenous peoples, or nomadic peoples with traditional
ways of life (including areas which are used for cultural and spiritual purposes) and other areas
with special social value

Does the project involve the following characteristics?

Q10.

(Yes / No)
If “Yes”, please specify their scale and go to Q11.
If “No”, please go to Q12.

 （1）Involuntary resettlement or loss of means of livelihood(Number of affected people:(Scale: （2）Groundwater pumping
 （3）Land reclamation, land development, and land clearing (Scale:(Scale: （4）Logging)m3/year)
ha)
ha)

Q11.
Under the environmental and social impact assessment system of the country where the project will be
implemented, do the applicable characteristics (1) – (4) of Q10 above and their scale serve as the basis for
executing an ESIA for the project?
□□

Yes, they do
Other (□)

No, they do notIs the project likely to have a significant social impact, including human rights?

Q12.

(Yes / No)
If “Yes”, please describe the impacts and go to Q13.
If “No”, please go to Q13.
□□

Likelihood of a significant impact on human rights
Other()()

Q13. Will JBIC’s funding or NEXI’s insurable value be equal to or less than 5% of the total project cost, orwill JBIC’s funding or NEXI’s insurable value be equal to or less than SDR 10 million? (If the funding orinsurable value is additional to a project that has been supported by JBIC or NEXI, please add up the previous
funding or insurable value and the funding or insurable value being considered to apply for this time.)(Yes / No)
If “Yes”, please disregard the following questions.
If “No”, please go to Q14.

Q14. Is the project for capital investment or working capital in a project that has been implemented and does itinvolve no material change in output or function (as in the case of maintenance of the existing facilities,
non-expansionary renovation project, and acquisition of rights and interests without additional capitalinvestment)?

(Yes / No)
If “Yes”, please disregard the following questions.
If “No”, please go to Q15.
Q15.

Is the project in any of the following sectors?

(Yes / No)
If “Yes”, mark the applicable sectors and go to Q16.
If “No”, please disregard the following question.



(1) Mining(2) Oil and natural gas development(3) Pipelines(4) Iron and steel (projects that include large furnaces)(5) Non-ferrous metals smelting and refining(6) Petrochemicals (manufacture of raw materials; including complexes)(7) Petroleum refining(8) Oil, gas, and chemical terminals(9) Paper and pulp(10) Cement plants (including a greenfield quarry)(11) Manufacture and transport of toxic or poisonous substances regulated by international treaties, etc.
(12) Thermal power(13) Nuclear power(14) Hydropower, dams, and reservoirs(15) Power transmission and distribution lines involving large-scale involuntary resettlement, large-scalelogging, or submarine electrical cables(16) Roads, railways, and bridges (17) Airports (18) Ports and harbors
 (19) Sewage and wastewater treatment having sensitive characteristics or located in sensitive areas ortheir vicinity(20) Waste management and disposal(21) Agriculture involving large-scale land-clearing or irrigation(22) Forestry(23) Tourism (construction of hotels, etc.)

Q16.
Please provide information on the scale of the project (project area, area of plants and buildings,production capacity, amounts of power generation, etc.). In addition, pleased explain whether an environmental
and/or social impact assessment is required on account of the large scale of the project in the country where theproject will be implemented.