Sheet 2-6.
Sheet 2-6.
Sheet 2-6.
1. Country:
2. Date (dd/mm/yy):
3. Requesting Department/Ministry
(1) Name of the department/ministry in charge of this application
(2) Name and official position of the person in charge of this application
(3) Postal address, Telephone/Fax number, E-mail address
4. Project/program title
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- Facirities design, construction standards in the requesting country
- Country from which materials are potentially available for construction
- Estimated cost of construction (equivalent to 7.(2))
(5) Outline of the equipment
- Layout plan and photographs of the facility in which the equipment will be
installed, and the size of the facility
- List of existing equipment (name, quantity, year of procurement, around 10
photographs of the equipment)
- List of the equipment requested (name, specification, quantity, and unit cost)
and the criteria for the equipment selection
- Country where the equipment is potentially available and can be procured
(please select from : the requesting country, Japan, other countries)
- Estimated cost of the equipment (equivalent to 7.(2)), with an estimate if
available.
(6) Outline of the soft components
- Contents of the activities
- Estimated cost
- Human Resources for implementing the soft components activities (please
select from : the requesting country, Japan, or other countries)
(7) Items for which the costs are borne by the requesting country (items and the
budget)
(8) Benefits/beneficiaries and the expected results of the project/program
(qualitative or quantitative descriptions such as the population and areas
that will benefit from the project
9. Implementing agency
(1) Title of the implementing agency
(2) Number of personnel
(3) Organization chart
(4) Amount of budget for last three (3) years
(5) Contents of the activities of the organization that relate to the request)
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(In the Japans Grant Assistance project, the custum duties, internal taxes and
other fiscal levies which may be imposed in the recipient country should be exempted
or borne by the the recipient countrys government.
(1) Names of the taxes to be exempted (customs duties, internal taxes, etc.)
(2) If tax exemption is not applicable, specify any alternative methods
12. Lessons learnt from past similar projects using Japanese grant aid
(1) Title of the past similar project
(2) Results of the related evaluation
(3) Follow-up situation
(4) Lessons learnt and feedback in relation to this request
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Screening FormatEnvironmental and Social Considerations
Please write to be advised (TBA) when the details of a project are yet to be determined.
Question 2: Scale and contents of the project (approximate area, facilities area, production,
electricity generated, etc.)
2-1. Project profile (scale and contents)
2-2. How was the necessity of the project confirmed?
Is the project consistent with the higher program/policy?
YES: Please describe the higher program/policy.
NO
2-3. Did the proponent consider alternatives before this request?
YES: Please describe outline of the alternatives
NO
2-4. Did the proponent implement meetings with the related stakeholders before this
request?
Implemented Not implemented
If implemented, please mark the following stakeholders.
Administrative body
Local residents
NGO
Others
Question 3:
Is the project a new one or an ongoing one? In the case of an ongoing project, have you
received strong complaints or other comments from local residents?
New Ongoing (with complaints) Ongoing (without complaints)
Other
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Question 4:
Is an Environmental Impact Assessment (EIA), including an Initial Environmental
Examination (IEE) Is, required for the project according to a law or guidelines of a host
country? If yes, is EIA implemented or planned? If necessary, please fill in the reason why
EIA is required.
Necessity (Implemented Ongoing/planning)
(Reason why EIA is required: )
Not necessary
Other (please explain)
Question 5:
In the case that steps were taken for an EIA, was the EIA approved by the relevant laws of
the host country? If yes, please note the date of approval and the competent
authority.
Approved without a Approved with a Under appraisal
supplementary condition supplementary condition
(Date of approval: Competent authority: )
Under implementation
Appraisal process not yet started
Other ( )
Question 6:
If the project requires a certificate regarding the environment and society other than an EIA,
please indicate the title of said certificate. Was it approved?
Already certified
Title of the certificate: ( )
Requires a certificate but not yet approved
Not required
Other
Question 7:
Are any of the following areas present either inside or surrounding the project site?
Yes No
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If yes, please mark the corresponding items.
National parks, protection areas designated by the government (coastline, wetlands,
reserved area for ethnic or indigenous people, cultural heritage)
Primeval forests, tropical natural forests
Ecologically important habitats (coral reefs, mangrove wetlands, tidal flats, etc.)
Habitats of endangered species for which protection is required under local laws and/or
international treaties
Areas that run the risk of a large scale increase in soil salinity or soil erosion
Remarkable desertification areas
Areas with special values from an archaeological, historical, and/or cultural points of
view
Habitats of minorities, indigenous people, or nomadic people with a traditional lifestyle,
or areas with special social value
Question 8:
Does the project include any of the following items?
Yes No
Question 9:
Please mark related environmental and social impacts, and describe their outlines.
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Involuntary resettlement
Local economies, such as employment,
livelihood, etc.
Land use and utilization of local
resources
Social institutions such as social
infrastructure and local decision-making
institutions
Existing social infrastructures and
services
Poor, indigenous, or ethnic people
Misdistribution of benefits and damages
Local conflicts of interest
Gender
Childrens rights
Cultural heritage
Infectious diseases such as HIV/AIDS
Other ( )
Outline of related impact:
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Question 10:
In the case of a loan project such as a two-step loan or a sector loan, can sub-projects be
specified at the present time?
Yes No
Question 11:
Regarding information disclosure and meetings with stakeholders, if JICAs environmental
and social considerations are required, does the proponent agree to information disclosure and
meetings with stakeholders through these guidelines?
Yes No