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If Insurance of Credit for the Financing of Investment in Foreign Countries Insurance of Credit for the Financing of Investment in Foreign Countries

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Annex No. 3
to the application for Insurance of a Credit for Investment
in Foreign Countries against the Risk of Non Repayment of the Credit
GIC type If
Questionnaire to assess the environmental and social impact of the export and the exporter's statement

Part A

I. Basic information

1. Name of the export project, its capacity (range) and location (facility address and GPS coordinates)

2. Value (i.e., the principal) of the export credit

3. Is it modernization of an existing facility or new construction?

4. In the case of modernization, please specify the original size or capacity of the original facility.

5. A brief description of the technical and technological solutions to the export project.

6. Expected date of commencement of the implementation of the export and its completion.

7. Is the export contract for which you are requesting insurance of export credit risks part of a project secured
by another entity?

8. Has the Environmental and Social Impact Assessment (ESIA) of the export or of the project which includes
the export been conducted?

II. Information about the current state of the environment in the area where
the export project is to be implemented

1. Are there any sensitive locations in the area or are there any sensitive locations affected by the export?
national parks or other protected areas identified by national or international law, and other sensitive locations of international, national or regional importance, such as wetlands, forests with high biodiversity value, areas of archaeological or cultural significance, and areas of importance for indigenous peoples or other vulnerable groups

III. Information on potential impacts to human rights in the country where
the export project is to be implemented

1. Is there a high probability of severe impacts to human rights in the country where the export project is to be
implemented?
e.g., impacts that are particularly severe (e.g., a threat to life, child labour, forced labour and human trafficking), extensive (e.g., massive relocation and working conditions across the industry), irreparable (e.g., torture, loss of health, destruction of indigenous peoples' land), or related to the operation of the project (e.g., in conflict and post-conflict areas)

Part B

Vztahuje se na:

all projects for which their share is equal to or above SDR 10 million,
all projects in or near sensitive areas irrespective of their share,
all existing operations and projects, irrespective of their share, where the screening has identified that there is a high likelihood of severe project-related human rights impacts occurring.

IV. Information about the inputs

1. Land – specify the total area of land occupation after the implementation of the project and how much of it is
"green field".

2. Water – specify annual water consumption

3. Primary raw-material and energy sources (type, annual consumption).

4. Does the export involve construction or the upgrading of the supporting transport or other infrastructure
(e.g., power lines)?

V. Information about the outputs

1. Air (type and quantity of emissions)

2. Waste water (amount of waste water, type and amount of pollutants discharged)

3. Waste (categorization and quantity of waste)

4. Other (e.g., noise and vibration, radiation, odours, other outputs, amount of emissions)

Exporter's statement

to the binding application for insurance under the GIC If

I hereby declare that:

the facts stated in this questionnaire, in negotiations and in related written correspondence have been provided to the best of my knowledge and are true,
I have not distorted or withheld anything that could affect the assessment of the impact of the export, including the project, on the environment, social environment or human rights,
I acknowledge and agree with the possibility of sanctions in the event that the insured event occurred in breach of the conditions arising from the assessment of the impact of the export/project on the environment and social environment or its authorization,
I will provide the necessary assistance in the insurance of the risk of default of the buyer's credit / bank financed supplier credit for the financing of the export and the credit for financing the investment to the insured bank when submitting data to assess the impact of the export, including the project, on the environment, social environment and human rights.

Place and date:
Name and registered office of the exporter/investor:

[Signature of the person authorized to act for the exporter/investor]

Name and title:

Illustrative list of ESE (environment and social environment)
category A projects

The following is an illustrative list containing examples of the types of new ŽSP projects and major expansion ESE projects that may be classified as Category A

Crude oil refineries (excluding undertakings manufacturing only lubricants from crude oil) and installations for the gasification and liquefaction of 500 tonnes or more of coal or bituminous shale per day.
Thermal power stations and other combustion installations (including cogeneration) with a heat output of not less than 300 megawatts (equivalent to a gross electrical output of 140 MWe for steam and single cycle gas turbines power stations) and nuclear power stations and other nuclear reactors, including the dismantling or decommissioning of such power stations or reactors (except research installations for the production and conversion of fissionable and fertile materials, whose maximum power does not exceed 1 kilowatt of continuous thermal load).
Installations designed for the production, or enrichment of nuclear fuels, the reprocessing, storage or final disposal of irradiated nuclear fuels, or for the storage, disposal or processing of radioactive waste.
Integrated works for the initial smelting of cast-iron and steel, e.g. installations for the production of primary steel by blast furnace route or direct reduction; installations for the production of non-ferrous crude metals from ore, concentrates or secondary raw materials by metallurgical, chemical or electrolytic processes.
Installations for the extraction of asbestos and for the processing and transformation of asbestos and products containing asbestos: for asbestos-cement products, with an annual production of more than 20,000 tonnes finished product; for friction material, with an annual production of more than 50 tonnes finished product; and for other asbestos utilisation, of more than 200 tonnes per year.
Installations for the manufacture and/or recovery of chemicals (including but not limited to petrochemicals, fertilisers, pesticides & herbicides, health care products, detergents, paints, adhesives, agro-chemicals, pharmaceuticals, explosives) on an industrial scale using physical, chemical and/or bio chemical processes and for the large-scale distribution of such chemicals via pipelines/terminals and associated facilities.
Construction of airports with a basic runway length of 2,100 metres or more.
Construction of motorways and express roads.
Construction of a new road, or realignment and/or widening of an existing road, where such a new road, or realigned and/or widened section of road, would be 10 km or more in a continuous length.
Construction of railway lines that go beyond urban areas and of long-distance railway lines.
Sea ports and also inland waterways and ports for inland-waterway traffic which permit the passage of vessels of over 1,350 tonnes; trading ports, piers for loading and unloading connected to land and outside ports (excluding ferry piers) which can take vessels of over 1,350 tonnes.
Waste-processing and disposal installations for the incineration, chemical treatment or landfill of hazardous, toxic or dangerous wastes.
Large1 dams and other impoundments designed for the holding back or permanent storage of water.
Groundwater abstraction activities or artificial groundwater recharge schemes in cases where the annual volume of water to be abstracted or recharged amounts to 10 million cubic metres or more.
Industrial plants for the production of pulp, paper and board from timber or similar fibrous materials.
Operations that involve large scale extraction, via underground or open-pit mining, solution mining, or marine or riverine operations to obtain precious metals, base metals, energy and industrial minerals, or construction materials. It may also include the processing of the extracted material.
Greenfield cement plants where the project includes a greenfield quarry.
Large scale oil, gas, or liquefied natural gas development that may include any or all of:
- exploration (seismic and drilling);
- field development and production activities;
- transport activities, including pipelines/terminals, pump stations, pigging stations, compressor stations and associated facilities; or
- gas liquefaction facilities.
Installations for the storage of petroleum, petrochemical, or chemical products with a capacity of 200,000 tonnes or more.
Large-scale logging.
Municipal waste water treatment plants with a capacity exceeding a 150,000 population equivalent.
Municipal solid waste-processing and disposal facilities.
Large-scale tourism and retail development.
Construction of overhead electrical power transmission lines with a length of 15 km or above and a voltage of 110 kV or above.
Large-scale land reclamation.
Large-scale primary agriculture/sylviculture involving the intensification or conversion of natural habitats.
Plants for the tanning of hides and skins where the treatment capacity exceeds 12 tons of finished products per day.
Installations for the intensive rearing of poultry or pigs with more than: 85,000 places for broilers and 60,000 places for poultry; 3,000 places for pigs (over 30 kg); or 900 places for sows.
Projects which are planned to be carried out in sensitive locations or are likely to have a perceptible impact on such locations, even if the project category does not appear in the above list.
Projects that can lead to significant negative social impacts to local communities or other projects of the affected parties, including those involved in the construction or operation of the project.
Projects involving land acquisition and the involuntary resettlement of a significant number of affected people.

Note:
Where boundary limits are not set for individual types of sensitive sectors, limits stipulated by Act No. 100/2001 Coll., on environmental impact assessment, can be tentatively used as follows:

installations for large-capacity transport over 800 millimetres (p. 8),
extraction of metal ores or coal over 1 million tons annually (p. 14),
large-scale logging with a clear-cut area over 25 hectares (p. 17),
municipal solid waste-processing and waste dumps exceeding 30,000 tons annually (p. 19),
large-scale tourism facilities over 200 beds (p. 20),
large-capacity transmission of electricity over 110 kilovolts (p. 21).

1 As per the definition of the International Commission on Large Dams (ICOLD), ICOLD defines a large dam as a dam with a height of 15m or more from the foundation. Dams that are between 5 and 15m high and have a reservoir volume of more than 3 million m3 are also classified as large dams.

Attachment No.2
Declaration of the Investor on compliance with legal provisions against bribery in international trade.

Insurance of export credit risks with state support cannot be given to exports which were negotiated by way of bribery in international trade in the sense of the § 160 and subsequent of the Criminal Code. For these purposes, I declare on behalf of our company and on behalf of persons representing our company that there has been and there will be no breach of rules against bribery in international trade 1). In this relation I further declare that persons acting on behalf of our company or representing our company were not charged by the criminal offence of bribery and they had not been convicted of such criminal offence in last 5 years. Furthermore, I declare that that our company has not been mentioned in the publicly accessible debarment list of the World Bank Group.

I accept that the insurer has the right to verify truthfulness of the above-mentioned declaration and obligate myself to submit all information and documentation the insurer may request in this regard.

According to Art. XII par. 3 letter c) of the GIC D, the insurer has the right to apply recourse against the Exporter if it has been proven that the Export breached norms and practices of international law binding for the Czech Republic, e.g. Convention on Combating Bribery of Foreign Public Officials in International Business Transactions (Communication of the Ministry of Foreign Affairs No. 25/2000 Coll. of international treaties).

Commercial name of the Applicant and Seat:

Name and position:
Place and date:

Signature of a person authorized to act on behalf of the Investor: .......................................................................................

1) Communication of the Ministry of Foreign Affairs No. 25/2000 Coll. of international treaties) on acceptance of Convention on Combating Bribery of Foreign Public Officials in International Business Transactions (part 13/2000 of the Collection of international treaties circulated on March 29, 2000).

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