Application C Form Application C Step 1 of 15 6% LinkedInThis field is for validation purposes and should be left unchanged.Scipion Capital Ltd - Finance Request – Application - C Please complete the Application to the fullest extent possible. If there is no response enter N/A, do not leave a blank. Additional lists may be attached to address questions, if needed and may accompany the application. The documents listed to be provided at the end of the form are mandatory and the application cannot be considered without their being made available. Those on the optional list need not be presented at this stage but will be required in due course and will be therefore useful additions if available. It remains the case that consideration of the completed form does not commit Scipion Capital Ltd in any way. Part C addresses the environmental social and impact (ESI) aspects of the business of the Organisation and if applicable its suppliers if the Organisation is a trading house. The form should be annotated where applicable to indicate whether the response refers to the Organisation or suppliers. 1 - Organisation Information Full registered name of company (the Organisation).Full registered address of the Organisation.Operating address of the Organisation.Website address of the Organisation.Contact party (name & role in Organisation).Email address. Telephone number (office).Telephone number (mobile phone).Legal counsel (name address email).Auditors (name address email).Ownership (specify parties addresses & percentages). 2.1 Environmental and Social Risk Management (in alignment with IFC Performance Standard 1)What are the identified environmental and social risks related to the operations of the Organisation?Does the Organisation have management programmes (operational procedures, practices, action plans) &/or an Environmental Management System to mitigate environmental risks &/or improve performance on these issues? (e.g. air emission limits, wastewater discharges)?Has the Organisation designated responsibilities to employees with reference to environmental aspects & do employees have the necessary capacity?How does the Organisation engage relevant stakeholders to plan & tackle these risks?Has the Organisation a Grievance Mechanism in place that is available and accessible to external stakeholders? If yes, please provide details.Has the Organisation received any grievances on environmental or social issues in the past three years? If yes, please provide details.Does the Organisation have an emergency preparedness & response system & does it involve relevant third parties (e.g. local authorities, affected communities)?Any additional comments for the above answers? 2.2 Labour and Working Conditions (in alignment with IFC Performance Standard 2) 2.2.1 Employment DataTotal full-time Employees.Total female full-time employees.Total youth full-time employees (under 30).Total part-time labourers at peak season.Total foreign personnel, if applicableTotal employee wage bill annually.Total taxes & duties paid to the government annually. 2.2.2 Base Data on Labour and Working Conditions Does the Organisation have a Written Human Resources Policy?Please selectYesNoIs the policy aligned with labour legislation &/or applicable collective agreements?Please selectYesNoAre employees provided (written) information on conditions of employment at the beginning & when major changes occur?Please selectYesNoWhat is the formal minimum wage for the Organisation? Please provide evidence.Please selectYesNoIs the minimum wage of the Organisation above the national minimum wage?Please selectYesNoIs training offered to employees? If yes, please provide details.Please selectYesNoWhat training has been offered in the last 12 months?Are employees permitted to be part of an organised labour union without interference?Please selectYesNoDoes the Organisation ensure equal opportunity & non-discrimination with respect to any aspects of the employment relationship?Please selectYesNoDoes the Organisation have a policy in place for collective dismissals?Please selectYesNoPlease describe the approach of the Organisation to collective dismissalsIs there a mechanism for employees to file complaints & grievances without fear of retribution?Please selectYesNoDoes the Organisation have a safe & healthy work environment? Please explain.Please selectYesNoAre all of the labour records & contracts of the Organisation kept up to date?Please selectYesNoDoes the Organisation have policies & procedures to prevent child & forced labour?Please selectYesNoDoes the Organisation have management programs (operational procedures, practices, action plans) &/or a Social Management System to mitigate social risks &/or improve performance on these issues?Please selectYesNoHas the Organisation designated employees with responsibilities for social aspects & do employees have the necessary capacity?Please selectYesNo 2.2.3 Compliance with applicable labour laws and regulations Holiday PayWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveOvertime/Weekend Work PayWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveSick Leave PayWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveInsuranceWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveMaternity LeaveWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveWorker health & safetyWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveChild LabourWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveForced LabourWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveMigrant LabourWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveWorker RepresentativesWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveNon-discrimination & equal opportunityWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add Remove 2.2.4 Employee Benefits Does the Organisation provide Health Insurance?Please selectYesNoDoes the Organisation provide Dental insurance?Please selectYesNoDoes the Organisation provide disability coverage?Please selectYesNoDoes the Organisation provide Life Insurance?Please selectYesNoDoes the Organisation provide Maternity Leave?Please selectYesNoDoes the Organisation have a sexual harassment policy?Please selectYesNoDoes the Organisation have a childcare support policy?Please selectYesNoDoes the Organisation provide a share ownership scheme to staff?Please selectYesNo 2.3 Resource Efficiency and Pollution Prevention (in alignment with IFC Performance Standard 3) 2.3.1 Compliance with applicable environmental laws and regulations 2.3 Resource Efficiency and Pollution Prevention (in alignment with IFC Performance Standard 3) 2.3.1 Compliance with applicable environmental laws and regulations Environmental management protectionWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveWater pollution & conservationWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveWaste management & reductionWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add RemoveHandling & disposal of hazardous substancesWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in the HR policy of the Organisation? Add Remove 2.3.2 Resource efficiency Has the Organisation implemented measures to improve efficiency in its consumption of energy?Please selectYesNoHas the Organisation implemented measures to improve efficiency in its consumption of water?Please selectYesNoHas the Organisation implemented measure to improve efficiency in its consumption of material inputs / waste?Please selectYesNoDoes the Organisation measure & manage greenhouse gas emissions?Please selectYesNoDoes the Organisation track water consumption & any potential adverse effects it may have on others?Please selectYesNo 2.3.3 Pollution Prevention Does the Organisation prevent release of pollutants to air water & land due to routine operations or accidents?Please selectYesNoPlease describe how…Does the Organisation manage waste generated? If yes, then how?Please selectYesNoPlease describe how…Does the Organisation handle & dispose of hazardous materials (including pesticides)?Please selectYesNoPlease describe how… 2.4 Community Health and Safety (in alignment with IFC Performance Standard 4) Please provide a brief description of the location of the Organisation within the community. Is there a village, urban centre, industrial zone?Are mechanisms in place to prevent accidents that could affect communities?Please selectYesNoFor example, if they have trucks, which carry hazardous materials, or go through areas where people are, what are measures to prevent accidents. If they have construction sites, how to avoid impacts on surrounding communitiesDoes the Organisation have a grievance mechanism for affected or surrounding communities?Please selectYesNoAre there ways to present such grievances to the Organisation (e-mail, phone number, formal letters, community consultation) & has this been communicated to the communities?Please selectYesNoIf yes, please provide the latest complaints (including records) & how these were resolved. Who was consulted & how was it resolved? CanDoes the Organisation or its employees participate in the local community? If so, how?Please selectYesNoCharitable donations, Community service, etc.2.5 Land Acquisition and Involuntary Resettlement (in alignment with IFC Performance Standard 5) Was there physical or economic displacement due to the setting up of the Organisation or related activities, even of people that did not have legal right to the land (i.e. customary land use)?Please selectYesNoWho was / is responsible for conducting the resettlement process (Organisation or government) if there was such a process?If so, is there a Resettlement Action Plan? (RAP)Please selectYesNo 2.6 Biodiversity Conservation & Sustainable Resource Management (in alignment with IFC Performance Standard 6) Describe the location & the natural resources & habitats surrounding it (e.g., forests, rivers, protected areas) of the area of operation of the OrganisationHas there been any deforestation caused by the activities of the Organisation?Please selectYesNo2.7 Indigenous Peoples (in alignment with IFC Performance Standard 7) Are there Indigenous communities in the area? Are they adversely affected by activities of the Organisation?Please selectYesNoIf there are Indigenous communities please provide detailsIf yes, please provide meeting minutes between the Organisation & the indigenous peoples leaderMax. file size: 64 MB. 2.8 Cultural Heritage (in alignment with IFC Performance Standard 8) Are there any cultural heritage areas / sites in the area of operation or supply of the Organisation, e.g., graves, sacred sites, sacred groves?Please selectYesNoWhat are they? How is the organisation tackling these risks? If it is not, what are the recommendations to tackle these risks?* 3. Supply Chain 3.1 Supply Chain E&S Risks Has the Organisation identified the social & environmental risks in its primary supply chain?Please selectYesNoIf yes, please provide detailsDoes the Organisation have certification for its supplier traceability? (Rainforest Alliance, FairTrade, UTZ, etc.)Please selectYesNoPlease provide the certification(Required) Drop files here or Select files Max. file size: 64 MB, Max. files: 6. Does the Organisation monitor compliance of its suppliers & contractors with applicable social & environmental legislation?Please selectYesNoDescribe the policies of the Organisation with reference to suppliers & contractors (Code of Conduct, Procurement policies) & clarify how they verify compliance with applicable legislationDoes the Organisation monitor biodiversity risks in its primary supply chain?Please selectYesNoDescribe the policies of the Organisation with reference to suppliers & contractors (Code of Conduct, Procurement policies) & clarify how they verify compliance with applicable legislation.Does the Organisation monitor risks of conversion of natural habitats in its primary supply chain?Please selectYesNoDescribe the policies of the Organisation with reference to suppliers & contractors (Code of Conduct, Procurement policies) & clarify how they verify compliance with applicable legislation.Does the Organisation monitor compliance of contractors with employment legislation, including child labour & occupational health & safety?Please selectYesNoPlease describe how? Are there any clauses about compliance with the applicable laws in the contracts between the Organisation and the supply chain of the Organisation? Are checks undertaken on third parties engaging workers to ensure that they are compliant with applicable laws including labour legislation3.2. Smallholder Focus Are you a Agricultural Company?(Required)YesNoWhat is the number of smallholders buying inputs from / selling to the Organisation?What is the average smallholder farm size?Does the Organisation pay more than the average to farmers?(Required)YesNoPlease provide details on how much this is?(Required)What is the price per ton/kg paid to farmers?Did farmers report any yield increases in the last year? Or decreased expenditure / increased efficiency?Have smallholders received any benefits beyond payments?(Required)This may include credit, educational assistance, training, outreach to NGOs.YesNoDoes the Organisation have any smallholder farmer outreach programmes?(Required)YesNoPlease provide details of how the organisation monitor these practices.(Required) Drop files here or Select files Max. file size: 64 MB. Does the Organisation monitor smallholders’ labour practices? (family labour, child labour, etc)(Required)YesNoPlease provide details of how the organisation monitor these practices.(Required) Drop files here or Select files Max. file size: 64 MB. 4. Corporate Governance 4.1 Base Data on Corporate Governance BriberyWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in one of the Organisation’s policies? Add RemoveExtortionWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in one of the Organisation’s policies? Add RemoveFinancial CrimeWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in one of the Organisation’s policies? Add RemoveLand legislation, including lands under customary useWhat is the relevant legislation?Does the Organisation comply with the legislation? Please describe what measures are in place to ensure this*Can the Organisation provide a certificate, audit / authority inspection report to show as proof of compliance?*Is the topic addressed in one of the Organisation’s policies? Add Remove 5. Development Impact 5.1 Impact objectives Target job creation.Target wage increases.Does the Organisation make any tax & community contributions?How many jobs would a Scipion facility create?What effect would a Scipion facility have on wage increases?How many jobs for females would a Scipion facility create?How many jobs for youths would a Scipion facility create?Would the Scipion facility provide financing that would not otherwise be available?Would a Scipion facility enable access to new export markets? If yes, to which & how? 5.2 United Nations Sustainable Development Goals Scipion Capital Ltd supports the United Nations SDGs. You can learn more about these at: www.undp.org/sustainable-development-goals Please consider the requirements of the SDGs and complete the table below with the view of the Organisation as to how the Organisation can contribute to the SDGs by operating and developing the business of the Organisation utilising the facility requested from Scipion Capital Ltd. No PovertyZero HungerGood Health and Well-BeingQuality EducationGender EqualityClean Water and SanitationAffordable and Clean EnergyDecent Work and Economic GrowthIndustry, Innovation and InfrastructureReduce InequalitiesSustainable Cities and CommunitiesResponsible Consumption and ProductionClimate ActionLife Below WaterLife on HandPeace, Justice and Strong InstitutionsPartnerships for the Goals Declaration On behalf of the Organisation, I confirm that the application contained in the above information is true and correct to the best of our knowledge. I confirm that the Organisation will provide all such additional information that Scipion Capital Ltd may request in a timely manner. I acknowledge that the submission of this application to Scipion Capital Ltd does not obligate Scipion Capital Ltd to make any funding of any nature whatsoever available to the Organisation. For and on Behalf of the Organisation Consent I agree to the privacy policy.UntitledDeclarationOn behalf of the Organisation, I confirm that the application contained in the above information is true and correct to the best of our knowledge. I confirm that the Organisation will provide all such additional information that Scipion Capital Ltd may request in a timely manner. I acknowledge that the submission of this application to Scipion Capital Ltd does not obligate Scipion Capital Ltd to make any funding of any nature whatsoever available to the Organisation. For and on Behalf of the Organisation I agree to the above statementName Full Name Position Signature(Required)
