This information is mandatory for IPAM to review and consider your request.
1. Who is submitting this Request? Please provide your name(s) or the name of your organisation *
2. IPAM is committed to protecting your identity if you fear reprisals. Do you want your name(s) (or the name of your organisation) to be kept confidential throughout this process?
Note. IPAM will share the concerns raised in your request with Bank staff and the Client, but your name and other details that would identify you will not be shared. *
Yes
No
a. Why do you require confidentiality? *
3. Do you fear risk of retaliation for sharing your concerns with IPAM? *
Yes
No
a. Please provide details. Let us know if this information should be treated confidentially. *
4. Country *
AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLANDS COCOS (KEELING) ISLANDS COLOMBIA COMOROS COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DEMOCRATIC REPUBLIC OF CONGO DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES FYR MACEDONIA GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY, C.I. GUINEA GUINEA-BISSAU GUYANA HAITI HEARD AND MCDONALD ISLANDS HONDURAS HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA KOREA, DEMOCRATIC PEOPLE'S REPUBLIC KOSOVO KUWAIT KYRGYZ REPUBLIC LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MULTINATIONAL MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEUTRAL ZONE (BETWEEN SAUDI ARABIA AND IRAQ) NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE ISLAND NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAK REPUBLIC SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA ST. HELENA ST. LUCIA ST. PIERRE AND MIQUELON ST. VINCENT AND THE GRENADINES SUDAN SURINAME SVALBARD AND JAN MAYEN ISLANDS SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN, R.O.C. TAJIKISTAN TANZANIA THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TÜRKIYE TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLAYING ISLAND URUGUAY UZBEKISTAN VANUATU VATICAN CITY STATE VENEZUELA VIETNAM VIRGIN ISLANDS (BRITISH) VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA ISLANDS YEMEN ZAMBIA ZIMBABWE
5. Please provide your contact information
a. Telephone number
b. Mobile number
c. Email address *
d. Mailing address *
e. Fax number
How can we best contact you?*
telephone mobile number email WhatsApp videoconference mail fax
6. Please name or describe the EBRD Project(s) that raises concerns. If you don’t know the Project name, you can include details like the name of the company in charge of the Project, its location, or the activities it is involved in that are affecting you. *
7. What harm do you believe has been caused, or might be caused, by the Project? * Please include details.
8. Are you directly and personally affected by the Project? *
Note: If you are a Representative we will require proof that you have been authorised by the requester to file the Request.
All supporting documentation must be sent via email to IPAM (ipam@ebrd.com )
Yes
No
b. Are you submitting this Request as an Organisation that is not directly or personally affected by the Project? *
Yes
No
i. Are there people living, working or using the land in the Project Area? *
Yes
No
a. Please describe your efforts to engage with Project-affected people on the issues you are raising. *
b. What feedback did Project-affected people give you about the Project impacts? *
c. What has prevented Project-affected people from submitting this Request? *
9. Have you ever contacted the EBRD or the EBRD Client to try to raise and voice your concerns? *
Note. IPAM is a 'tool of last resort' so , unless there is fear of retaliation, before submitting a Request to IPAM, you should first voice your concerns:
a) with EBRD staff by sending your concerns to cso@ebrd.com , or b) with the EBRD Client responsible for the Project.
Note: A written record of your correspondence with the EBRD or the Client in regards to this Request is required.
All supporting documentation must be sent via email to IPAM (ipam@ebrd.com )
Yes
No
Reason why you have not contacted the Client or EBRD