Environmental Management (Environmental Impact Assessment) Regulations, 2026

1. PARTICULARS OF APPLICANT Name of Applicant: ID No.: Position e-mail address: Name of Contact Person ID No.: Fax No.: e-mail address: Tel. No.: Cell No.: Fax No.: Tel. No.: Cell No.: Address: Position: Address: ASSESSMENT NO: FILE NO: Zambia Environmental Management Agency P. O. Box 35131 Lusaka, Zambia 260 1 254 130 / 254 023 / 254 059 Tel: Fax: 260 1 254 164 Email: administrator@zema.org.zm Web-site: www.zema.org.zm 82 Statutory Instruments 9th January, 2026

2. PROPOSED UNDERTAKING/DEVELOPMENT Title of proposed project ............................................................................................................................................................. ....................................................................................................................................................... Brief description of proposal (nature of undertaking, unit processes (flow diagram), raw materials, list of chemicals (source, types), storage facilities (number of sites and size), wastes/by-products (solid, liquid and gaseous) ....................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... ....................................................................................................................................................... ...................................................................................................................................................... Brief scope of Proposal (size of labour force, equipment and machinery, installed/production capacity, product type, area covered by facility/proposal, market) ....................................................................................................................................................... ...................................................................................................................................................... ....................................................................................................................................................... ...................................................................................................................................................... ................................................................................................................................................................ ....................................................................................................................................................... ...................................................................................................................................................... ......................................................................................................................................................

3. PROPOSED SITE Location (attach a site plan/map) Plot/House No.:............................... Street/Area Name............................................. Town................................................................................... District/Province................................................................. Major Landmark (if any)............................................................................................................... Distance to nearest residential and/or other facilities ........................................................................................................................................................ ...................................................................................................................................................... ........................................................................................................................................................ Adjacent land uses (existing and propsed) ....................................................................................................................................................... ...................................................................................................................................................... ....................................................................................................................................................... 9th January, 2026 Statutory Instruments 83 Current land uses of proposed project site (existing and proposed) ....................................................................................................................................................... ....................................................................................................................................................... ......................................................................................................................................................

4. INFRASTRUCTURE AND UTILITIES Structures (buildings and other facilities proposed and already existing on site) ...................................................................................................................................................... ...................................................................................................................................................... ...................................................................................................................................................... Water requirement (source) ......................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... Energy requirement (type, source) ....................................................................................................................................................... Distance to the nearest water body (where applicable) ...................................................................................................................................................... ...................................................................................................................................................... ........................................................................................................................................................ Means of access to the project site ......................................................................................................................................................... ....................................................................................................................................................... ......................................................................................................................................................

5. ATTACHMENTS Tick appropriate letters below indicating that the following required documents have been attached: (a) Copy of a map of the relevant area (A4 size) (b) Site plan or Block plan of the site. (c) Photographs of the site (d) Proof of land use as authorised by the relevant local authority (e) Any other (Indicate) ....................................................................................................................................... ....................................................................................................................................... 84 Statutory Instruments 9th January, 2026 DECLARATION I,...................................................................................being the Developer/project proponent, hereby declare that the information provided on this form is true to the best of my knowledge and shall provide any additional information that shall come to my notice in the course of processing this application. ....................................................... Signature ............................................................. Date *Use extra pages where space provided is inadequate. LUSAKA 26th December, 2025 M. E. MPOSHA, Minister of Green Economy and Environment