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Guidelines of Application Form for

the JICA Knowledge Co-Creation Program

The attached form is to be used to apply for the Knowledge Co-Creation program (KCCP) of the Japan
International Cooperation Agency (JICA), which are implemented as part of the Official Development
Assistance Program of the Government of Japan. Please complete the application form while referring
to the following and consult with the respective country’s JICA Office - or the Embassy of Japan if the
former is not available - in your country for further information.

1. Parts of Application Form to be completed

1) Which part of the form should be submitted?
It depends on the type of KCCP you are applying for.
>Application for KCCP (Group and Region Focus)
Official application and Parts A and B including Medical History must be submitted.

>>Application for KCCP (Country Focus) including KCCP for Counterpart and KCCP
related to ODA Loan
Official Application and Part B including Medical History will be submitted. Part A needs not
to be submitted.

2) How many parts does the Application Form consist of?

The Application Form consists of three parts as follows;
Official Application
This part is to be confirmed and signed by the head of the relevant department/division of
the organization which is applying.

Part A. Information on the Applying Organization

This part is to be confirmed by the head of the relevant department/division of the
organization which is applying.

Part B. Information About the Nominee including Medical History

This part is to be completed by the person who is nominated by the organization applying.
The applicants for KCCP (Group and Region Focus) are required to fill in every item. As
for the applications for KCCP (Country Focus) including KCCP for Counterpart and some
specified programs, it is required to fill in the designated “required” items as is shown on
the Form.

Please refer to the General Information to find out which type KCCP that your organization applies for
belongs to.

2. How to complete the Application Form

In completing the application form, please be advised to:
(a) carefully read the General Information (GI) for which you intend to apply, and confirm if the
objectives and contents are relevant to yours,
(b) be sure to write in the title name of KCCP accurately according to the GI, which you intend to apply,
(c) use a typewriter/personal computer in completing the form or write in block letters,
(d) fill in the form in English,
(e) use or “x” to fill in the ( ) check boxes,
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(f) attach a picture of the Nominee,

(g) attach additional page(s) if there is insufficient space on the form,
(h) prepare the necessary document(s) described in the General Information (GI), and attach it (them)
to the form,
(i) confirm the application procedure stipulated by your government, and
(j) submit the original application form with the necessary document(s) to the responsible organization
of your government according to the application procedure.

Any information that is acquired through the activities of the Japan International Cooperation Agency
(JICA), such as the nominee’s name, educational record, and medical history, shall be properly handled
in view of the importance of safeguarding personal information.

3. Privacy Policy
1) Scope of Use
Any information used for identifying individuals that is acquired by JICA will be stored, used, or
analyzed only within the scope of JICA activities. JICA reserves the right to use such identifying
information and other materials in accordance with the provisions of this privacy policy.

2) Limitations on Use and Provision

JICA shall never intentionally provide information that can be used to identify individuals to any third
party, with the following three exceptions:
(a) In cases of legally mandated disclosure requests;
(b) In cases in which the provider of information grants permission for its disclosure to a third party;
(c) In cases in which JICA commissions a party to process the information collected; the information
provided will be within the scope of the commissioned tasks.

3) Security Notice
JICA takes measures required to prevent leakage, loss, or destruction of acquired information, and to
otherwise properly manage such information.

4. Copyright policy
Participants of KCCP are requested to comply with the following copyright policy;

Article 1. Compliance matters with participants’ drafting of documents (various reports, action plans,
etc.) and presentations (report meetings, lectures, speeches, etc.)

1. Any contents of the documents and presentations shall be created by themselves in principle.
2. Comply with the following matters, if you, over the limit of quotation, have to use a third person’s
work (reproduction, photograph, illustration, map, figure, etc.) that is protected under laws or regulations
in your country or copyright-related multinational agreements or the like:
(1) Obtain license to use the work on your own responsibility. In this case, the scope of the license shall
meet the provisions of Article 2.
(2) Secure evidential material that proves the grants of the license and specifies the scope of the
license.
(3) Consult with the third party and perform the payment procedure on your own responsibility regarding
negotiations with a third person about the consideration for granting the license and the procedure for
paying the consideration.
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Article 2. Details of use of works used for KCCP

(1) The copyright on a work that a participant prepares for KCCP shall belong to the participant. The
copyright on the parts where a third party’s work is used shall belong to the third party.
(2) When using texts, supplementary educational materials and other materials distributed for KCCP,
participants shall comply with the purposes and scopes approved by each copyright holder.
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Knowledge Co-Creation Program under Technical Cooperation with the Government of Japan

Application Form for the JICA Knowledge Co-Creation Program

OFFICIAL APPLICATION
(to be confirmed and signed by the head of the relevant department / division of the applying organization)

1. Title of the training course/Name of the training course: (Please write down as shown in the General
Information)

Metal-Mining Development Administration

2. Number: (Please write down as shown in the General Information)
J 1 7 - 0 4 1 4 9

3. Country Name:
MOZAMBIQUE

4. Name of Applying Organization:

INAMI-National Institute of Mine

5. Name of the Nominee(s):

1) CARLOS ALBANO MAROVE 3)
2) 4)

Our organization hereby applies for Knowledge Co-Creation program (KCCP) of the Japan International
Cooperation Agency and proposes to dispatch qualified nominees to participate in the programs.

Date: 30/06/2017 Signature:

Name: Zaquir Issufo

Designation / Position Head of Service

Service of Projects, Mineral Technology and
Official Stamp
Department / Division Environment
Address: Praça 25 de Junho nº 380; CP. 4605;
Office Address and Maputo; Mozambique.
Contact Information Telephone: Fax: E-mail:
(258)21325934/21320024 (258)21360198/21427121 zaquir.issufo@gmail.com

Confirmation by the organization in charge (if necessary)

I have examined the documents in this form and found them true. Accordingly I agree to nominate this
person(s) on behalf of our government.

Date: 30/06/2017 Signature:

Name: ADRIANO SILVESTRE SENVANO

Designation / Position Head of the Institution Official Stamp

Department / Division INAMI

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Part A: Information on the Applying Organization

(to be confirmed by the head of the department / division)

1. Profile of Organization

1) Name of Organization:
INAMI-National Institute of Mine

2) The mission of the Organization and the Department / Division:

A. Propose policies for the development of the mining sector and monitor their implementation;
B. Analyze and approve projects and technical and economic studies for the opening of new mines
as well as the rehabilitation and/or closure of mines;
D. To promote, support and control, in coordination with other institutions, the exploration and
extraction and use of mineral resources, excluding oil and gas;
E. Promote, support and control small-scale mining, taking into account the minimization of
negative environmental and social impacts;
F. Collaborate in the elaboration of norms of research and calculation of reserves and to develop
other activities within the scope of its attributions;
G. Promote and develop efficient and sustainable mining processing technologies that add value to
mineral products;
H. To promote and carry out studies, development and transfer of technologies, as well as to publish
and disseminate their results.

2. Purpose of Application

1) Current Issues: Describe the reasons for your organization claiming the need to participate in
Knowledge Co-Creation Program (KCCP), with reference to issues or problems to be addressed.
My organization intends to support Mozambican government in the elaboration of
appropriate policies and strategies that will promote a sustainable exploitation of mineral
resources and avoid or minimize environmental impacts.

2) Objective: Describe what your organization intends to achieve by participating in KCCP.

The organization is expecting to achieve the following:
1. Deep understanding of the importance of metal resources in resource-producing
countries;
2. Deep understanding of the appropriate methods or strategies for resource exploration
including satellite image processing;
3. Deep understanding of mining policies that will promote a sustainable exploration of
metal-resources;
4. Deep understanding of mining pollution and its countmeasures including mining
reclamation;
5. Deep understanding of environmental impacts and systems or methods for environment-
friendly mining development;
6. To understand financing mechanisms for mining projects in the developing countries.
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3) Future Plan of Actions: Describe how your organization shall make use of the expected achievements, in
addressing the said issues or problems.
The organization (INAMI) will make use or apply the knowledge, skills and experience that
the participant will acquire from the KCCP program in the implementation of its new project
about ONLINE MANAGEMENT/MONITORING OF ALL MOZAMBICAN MINING TITLES
BY USING GIS AND REMOTE SENSING in order to promote a sustainable development
of mineral resources and minimize or avoid environmental impacts. In this project, all
information such as mining methods to be used, geochemical, mineralogical and
geophysical data and other findings from the exploration site will be provided online by the
mining company to INAMI’s data base and evaluated, analyzed and/or compared with the
previous information by INAMI’s staff. This will include validation of mining methods being
applied by the mining company, control how a given mining company manages its
overburden material and mine effluents, monitor of the progress of mining activities as well
as mining rehabilitation/reclamation including online monitoring of tax payment.

4) Selection of the Nominee: Describe the reason(s) the nominee has been selected for the said
purpose, referring to the following view points; 1) Course requirement, 2) Capacity /Position, 3) Plans
for the candidate after the KCCP, 4) Plan of organization and 5) Others.
The nominee has been selected for the said purpose because he has a background in
mining engineering and a good experience in mining exploration methods, EIA and mining
reclamation. Currently he is working in the Department of Projects, Mineral technology and
Environment where is dealing with the same issues and others. After the KCCP program,
the participant is expected to be in charge of the said new project of INAMI (ONLINE
MANAGEMENT/MONITORING OF ALL MOZAMBICAN MINING TITLES BY USING GIS
AND REMOTE SENSING) including collaboration in the elaboration of mining policies for
sustainable development in the country.
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Part B: Information about the Nominee

(to be completed by the Nominee)
NOTE>>>The applicants for Knowledge Co-Creation Program (KCCP) (Group and Region Focus) are required to fill in
“Every Item”. As for the applications for KCCP (Country Focus) including KCCP for Counterpart and some specified
programs, it is required to fill in the designated “required” items as is shown below.

1. Title of the training course/Name of the training course: (Please write down as shown in the General
Information)
Metal-Mining Development Administration Attach the
nominee’s
2. Number: (Please write down as shown in the General Information) (required)
photograph (taken
J 1 7 - 0 4 1 4 9 within the last three
months) here
Size: 4x6
3. Information about the Nominee (nos. 1-9 are all required) (Attach to the
1) Name of Nominee (as in the passport) documents to be
submitted.)
Family Name
M A R O V E
First Name
C A R L O S
Middle Name
A L B A N O

2) Nationality MOZAMBICAN 5) Date of Birth (please write out the

(as shown in the passport) month in English as in “April”)
3) Sex ( X ) Male ( ) Female Date Month Year Age
4) Religion CHRISTIAN 30 06 2017 34

6) Present Position and Current Duties

Organization INAMI-National Institute of Mine

Department / Division Department of Projects, Mineral Technology and Environment

Present Position Mining Engineer

Date of employment by Date Month Year Date of assignment to the Date Month Year
the present organization 12 04 2014 present position 15 02 2017

7) Type of Organization
( X ) National Governmental ( ) Local Governmental ( ) Public Enterprise
( ) Private (profit) ( ) NGO/Private (Non-profit) ( ) University
( ) Other ( )

8) Outline of duties: Describe your current duties

At present I am working in the Department of Projects, Mineral technology and
Environment. My Department is responsible for EIA and monitoring of mining activities,
promotion of mining technology for sustainable development of mining activities and
evaluation of mining projects and EIA reports of mining companies.

9) Contact Information
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Address (Name of the street/road/city/town/village/province/district, street

number and name of country):
Office
TEL: (258)21325934/21320024 Mobile (Cell Phone): (258)823200520
FAX: (258)21360198/21427121 E-mail:
Address (Name of the street/road/city/town/village/province/district, street
number and name of country):
Home
TEL: Mobile (Cell Phone): (258)844457605
FAX: E-mail: eng.marove@gmail.com
Name: Emilia Barros
Relationship to you: Wife
Contact Address (Name of the street/road/city/town/village/province/district, street
person in number and name of country):
emergency
TEL: Mobile (Cell Phone): (258)845583177
FAX: E-mail: emilia.barros6@gmail.com

10) Others (if necessary)

NOT NECESSARY

4. Career Record
1) Job Record (After graduation)
Period
Organization City/Country From To Position or Title Brief Job Description
Month/Year Month/Year
I am working in the Department of Projects,
Mineral technology and Environment. My
Department is responsible for EIA and
monitoring of mining activities, promotion of
INAMI Maputo/Mozambique 04/2014 Mining Engineer
mining technology for sustainable
development of mining activities and
evaluation of mining projects and EIA reports
of mining companies.

Ministry of Mineral Maputo/Mozambique I have been participating in the exploration of

08/2012 08/2013 Geophysicist
Resources mineral resources including groundwater

Maputo/Mozambique Teach Radiation (Protection and Safety) to BSc

Eduardo Mondlane
04/2009 09/2010 Assistant Lecturer students of Radiology course and organize tutorials
University
on all aspects of the class.

2) Educational Record (Higher Education) (required)

Period
Institution City/Country From To Degree obtained Major
Month/Year Month/Year
Mining Engineering
Hokkaido University Sapporo/Japan 04/2015 04/2017 MSc. (Sustainable Resources
Engineering)

Maputo/
Eduardo Mondlane University 02/2005 12/2008 BSc. Applied Physics
Mozambique
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3) Training or Study in Foreign Countries; please write your past visits to Japan specifically as much as
possible, if any.
Period
Institution City/Country From To Field of Study / Program Title
Month/Year Month/Year
Mineral resources and hydrocarbons business
Mitsui & Co, Lda Tokyo/Japan 08/2015 09/2015
strategies in Africa/ Summer Internship

Mining Engineering (Sustainable Resources

Hokkaido University Sapporo/Japan 04/2015 04/2017
Engineering)

5. Language Proficiency (required)

1) Language to be used in the program (as in GI)

Listening ( ) Excellent ( X ) Good ( ) Fair ( ) Poor

Speaking ( ) Excellent ( X ) Good ( ) Fair ( ) Poor

Reading ( ) Excellent ( X) Good ( ) Fair ( ) Poor

Writing ( ) Excellent ( X ) Good ( ) Fair ( ) Poor

Certificate (Examples: TOEFL, TOEIC) TOEIC

2) Mother Tongue Cisena

3)Other languages ( Portuguese ) ( X ) Excellent ( ) Good ( ) Fair ( ) Poor

Excellent: Refined fluency skills and topic-controlled discussions, debates & presentations. Formulates strategies to deal with various
essay types, including narrative, comparison, cause-effect & argumentative essays.

Good: Conversational accuracy & fluency in a wide range of situations: discussions, short presentations & interviews.
Compound complex sentences. Extended essay formation.
Fair: Broader range of language related to expressing opinions, giving advice, making suggestions. Limited compound and complex
sentences & expanded paragraph formation.
Poor: Simple conversation level, such as self-introduction, brief question & answer using the present and past tenses.

6. Expectation on the applied KCCP

1) Personal Goal: Describe what you intend to achieve in the applied KCCP in relation to the organizational
purpose described in Part A-2.

From the KCCP program I intend to achieve the following:

1. Deep understanding of the appropriate methods or strategies for resource exploration
including satellite image processing;
2. Deep understanding of theories and methods/strategies to elaborate appropriate mining
policies for sustainable development of metal resources;
3. Deep understanding of mining pollution and its countmeasures including mining
reclamation;
4. Deep understanding of environmental impacts and systems or methods for environment-
friendly mining development;
5. To understand financing mechanisms for mining projects in the developing countries.
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2) Relevant Experience: Describe your previous vocational experiences which are highly relevant in the themes
of the applied KCCP. (required)
1. Feb 2017 – Mar 2017: Participation in the KAMPAI (KAbwe Mine Pollution
Amelioration Initiative) project in Zambia for environmental impact assessment,
monitoring, and proposal of methods for remediation.

Functions performed: collection and analysis of soil samples, air dust, vegetation,
tailing, surface water, groundwater and proposal of methods for remediation including
participation in the implementation of pilot test for remediation of the contaminated
area.

The project is owned by Japanese government and is being financed by world bank.

2. Apr 2015 – Mar 2017: Research on the Environmental Impact Assessment of Coal
Mining Activities in Benga and Moatize, Mozambique, and Proposal of Methods for
Prevention and Remediation (MSc Thesis).

Samples analyzed during the research: coal, coal ash (produced in the laboratory),
sandstones, siltstones, soil, mine effluents, riverbed sediments, surface water, and
groundwater.

3. Feb 2013 – Mar 2013: participation in the exploration of mineral resources

including groundwater in Beluluane, Maputo.

3) Area of Interest: Describe your subject of particular interest with reference to the contents of the applied
KCCP. (required)
1. To learn knowledge and technology on mineral resource exploration, including
satellite image processing, as well as policy schemes and functions of resource-related
organizations for improvement in resource discoverability.

2. To understand the importance of government agency’s role on the environment-

friendly mining development and the points of environmental impact assessment and
guidance in such planning.

3. To learn financing mechanisms for mining projects in developing countries, as well

as the current situation of industry in Japan.

*7. Declaration (to be signed by the Nominee) (required)

I certify that the statements I have made in this form are true and correct to the best of my knowledge.
If accepted for the program, I agree:

(a) not to bring or invite any member of my family (except for a program whose period is one year or more),
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(b) to carry out such instructions and abide by such conditions as may be stipulated by both the nominating government
and the Japanese Government regarding the program,
(c) to follow the program, and abide by the rules of the institution or establishment that implements said program,
(d) to refrain from engaging in political activity or any form of employment for profit or gain,
(e) to return to my home country at the end of the activities in Japan on the designated flight schedule arranged by JICA,
(f) to discontinue the program if JICA and the applying organization agree on any reason for such discontinuation and not
to claim any cost or damage due to the said discontinuation.
(g) to consent to waive any copyright holder’s rights for documents or products produced during the project, against
duplication and/or translation by JICA, as long as they are used for the purposes of the program.
(h) to approve the privacy policy and the copyright policy mentioned in the Guidelines of Application.
JICA’s Information Security Policy in relation to Personal Information Protection
■ JICA will properly and safely manage personal information collected through this application form in accordance
with JICA’s privacy policy and the relevant laws of Japan concerning protection of personal information and take
protection measures to prevent divulgation, loss or damages of such personal information.

■ Unless otherwise obtained approval from an applicant itself or there are valid reasons such as disclosure under
laws and ordinances, etc., and except for the following 1.-3., JICA will neither provide nor disclose personal
information to any third party. JICA will use personal information provided only for the purposes in the following
1.-3 and will not use for any purpose other than the following 1.-3 without prior approval of an applicant itself.

1. To provide KCCP to the participants from developing countries.

2. To provide KCCP to the participants from developing countries under the Citizens’ Cooperation Activities.

3. In addition to 1. and 2. above, if the government of Japan or JICA determines necessary in the course of
technical cooperation.

(i) to observe Japanese laws and ordinances during my stay, if I violate Japanese laws and ordinances,
I will return the total amount or a part of the expenditure required for the KCCP depending on the extent of the
violation.
(j) to understand that JICA does not assure issuance of Japan entry visa even after JICA decide to accept me. I
understand the Embassy of Japan will decide it according to necessary formalities upon the submission of visa
application from each participant.

Date (DD/MM/YYYY) : Signature:

Print Name: CARLOS ALBANO MAROVE

30/06/2017

MEDICAL HISTORY

1. Present Medical Status

(a) Do you currently use any medicine or have regular medical checkup by a physician for your illness?
[ X ] No [ ] Yes: Name of illness ( ), Name of medicine ( )
If yes, please attach your doctor's letter (preferably, written in English) that describes
current status of your illness and agreement to join the program.
(b) Are you pregnant?
[ X ] No [ ] Yes: Months of pregnancy ( months)
(c) Are you allergic to any medication or food?
[ X ] No [ ] Yes: What are you allergic to? ( )
(d) Please indicate any needs arising from disabilities that might necessitate additional support or
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facilities.
( No need )
Note: Disability does not lead to exclusion of persons with disability from the program. However, upon the
situation, you may be directly inquired by the JICA official in charge for a more detailed account of your condition.
2. Past Medical History
(a) Have you had any significant or serious illness?
[ X ] No [ ] Yes: Please specify ( )

(b) Have you ever been a patient in a mental clinic or been treated by a psychiatrist?
[ X ] No [ ] Yes: Please specify ( )

3. Other Medical Problems

If you have any medical problems that are not described above, please indicate below.

I don’t have

I certify that I have read the above instructions and answered all questions truthfully and completely to
the best of my knowledge.
I understand and accept that medical conditions resulting from an undisclosed pre-existing condition
may not be financially compensated by JICA and may result in termination of the program.

Date Signature
(DD/MM/YYYY) :
30/06/2017 Print Name CARLOS ALBANO MAROVE
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Japan International Cooperation Agency（JICA）

Resident Representative of JICA ____________________

Consent Form for Medical Examinations and Vaccinations

I, CARLOS ALBANO MAROVE, understood the content of medical examinations and vaccinations necessary for
participating in JICA Knowledge Co-Creation Program_____________________________.
I will take the necessary examinations and vaccinations, with full understanding of their effect and risks
explained by the doctors in charge.

NAME (PRINT): CARLOS ALBANO MAROVE

SIGNATURE :
Date ofAgreement(YYYY/MM/DD): 2017 / 06 / 30
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Definition of International departure airport

Please mark with X the airport from which you would like to depart from:

Maputo International airport X Yes No

Nampula International airport Yes No

I certify that the statements I have made in this form are true and correct to the best of my knowledge.

If accepted for the program and I agree:

(i) The departures in Mozambique can only be made by one of the two international airports
defined by JICA (Maputo International airport or Nampula International airport).

(ii) The airport of departure is defined by the time I apply to the training course and it can not be
changed after I have chosen and indicated in this form

Date Signature
(DD/MM/YYYY) :
Print Name CARLOS ALBANO MAROVE
30/06/2017
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Japan International Cooperation Agency（JICA）

Resident Representative of JICA ____________________

Consent Form for Medical Examinations and Vaccinations

I, CARLOS ALBANO MAROVE, understood the content of medical examinations and vaccinations necessary for
participating in JICA Knowledge Co-Creation Program_____________________________.
I will take the necessary examinations and vaccinations, with full understanding of their effect and risks
explained by the doctors in charge.

NAME (PRINT): CARLOS ALBANO MAROVE

SIGNATURE :
Date of Agreement (YYYY/MM/DD): 2017 / 06 / 30