1.	Project Details

   Whether it is a violation case and application is being submitted under Notification No. S.O.804(E) dated 14.03.2017 ? : No

1.	Project Details

   i. Proposal No. : IA/UK/NCP/75005/2018    ii. MoEFCC File No. : NIL    iii.Short narrative of the project: Expansion of Base Hospital    iv. Project Sector : INFRA-1    v. Company/Proponent : DIRECTOR MEDICAL EDUCATION

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Uttarakhand	Almora	Almora

vii. Uploaded EC Compliance report by rigional office of MoEFCC: Annexure-Uploaded EC Compliance report viii. Certified Monitoring report by RoMoEF: Annexure-Uploaded Monitoring report    ix.Date of TOR Granted N/A ix.Date of Submission for EC: 09 Jun 2018 x.Project Type: Expansion

2.	Uploaded Documents of EIA/EMP,Risk Assessment,Public Hearing etc.

i.EIA/EMP: Annexure-EIA/EMP ii.Risk Assessment: Annexure-Risk Assessment iii.Public Hearing: Annexure-Public Hearing    iv. Date of Public Hearing: 27 Jun 2017   v. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: Annexure-Additional Report/Study/Document   vi. Uploaded Cover Letter: Annexure-Cover Letter   vii.Remarks: NIL

Additional Attachments, if any
S.no.	Attached File	Date of Submission
1.	FORM 1	09 Jun 2018
2.	FORM 1	09 Jun 2018
3.	conceptual plan	09 Jun 2018

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : 132    iii. Name of Consultant: SAWEN Consultancy Services Pvt. Ltd.   iv. Address : 417 A and B Sahara Shopping Centre Faizabad Road lucknow   v. Mobile No.: 7379444473   vi. Landline No.: 05222341312   vii. Email Id: medicalcollegedehra01@gmail.com

5.	Undertaking

I hereby give undertaking that the data and information given in the application and enclosures are true to be best of my knowledge and belief and I am aware that if any part of the data and information found to be false or misleading at at any stage, the project will be rejected and clearance given, if any to the project will be revoked at our risk and cost.

   i. Name of Applicant : Director    ii. Designation : DirectorMedicalEducation    iii. Name of Company(Applicant Name should not be given here) : DIRECTOR MEDICAL EDUCATION    iv. Address : Dehradun v. Uploaded copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency: Annexure-Uploaded copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency