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/MH/MIS/56371/2016    ii. MoEFCC File No. : 21-90/2014- IA III    iii.Short narrative of the project: “TRIVEDI TOWER” PROPOSED MIXED USED DEVELOPMENT at C.T.S. No. 551/13 at Junction of Madan Mohan Malviya Road & 18.30 m wide D.P.Road of village- Nahur, Mulund (W), Mumbai.    iv. Project Sector : INFRA-2    v. Company/Proponent : MS CHHAGANLAL KHIMJI AND CO LTD

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Maharashtra	Mumbai (Suburban)	Kurla

vii. Uploaded EC Compliance report by rigional office of MoEFCC: NIL viii. Certified Monitoring report by RoMoEF: Annexure-Uploaded Monitoring report    ix.Date of TOR Granted N/A ix.Date of Submission for EC: 17 Jun 2016 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: 17 Jun 2016   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

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : Certificate No: NABET/EIA/1417/RA010    iii. Name of Consultant: M/s. Ultra-Tech Environmental Consultancy & Laboratory (Laboratory - Gazetted by MoEF- Govt. of In   iv. Address : Unit No. 206, 224, 225, Jai Commercial Complex, Eastern Express Highway, Opp. Cadbury Factory, Khopat, Thane (W) – 400601   v. Mobile No.: 9324029746   vi. Landline No.: 02225342776   vii. Email Id: deepa@ultratech.in

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 : Urvesh    ii. Designation : Vice President (Projects)    iii. Name of Company(Applicant Name should not be given here) : MS CHHAGANLAL KHIMJI AND CO LTD    iv. Address : 702, Marathon Max, Mulund Goregaon Link road, Mulund west, Mumbai 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: NIL