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/60754/2016    ii. MoEFCC File No. : 11-2/2017-IA-III    iii.Short narrative of the project: PROPOSED HOLIDAY RESORT IN CRZ-III AREA AT G.NO. 532 KIHIM, TAL. ALIBAG BY MRS. SAVITRI NANDAKISHOR DUBE    iv. Project Sector : INFRA-2    v. Company/Proponent : SAVITRI NANDKISHOR DUBE

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Maharashtra	Raigad	Alibag

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 03 Jan 2017 x.Project Type: New

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: 28 Oct 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. : Sr.No.101, List of Accredited Consultant Organizat    iii. Name of Consultant: MITCON Consultancy and Engineering Services Ltd   iv. Address : Agriculture College Campus, Next to DIC Office, Shivajinagar, Pune – 411005   v. Mobile No.: 9665043400   vi. Landline No.: 02066289400   vii. Email Id: aejaz06102007@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 : SAVITRI DUBE    ii. Designation : OWNER    iii. Name of Company(Applicant Name should not be given here) : SAVITRI NANDKISHOR DUBE    iv. Address : G.No. 532, Kihim Village, Tal. Alibag, Distt. Raigad 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