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/MIS/62089/2017    ii. MoEFCC File No. : 21-145/2017-IA-III    iii.Short narrative of the project: Group Housing "Orchid Park" situated At Khasra No: 39, 40Ka, 41Ka, 41Ga, 41Gha, 42Kha, 42Ka, 43Ka, 43Kha, 44, 45Kha, 1078, 1080, 1081, 1082 & 1083, Village Mauza Chalang, Pargana Parwa Doon, Distt. Dehradun    iv. Project Sector : INFRA-2    v. Company/Proponent : PUSHPANJALI REALMS AND INFRATECH PVT. LTD.

vi.Details of State of the project

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

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 27 Feb 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: 27 Jan 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 IA	27 Jan 2017
2.	Conceptual Plan	27 Jan 2017
3.	Signed Form I	27 Feb 2017
4.	Form I	27 Feb 2017

3.	Additional Detail Sought

Additional Detail Sought
Sno.	ADS Letter	Remarks	Date of ADS
1.	NA	ADS sought by EAC	13 Jun 2017

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : 60    iii. Name of Consultant: ENVIRTA Sustainable Solutions India Pvt. Ltd.   iv. Address : 2412 4th floor express trade tower tower 2 b36 sector 132 noida   v. Mobile No.: 9910037943   vi. Landline No.: 01204974242   vii. Email Id: pushpanjalirealmsandinfratech@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 : Biplab    ii. Designation : Authorizedsignatory    iii. Name of Company(Applicant Name should not be given here) : PUSHPANJALI REALMS AND INFRATECH PVT. LTD.    iv. Address : Nath House, Devpura, Haridwar, Uttarakhand 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