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/62254/2017    ii. MoEFCC File No. : 11-18/2017-IA.III    iii.Short narrative of the project: Application for CRZ Clearance for proposed addition / alteration & extension to the existing Breach Candy Hospital at Mumbai    iv. Project Sector : INFRA-2    v. Company/Proponent : BREACH CANDY HOSPITAL TRUST

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Maharashtra	Mumbai City	Mumbai

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 25 Apr 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: 03 Nov 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

Additional Attachments, if any
S.no.	Attached File	Date of Submission
1.	MCZMA Recommendation Letter	16 Feb 2017
2.	Demarcation of HTL	16 Feb 2017
3.	EDS reply letter	10 Mar 2017
4.	EDS reply letter	19 Apr 2017

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : Accredited by NABET by it’s vide letter No. QCI/NA    iii. Name of Consultant: Mahabal Enviro Engineers Pvt. Ltd.   iv. Address : F-7, RoadF-7, Road No. 21, Wagale Estate, Thane (W)-400604, Maharashtra   v. Mobile No.: 9323058368   vi. Landline No.: 02221716389   vii. Email Id: breachcandy01@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 : N    ii. Designation : CEO    iii. Name of Company(Applicant Name should not be given here) : BREACH CANDY HOSPITAL TRUST    iv. Address : 60-A, Bhulabhai Desai Road, 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: 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