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/63068/2017    ii. MoEFCC File No. : NIL    iii.Short narrative of the project: Proposed SRA Scheme project at Mandapeshwar Road, Borivali West, Mumbai, Maharashtra.    iv. Project Sector : INFRA-2    v. Company/Proponent : INTEGRATED SPACES LIMITED

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)	Borivali

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 09 Mar 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: 24 Feb 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

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : QCI/NABET/ENV/ACO/16/06/0172 Dated 16th June 2016    iii. Name of Consultant: Mahabal Enviro Engineers Pvt. Ltd.   iv. Address : Plot No F-7, Road No-21, Wagle Estate, Thane West-400 604, Maharashtra.   v. Mobile No.: 9323058368   vi. Landline No.: 02221716389   vii. Email Id: dap_24@hotmail.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 : Kantilal    ii. Designation : Director    iii. Name of Company(Applicant Name should not be given here) : INTEGRATED SPACES LIMITED    iv. Address : D Wing, Karma Sankalp, Corner of 6th and 7th Road of Rajawadi, Ghatkopar (East), Mumbai - 400077 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