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/NCP/60601/2016    ii. MoEFCC File No. : 21-61/2016-IA-III    iii.Short narrative of the project: “Shiv- Kailasha” Proposed group Housing Scheme at NIT Metro area, Nagpur    iv. Project Sector : New Construction Projects and Industrial Estates    v. Company/Proponent : OM SHIVAM BUILDCON PRIVATE LIMITED

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Maharashtra	Nagpur	Hingna

   vii.Date of TOR Granted 09 Jan 2017 viii.TOR letter issued by Ministry: Annexure-TOR letter ix.Date of Submission for EC: 31 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: 28 Dec 2016   v. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: None   vi. Uploaded Cover Letter: Annexure-Cover Letter   vii.Remarks: NIL

Additional Attachments, if any
S.no.	Attached File	Date of Submission
1.	Annexures 6	31 Mar 2017
2.	Ann 3	31 Mar 2017
3.	ANnexures10-12	31 Mar 2017

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : NABET/EIA/1617/RA 0044    iii. Name of Consultant: Pollution & Ecology Control Services   iv. Address : Near Dhantoli Police Station, Dhantoli Nagpur - 440012   v. Mobile No.: 9373128182   vi. Landline No.: 07122293225   vii. Email Id: omshivambuildcon2007@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 : Ravindra    ii. Designation : Chairman    iii. Name of Company(Applicant Name should not be given here) : OM SHIVAM BUILDCON PRIVATE LIMITED    iv. Address : Om Shivam Buildcon Pvt. Ltd., 203/204 Gokul Keshav Apartment Deo Nagar, Khamla Road, Nagpur. 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