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/HR/MIS/63824/2017    ii. MoEFCC File No. : NIL    iii.Short narrative of the project: Commercial Complex at Village Naurangpur, Sector 78, Gurgaon, Haryana    iv. Project Sector : INFRA-2    v. Company/Proponent : SPAZE TOWERS PVT LTD

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Haryana	Gurgaon	Gurgaon

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 15 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: 20 Jul 2016   v. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: None   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. : S.No.114, rev.51, March07,2017 in List A    iii. Name of Consultant: Perfact Enviro Solutions Pvt. Ltd.   iv. Address : 5th Floor, NN Mall, Mangalam Palace, Sector 3, Rohini, New Delhi   v. Mobile No.: 9818346370   vi. Landline No.: 01147528467   vii. Email Id: dhiraj.malik@spaze.in

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 : Dhiraj    ii. Designation : VicePresident    iii. Name of Company(Applicant Name should not be given here) : SPAZE TOWERS PVT LTD    iv. Address : R/o Spazedge, Sector-47, Gurugram- Sohna Road, Gurugram 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