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/GJ/IND2/51744/2016    ii. MoEFCC File No. : J-11011/107/2016- IA II(I)    iii.Short narrative of the project: M/s Kalintis Healthcare Pvt Ltd    iv. Project Sector : Industrial Projects-2    v. Company/Proponent : KALINTIS HEALTHCARE PVT LTD

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Gujarat	Vadodara	Savli
2.	Gujarat	Vadodara	Savli
3.	Gujarat	Vadodara	Savli

vii. Uploaded EC Compliance report by rigional office of MoEFCC: Annexure-Uploaded EC Compliance report viii. Certified Monitoring report by RoMoEF: Annexure-Uploaded Monitoring report    ix.Date of TOR Granted 02 Aug 2016 x.TOR letter issued by Ministry: Annexure-TOR letter ix.Date of Submission for EC: 08 May 2017 x.Project Type: Expansion

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: 21 Apr 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: MSDS of all chemicals is uploaded as additional report.

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : NABET/EIA/1417/IA 003    iii. Name of Consultant: M/s. Envision Enviro Technologies Pvt. Ltd.   iv. Address : 2nd Floor, Shree Ram Complex, Above Bank of India, Near Kargil Chowk, Surat Dumas Road, Piplod, Surat Gujarat   v. Mobile No.: 9428001875   vi. Landline No.: 02612223003   vii. Email Id: envision.surat@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 : Mr Bhargav    ii. Designation : General Manager    iii. Name of Company(Applicant Name should not be given here) : KALINTIS HEALTHCARE PVT LTD    iv. Address : 52A, Jarod-Samlaya Road, Gardhiya, savli, Vadodara, Gujarat 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