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/64969/2016    ii. MoEFCC File No. : SEAC 2016/ CR-501/T.C.1    iii.Short narrative of the project: Redevelopment project “SAIFEE BURHANI UPLIFTMENT PROJECT”    iv. Project Sector : Infrastructure and Miscellaneous Projects & CRZ    v. Company/Proponent : SAIFEE BURHANI UPLIFTMENT 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. 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 06 Mar 2017 x.TOR letter issued by Ministry: Annexure-TOR letter ix.Date of Submission for EC: 26 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: 26 May 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: A detailed Social Economic Impact Assessment Study (SIA) is not attached in the EIA report due to size limitation but will be submitted in hard copy with EIA report

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : Certificate No: NABET/EIA/1417/SA0011    iii. Name of Consultant: M/s. Ultra-Tech   iv. Address : Unit No. 206, 224, 225, Jai Commercial Complex, Eastern Express Highway, Opp. Cadbury Factory, Khopat, Thane (W) – 400601.   v. Mobile No.: 9819438773   vi. Landline No.: 91-22-25342776   vii. Email Id: deepa@ultratech.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 : Mohammed    ii. Designation : Vice President - HOD Construction    iii. Name of Company(Applicant Name should not be given here) : SAIFEE BURHANI UPLIFTMENT TRUST    iv. Address : Ground Floor, Ezzy Hall, 47/49, Raudat Tahera Street, Bhendibazar, 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