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/65549/2017    ii. MoEFCC File No. : F. No. 21-236/2017    iii.Short narrative of the project: RESIDENTIAL & COMMERCIAL PROJECT “AMBIKA ESTATE” At Survey No. 7,8, 9, 13 to 15, 19, 22 to 28, 30, 31 & 32, Village Borpada, Taluka: Bhiwandi, District: Thane, State: Maharashtra of M/s. Ambika Brickwell Pvt. Ltd.    iv. Project Sector : INFRA-1    v. Company/Proponent : AMBIKA BRICKWELL PVT LTD

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Maharashtra	Thane	Bhiwandi

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 19 Jun 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: 13 May 1973   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: ToR was approved in 45th SEAC II meeting subsequently EIA was appraised in 50th SEAC II meeting EC granted dated 12.5.2017 in 111th SEIAA meeting now we are submitting to EAC in view of the letter received dated 13.06.2017 (SEIAA 2017/CR-8-262/Est) as the construction area is exceeding 3,00,000 sqm

Additional Attachments, if any
S.no.	Attached File	Date of Submission
1.	form 1	19 Jun 2017
2.	form 1 A	19 Jun 2017
3.	layout approval from MMRDA	19 Jun 2017
4.	Fire NOC from MFS	19 Jun 2017
5.	water supply NOC	19 Jun 2017

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : 49    iii. Name of Consultant: Enviro Analysts and Engineers Pvt. Ltd   iv. Address : B-1003, Enviro House, 10th Floor. Western Edge II, Western Express Highway, Borivali (E), Mumbai-400 066.   v. Mobile No.: 9321619749   vi. Landline No.: 28541647   vii. Email Id: ambikabrickwell@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 : Anup    ii. Designation : Director    iii. Name of Company(Applicant Name should not be given here) : AMBIKA BRICKWELL PVT LTD    iv. Address : 301, Shalaka, Plot No. 32, Juhu Road, Near Santacruz Police Station, Santacruz West, 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