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/GA/MIS/65995/2017    ii. MoEFCC File No. : 11-32/2017-IA.III    iii.Short narrative of the project: Chakshu Properties Pvt. Ltd.    iv. Project Sector : INFRA-2    v. Company/Proponent : CHAKSHU PROPERTIES PVT LTD

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Goa	North Goa	Pernem

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 23 Aug 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: 01 Jan 1900   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: NIL

Additional Attachments, if any
S.no.	Attached File	Date of Submission
1.	Covering letter and Annexure I	23 Aug 2017
2.	Annexure II	23 Aug 2017
3.	Annexure III	23 Aug 2017
4.	Annexure IV	23 Aug 2017
5.	Annexure V	23 Aug 2017

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : NABET/EIA/1518/SA021 dated 28/3/2017    iii. Name of Consultant: Sadekar Enviro Engineers Pvt. Ltd.   iv. Address : 310, Dempo Towers, EDC Patto, Panaji Goa   v. Mobile No.: 9820144125   vi. Landline No.: 08322437048   vii. Email Id: chakshuproperties@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 : Alpesh    ii. Designation : Director    iii. Name of Company(Applicant Name should not be given here) : CHAKSHU PROPERTIES PVT LTD    iv. Address : 3-D/2, Chambers, 35, New marine lines, 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