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/UK/IND2/69533/2017    ii. MoEFCC File No. : NIL    iii.Short narrative of the project: M/s Matangi Rubber Pvt. Ltd. Khasra no. 1036, 1038, 1039 Industrial Area Camp Road, Selaqui, Dehradun, Uttarakhaand.    iv. Project Sector : Industrial Projects - 2    v. Company/Proponent : SELF

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Uttarakhand	Dehradun	Vikasnagar

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 18 Sep 2017 x.Project Type: Change of Product Mix under para 7(ii)

2.	Uploaded Documents of EIA/EMP,Risk Assessment,Public Hearing etc.

i. Uploaded EC Compliance report by rigional office of MoEFCC: Annexure-Uploaded EC Compliance report ii. Certified Monitoring report by RoMoEF: Annexure-Uploaded Monitoring report iii. Uploaded Form I: Annexure-Uploaded Form I   iv. Uploaded Additional Report/Study/Document as desired by Ministry/EAC: Annexure-Additional Report/Study/Document   v. Uploaded Cover Letter: Annexure-Cover Letter   vi.Remarks: Proposed Increase in Process of Manufacturing “Vulcanization” of Rubber.

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : No    ii. Reason for not hiring the Consultant : Self

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 : Sanjay    ii. Designation : Consultant    iii. Name of Company(Applicant Name should not be given here) : SELF    iv. Address : Khasra No- 1036, 1038 & 1039 Camp Road Selaqui Industrial Area Dehradun 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