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/70157/2017    ii. MoEFCC File No. : 11-40/2017-IA.III    iii.Short narrative of the project: Application for CRZ clearance for proposed addition/ alteration & extension in the premises of existing B. D. Petit Parsee General Hospital    iv. Project Sector : INFRA-2    v. Company/Proponent : B D PETIT PARSEE GENERAL HOSPITAL

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.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 06 Oct 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 Oct 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: Application is for CRZ clearance for proposed addition/ alteration & extension in the premises of existing B. D. Petit Parsee General Hospital

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : QCI/NABET/ENV/ACO/16/06/0172 Dated 16th June 2016    iii. Name of Consultant: Mahabal Enviro Engineers Pvt. Ltd.   iv. Address : Plot No F-7, Road No-21, Wagle Estate, Thane West-400 604, Maharashtra.   v. Mobile No.: 9323058368   vi. Landline No.: 21716389   vii. Email Id: dap_24@hotmail.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 : Yezdi    ii. Designation : Chairman    iii. Name of Company(Applicant Name should not be given here) : B D PETIT PARSEE GENERAL HOSPITAL    iv. Address : The B D Petit Parsee General Hospital, Bomanji Petit Road, Cumbala Hill, 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