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/70617/2017    ii. MoEFCC File No. : 11-14/2018-IA.III    iii.Short narrative of the project: Boutique Hotel Project    iv. Project Sector : INFRA-2    v. Company/Proponent : HERMITAGE BUILDERS PRIVATE LIMITED

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Goa	South Goa	Salcete

   vii.Date of TOR Granted N/A viii.TOR letter issued by Ministry: N/A ix.Date of Submission for EC: 02 May 2018 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: 05 Sep 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: Documents uploaded approved by NIO as per EDS generated.

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : Rev 58/ 16th October 2017/ S.No. 107    iii. Name of Consultant: Perfact EnviroSolutions Pvt. Ltd.   iv. Address : NN Mall, Sector-3, Rohini, New Delhi - 110085   v. Mobile No.: 9818362330   vi. Landline No.: 01149281360   vii. Email Id: sammuchaudhri@yahoo.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 : Sumeet    ii. Designation : VicePresident    iii. Name of Company(Applicant Name should not be given here) : HERMITAGE BUILDERS PRIVATE LIMITED    iv. Address : C-4/5, Safdarjung Development Area 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