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/AS/IND2/58064/2016    ii. MoEFCC File No. : J-11011/192/2016- IA II(I)    iii.Short narrative of the project: Synthetic Organic Chemical Industry    iv. Project Sector : Industrial Projects-2    v. Company/Proponent : CENTURY ADHESIVE A DIVISION OF CENTURY PLYBOARDS INDIA LTD

vi.Details of State of the project

Details of State of the project
S.no.	State Name	District Name	Tehsil Name
1.	Assam	Kamrup	Palasbari

   vii.Date of TOR Granted 30 Nov 2016 viii.TOR letter issued by Ministry: Annexure-TOR letter ix.Date of Submission for EC: 29 Dec 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: 14 Nov 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: NIL

3.	Additional Detail Sought:   NIL

4.	Accredited Consultant Details

   i. Accreditation status : Yes    ii. Accreditation No. : NABET/EIA/1619/RA0049    iii. Name of Consultant: BHAGAVATHI ANA LABS PRIVATE LIMITED   iv. Address : PLOT NO 7-2-C14, INDUSTRIAL ESTATE SANATHNAGAR   v. Mobile No.: 9391116319   vi. Landline No.: 04023803800   vii. Email Id: ykc@centply.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 : Yogesh    ii. Designation : Unit Head    iii. Name of Company(Applicant Name should not be given here) : CENTURY ADHESIVE A DIVISION OF CENTURY PLYBOARDS INDIA LTD    iv. Address : Palasbari Industrial Estate-I, Mirza Palasbari Road, P.O.Palasbari, Dist. Kamrup, Assam. 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