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Form-4

APPLICATION FOR AMENDMENT IN ENVIRONMENTAL CLEARANCE

(To be filled up by User Agency)

1.	Details of Project

Proposal No. : SIA/TN/MIS/178166/2020
(a) Name of the project : Proposed Construction of Multi Specialty Hospital and Residential Quarters by Christian Medical College Vellore Association
(b) Name of Company / Organisation. : CHRISTIAN MEDICAL COLLEGE VELLORE ASSOCIATION
(c) Registered Address. : 166/1A, 166/1B, 166/1C, 166/1D, 166/1E, 166/1F, 166/1G, 166/1H, 166/2A, 166/2B, 166/2C etc., Kilminnal Village, Walajah Taluk, Ranipet District Tamil Nadu 632517
(d) Legal Status of the Company. : Others
(e) Joint Venture (Yes/No) : No

2.	Address for the Correspondence

(a) Name of the Applicant. : David Chandran
(b) Designation (Owner/Partner/CEO) : General Superintendent
(c) Address :-
       State : Tamil Nadu
       District : Vellore
       Town / Village : No
(d) Pin Code : 632517
(e) Email : cmckannigapuram@gmail.com
(f) Telephone no : 2282008
(g) Fax no : No
(h) Mobile no : 9443534745
(i) Contact Person. : David
(j) Website (if any) : No

3.	Category of the Project/Activity as per Schedule of EIA Notification,2006

(a). Major Activity. : 8(a) Building and Construction projects

      Minor Activity : 8(a) Building and Construction projects

      Major Sub Activity. : No
      Minor Sub Activity : No
(b). Category : B2
      Reason for applicant at central level/state level(in case of B1 and B2 ): No
(c). Reason : No
      EAC Concerned (for category A Projects Only ): No

4.	Location of the Project

(a) Plot No/Survey No/Khasra No : 319/1A2,1B2,3A,3B,1C,2B2,317/1B,2,318/1,2A,2B,2C,2F,188/1B,185/1C,1B,1D,184/3,1A2,etc
(b) Village : Kilminnal
(c) Tehsil : Wallajah
(d) District : Vellore
(e) State : Tamil Nadu
(f) Pin Code : 632517
(g) Bounded Latitudes (North) : Yes
        From : Degree:12, Minutes : 55, Seconds :54
        To    : Degree:12, Minutes : 56, Seconds :23
(h) Bounded Longitudes (East) : Yes
        From : Degree:79, Minutes : 13, Seconds :52
        To    : Degree:79, Minutes : 14, Seconds :17
(i) Survey of India Topo Sheet No : 57P1, 57P5

5	Details of Environmental Clearance

(a) Project Name : Proposed Construction of Multi Specialty Hospital and Residential Quarters by Christian Medical College Vellore Association
(b) MoEF&CC / SEIAA File No : 2634/EC(8a)/379/2014 Dt:30.03.2015
(c) Date of issue of EC : 30/03/2015 (d) Uploaded EC letter :

6	Details of Consent to Operate

(i) Whether Consent to operate obtained (Yes/No) ? : No

7	Amendment Sought for

Amendment in Configuration/ Amendments in Clearance condition/ Other (specify) : -

8	Details of Product (as per the approved EC)

Details of Products
S.no	Product / Activity (Capacity/ Area).	Quantity	Unit	Mode of Transport/ Transmission of Product
1	Hospital Block with Amenities and Residential Quarters	13.950519	Hectares(HA)	Road

9	Details of Configuration (Multiple Entries Allowed)

Details of Configurations
S.no	Plant/ Equipment/ Facility	Existing Configuration	Proposed Configuration	Final configuration after Amendment	Remarks if Any
1	-	-	-	-	-

10	Reasons for Amendment

Reasons for Amendment : We have proposed for Hospital Block - Common Basement + Ground+7 Floors instead of Hospital Block - Common basement + Ground + 6 Floors

11	Any Other Amendment required

Any Other Amendment Required
S.no	Reference of Approved EC	Description as per Approved EC	Description as per Proposal.	Remarks
1	Para2	Hospital Block-14 Nos of Common Basement +Ground+	Hospital Block- Common Basement + Ground +
2	Para2	6 Floors With Amenities and Residential Quarters	7 Floors With Amenities and Residential Quarters

12	Details of EIA Consultant

Have you hired Consultant for preparing document (Yes/No) ? : No
(i)Reason for not engaging the Consultant : As the project has already been issued EC

13.	Documents to be Attached

(a) Uploaded addendum to EIA/EMP Report : No Data (b) Uploaded Copy of revised -Feasibility Report /Detailed Project Report (DPR) / Detailed Engineering Report / Detailed Conceptual Plan / Approved Mining Plan (in case of mining proposals):

(c) Uploaded Copy of final Layout Plan:

(d)Uploaded Cover Letter duly signed by the project proponent or authorized person:

(e)Uploaded a copy of authorization duly signed by the project proponent in support of the person making this application on behalf of the User Agency:

(f)Uploaded Additional File, If any : No Data

Essential Details Sought

Essential Details Sought
S.no.	EDS Sought Date	EDS Sought	Letter
NIL

Additional Detail Sought: NIL

14.	Undertaking

(a): 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 any stage, The project will be rejected and clearance given, If any to the project will be revoked at our risk and cost. In addition to above, I hereby give undertaking that no activity / construction / expansion has since been taken up. (b)Name : David Chandran (c)Designation: General Superintendent (d)Company: CHRISTIAN MEDICAL COLLEGE VELLORE ASSOCIATION (e)Address: 166/1A, 166/1B, 166/1C, 166/1D, 166/1E, 166/1F, 166/1G, 166/1H, 166/2A, 166/2B, 166/2C etc., Kilminnal Village, Walajah Taluk, Ranipet District Tamil Nadu 632517