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    Validity: Application Forextension TOR

    Uploaded by

    Prakhar sen
    This document is an application form for extending the validity of terms of reference (ToR) for an environmental impact assessment (EIA) of a proposed project. It requests basic details about the project such as its name, location, category and production capacity. It also asks if an EIA report and public hearing have been completed according to the ToR and whether any changes to the ToR are needed.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Validity: Application Forextension TOR

    Uploaded by

    Prakhar sen
    47 views4 pages
    This document is an application form for extending the validity of terms of reference (ToR) for an environmental impact assessment (EIA) of a proposed project. It requests basic details about the project such as its name, location, category and production capacity. It also asks if an EIA report and public hearing have been completed according to the ToR and whether any changes to the ToR are needed.

    Original Title

    FORM_5_EC

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    This document is an application form for extending the validity of terms of reference (ToR) for an environmental impact assessment (EIA) of a proposed project. It requests basic details about the project such as its name, location, category and production capacity. It also asks if an EIA report and public hearing have been completed according to the ToR and whether any changes to the ToR are needed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views4 pages

    Validity: Application Forextension TOR

    Uploaded by

    Prakhar sen
    This document is an application form for extending the validity of terms of reference (ToR) for an environmental impact assessment (EIA) of a proposed project. It requests basic details about the project such as its name, location, category and production capacity. It also asks if an EIA report and public hearing have been completed according to the ToR and whether any changes to the ToR are needed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    FORM-5

    APPLICATION FOREXTENSION OF VALIDITY OF TOR

    I Details of Proiect
    a. Name ofthe Proiect (s)
    b. Name ofthe Company / organisation
    c. Registered Address
    d. Lcsal Status ofthe ClomDanv
    Joint Venture (YesNo)
    lfYes.
    (i) No. ofJV Panners(Mtrlrrble Enlries Allowedl
    Name ofthe JV Share ofthe JV Address ofthe Email Id of Mobile No. of
    Partner Partner J V Partner JV Partner JV Partner

    Address for the corrcsDotrdence


    a Namc ofthe apDlicant
    b Desisnation (Owner / Partner / CEO)
    c. Address
    o Pin code
    e-mail
    i TeleDhone No.
    A. Fax No.
    Categorv ofthe Proiect/Activitv as Der Schedule ofElA Notification.2006
    a. Projcct / Activity
    [f (axi) / l(axii) | t(b) / 1(c) / t(d) / | (e) / 2(r) / 2(b) / 3(d) / 3(b) I 4(a) /
    4(bxi)/ 4(b) (ii) / 4(c) / 4(d) / 4(e) t 4(I) / 5(a) / 5(b) / 5(c) / s(d) / s(e) / 5(t) /
    5(g) / s(h) / 5(i) / 5(j) / 6(a)/ 6(t )/ 7 (a) t ? (b)t 7 (c) / 7 (dt /'7 (da) t 7 (e) t 7 (f)
    / 7 (E\ / 7 (h\ t 7 li\ I I G) / I (b)'l
    b. Catccor\ (A/8,/B))
    If Br or Bu
    Rcason for application at Central Level / State level (in case ofB2 projects)
    If Othe6
    c. Please SDecifv
    EAC conc€med (for category A Proiects only)
    (Coal Mining /Non-coal Mining / ]'hermal / River Valley & Hydro / Industry-
    | / Industryll / lnfraslructure-l / In fmstmcture-l I / Nuclear & Defcnce / CRZ
    4 Local ior of the P.oiect
    Plot / Survev / Khasra No.
    b. Villase
    lbhsil
    d. District
    State
    f. Pin code
    s. Bounded Latitudes (North)
    From
    To
    h. Bounded Lonsitudes(East)

    PaEe 7 ol 17
    From
    tb
    l. Surve) of India Topo Sheet No
    5 I Detr ril ofTerms of Rcferencc
    a. Date ofissue ofToR
    D MoEI&CC / SEIAA F ile No.
    Upload ToR letter (PDF Only)
    6 Re&soD for seeking extension of validity of the ToR
    Upload supponing documents ifany {PDF oI]I)
    7 Whether baseline data $as collected (Yes/No)
    It ves
    Period of bsseline data collection
    8 Whcther EIA/EMP $as prepsred b.sed on the ToR (Yes/Nol
    Ifyes
    Whetr was the ElA./EMP prepared?
    Whcther Public Hearins was conducted? (Yes/No)
    Ifvcs
    a, Date of Advert sehent of Public Hearing
    b. Cop) ofad\ert scment in Flnglish (Upload PDF only)
    Whether Public hearing was presided over by an ofliccr of the rank of
    Additional District Magistratc or above (Yes,No)?
    lf yes
    d. Designation of Presiding Officer (District Magistrate / District Collector /
    .rypuy Commissioner / others - plcase specily)
    c. Copy ol'duly signed Proceedings of Ptblic tlearing (Upload plf onty)
    t Date ofPublic HcarinS
    e. Venue of Public Hearine;
    Villagc
    Tehsil
    Disrricl
    State
    h. Distancc of Public Hearing Venue fiom lhe lroposcd Proiecr (km)
    l. No. ofpeopie atlcnded
    Ifthe multiple public hearinqs conducted
    Pl givc the details ofeach PH as per (a) to (i) abovc
    l0 Any amendment in thc ToR is needed?
    If Yes
    a. Iletaifs ofconfiguralion (M hiple Entrie! Alloved)
    Plant / Equipment / Existing Proposed Final configuralion Remarks if
    Facility Confirruration Configulation after amcndment any

    b. Details ofprcduction
    Product/Activity Quantify From Quantit) To tlnit Mode ofTransport
    (Capacity/Area) / Transmission of
    Produot

    Page 8 of 17
    - Unit:- (rons pef Annum(TPA), Mega l^]att(t4l,,l), Hectares(ha), Kl]o Lltre per Day(KrD),
    Tons c.ushed per Day(ICD), cublc rtleter per Day, Kilomet€rs(km)J li1illion Lite.s per
    Day(MtD), Others)
    - Mode ofTEnspon/Tmnsmission of Product (Road, Rail, conveyor Be1t, Pipe conveyo.,
    Arial Rope$ay, combl nat lon of two or three nbdes, Others
    c, Atry Other Amendmert required
    Description as per Description as

    Details of EIA Cotrsultant


    Have you hired Consultant for prcparing document(Yes/No)?

    (i) Reason for not engaging the Consultanl


    If Yes,
    (i) Aocreditation No.
    (ii) Name ofthe EIA Consultant
    (iii) Address
    (iv) Mobile No.
    (v) Landline No.
    (vi) E-mail ld
    (vii) Category of Accreditation (EliSible for Category A / Eligible for
    (viii) Sector of Accreditation
    (ix) Validity of Accreditation
    (x) Upfoad Ccrtit'icate of Accreditation certifiedby QCINLBET (Upload pdJ

    Documents io be attacbed
    a. I pload Copy of r.t itedTor.l(Gii"cif6.ndmenr in toR atso required]
    Upload revised pre-feasibiliry report (in case of amendment in foR also

    Upload Cover Letter duly signed by the project proponcnt or authortcd

    Upload a copy of authorization duly signed by the project proponent in


    support of the person making this application on behalf of the Uscr

    Upload Addirional filc.if anr tupluad p.t[only)


    Undertsking
    - l t trerety give unaenit inglhat rF-ata and info..urion eir"n in the application and
    enclosurcs are true to be best ofmy knowledge and beliefand I am aware that ifany part of
    the data and information found to be false or misleading at any stage,fhe project will be
    rejected and clearance given,if any to the project will be revoked ar our risk and cost. In
    addition to above,l hereby give undertaking that no activity / constfuction / expansion has

    Page 9 of 17
    c. Designation
    d. Company
    Address

    Page 10 of 17

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