Appendix-II

(Refer clause 11)

FORM-1
1 Details of project: Name of the project; Name of the Company / Organization; Registered Address; Legal Status of
the Company; Joint Venture if any; etc.
2 Address for the correspondence: Name of the project proponent; Designation; Address; Postal Index Code; e-mail
ID; Mobile No.; Fax No., etc.
3 Category of the project as per schedule: Item number in the schedule; Category (A/B1/B2); Type of the proposal
(New/Expansion/Modernization); etc.
4 Location of the project: Plot / Survey / Khasra number; Village; Tehsil; District; State; Pin Code; Latitudes and
Longitudes of the project/activity site; Survey of India Topo Sheet number; Copy of Topo Sheet; Maximum
elevation above MSL; kml file; Distance of nearest Highest Flood Level (HFL) from the project boundary within the
study area; Seismic Zone; Nearest railway station; Distance from nearest railway station (in Km); Nearest Airport;
Distance from nearest Airport (in Km); Nearest Town/City/District head quarter (Specify); Distance from nearest
Town/City/District head quarter (in Km); Village Panchayats, Zila Parishad, Municipal Corporation, Local Body
(Complete postal Address with pin code and Telephone Number); etc.
5 Whether the project proposed to be located in the notified industrial area (Yes/No)
6 Whether the project proposed to be located in border states (Yes/No)
7 If project is executed in multiple States/UTs, details thereof: Number of States/UTs in which project will be
executed; Main State/UT of the Project; details of all the States/UTs where the project is located
8 Details of alternative sites
A Details of alternative sites examined
Alternative Village District State Bounded Latitudes Bounded
site (North) Longitudes(East)
From To From To

B Copy of Topo Sheet showing alternative locations

9 Details of products & by-products; and project configuration
A In case of new projects
a. Details of products and by-products :
Product / Activity (Capacity / Quantity Unit Mode of Transport / Transmission of
Area) Product / by-product

-Unit:- (Tons per Annum(TPA), Numbers; Mega Watt(MW), Hectares(ha), Kilo Liters per Day(KLD), Tons
Crushed per Day(TCD), Cubic Meter per Day, Kilometers(Km), Million Liters per Day(MLD), Hides per
month, Square meter, Others)
- Mode of Transport/Transmission of Product (Road, Rail, Conveyor Belt, Pipe Conveyor, Aerial Ropeway,
Inland water ways, Sea, combination of two or three modes, Others)
b. Details of project configuration
Description of Plant / Equipment / Facility Configuration Remarks if any

B In case of Expansion or Modernization

a Details of products and by-products
Product/Activity Quantity Quantity To Unit Mode of Transport / Transmission
(Capacity/Area) From of Product / by-product

- Unit:- (Tons per Annum(TPA), Numbers; Mega Watt(MW), Hectares(ha), Kilo Liters per Day(KLD), Tons
Crushed per Day(TCD), Cubic Meter per Day, Kilometers(Km), Million Liters per Day(MLD), Hides per
month, Square meter, Others)
- Mode of Transport/Transmission of Product (Road, Rail, Conveyor Belt, Pipe Conveyor, Aerial Ropeway,
Inland water ways, Sea, combination of two or three modes, Others)
b. Details of project configuration
Description of Plant / Existing Proposed Final configuration Remarks if

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