APPENDIX-VIII

(Refer clause 21)

FORM-5
APPLICATION FOR TRANSFER OF PRIOR ENVIRONMENTAL CLEARANCE
1 Name of the Project (s)
2 Details of Earlier Project Proponent (Multiple entries allowed in case of amalgamation of activities involved):
Name of the Company / Organisation; Registered Address; Legal Status of the Company; details of Joint Venture if
any; etc.
3 Details of New Project Proponent (Multiple entries allowed in case of splitting of activities involved): Name of
the Company / Organisation; Registered Address; Legal Status of the Company; details of Joint Venture if any; etc.
4 Address for the correspondence (Multiple entries allowed in case of splitting of activities involved): Name of
the applicant; Designation (Owner / Partner / CEO); Address; Pin code; e-mail; Telephone No.; Fax No.; etc.
5 Category of the Project/Activity as per Schedule of EIA Notification,2006: Item under schedule; Category
(A/B1/B2)
6 Details of Prior environmental clearance: Date of issue of Prior environmental clearance; MoEF&CC / SEIAA
File No.; copy of EC letter
7 Details of Consent to Establishment: Whether Consent to Establishment obtained (Yes/No); If yes, copy of
Consent to Establishment obtained including that valid till date; Date of issue; Validity; File No.; Application No.;
etc.
8 Status of Implementation of the project (In case of EC: physical progress made on the
project/facilities/activities for which Prior Environment Clearance was granted)
9 In case of the splitting of Prior Environment Clearance involved
a Proposed splitting of the project faculties/activities
Facility / activity Facility / activity Facility / activity granted Facility / activity granted
granted Prior granted Prior Prior Environment Prior Environment
Environment Environment Clearance proposed to Clearance proposed to
Clearance along Clearance proposed to transfer to “Y” along with transfer to “Z” along with
with configuration transfer to “X” along configuration and capacity configuration and capacity
and capacity with configuration and
capacity

b Proposed splitting of the prior environmental terms and conditions

Environmental terms and conditions Transferee X Transferee Y Transferee Z

9 In case of amalgamation of prior environmental clearances involved

a Proposed amalgamation of the faculties/activities
Facility / activity granted Facility / activity granted Prior Facility / activity Facilities /
Prior Environment Environment Clearance along granted Prior activities after
Clearance along with with configuration and Environment merger
configuration and capacity capacity to project-2 Clearance along with
to project-1 configuration and
capacity to project-3

b Proposed amalgamation of the environmental terms and conditions

Environmental Environmental Environmental Proposed
terms and terms and terms and Environmental
conditions conditions conditions terms and
prescribed for prescribed for prescribed for conditions after
project-1 project-2 project-3 merger

10 Documents to be attached
a. No Objection from the transferor
b. Undertaking by transferee stating regarding acceptance of the terms and conditions under which the Prior
Environment Clearance was granted.

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