|
I............S/o, D/o,
W/o........... aged.......occupation.........Occupier of ........... normally
resident of .......... Do hereby solemnly affirm on oath as under:
I/we affirm, the
Proprietor/Partner/Managing Director or authorized signatory of (firm Name)
......................and occupier of the said industry.
I am/we are authorized
to swear the affidavit by the management/Board/Etc.,
I/we state, that the
industry proposed to be established is the category of industry failing within
the green/orange category of industry as categorized by the Board.
(Notification No. KSPCB/DEO-1/EO-1/RE-CLA/98/1352 dated 1-7-1998. No.
KSPCB/CORPCELL/AEO-4/RE-CLA/99-2000/4125 dated 6-1-2000, No.
KSPCB/CONSENT/IND/CC/2001/5586 dated 15-3-2001 and No. KSPCB/RE-CLA/140TH
B.M/CC/2001-02/2803 Dated28-11-2001)
I/we affirm the total
capital investment on fixed assests (movable and immovable) is Rs..........
(Rupees in Words) (...............)
I/we affirm the building
is taken on rent/lease and the monthly lease rentals is Rs...... (Rupees
..........) only.
I/we affirm that the
contents/information furnished in the accompanying common application form
under the water (Prevention and control of Pollution) Act, 1974, and Air
(Prevention and control of Pollution) Act, 1981, is complete in all respects
and is correct to the best of my/our knowledge:-
I/we undertake to abide
by all the terms and conditions to be imposed by the Karnataka State Pollution
Control Board, in the consent for establishment order, which will be issued
under Sec.25 of water Act and/or sec.21 of the Air Act.
I/we affirm that the
industry is not located/situated in a residential area.
I/we state that the
industry is located in an industrial/commercial area.
I/we state that the
industry will not discharging any trade effluents
OR
I/we state that the industry will install adequate pollution control measures
to treat the trade and domestic effluent to the standard stipulated by the
Board at all times.
I/we state that the
industry will not be discharging any air emissions
OR
I/we say that industry will install adequate pollution control measures for
control of air emissions generated which will meet the standards stipulated by
the Board.
I/we undertake that in
case of any violation of the terms and conditions, which are incorporated in
the consent for establishment, I/we shall not operate the industry, apart from
being liable to be dealt under provisions of section 44 of water Act and
Section 37 of Air Act. I/we have read and understood the contents of this
affidavit.
| Place: |
|
| Date: |
DEPONENT/OCCUPIER |
| |
Signature: |
| |
Name: |
| |
Address: |
| Note:
strikeout whichever is not applicable
|
|