Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Other Establishment Individual Company Government Entity Commercial Registration Number City / Region Detailed Site AddressContact Information Contact Person NameJob Title Mobile number Email Address Preferred Method of Contact Email Phone Call WhatsAppType of Activity Main Activity Type Commercial Industrial Medical Agricultural Service Construction Educational OtherOther (please specify) Brief Description of the Activity and Its NatureActivity Status Under Construction Planned (New Project) ExistingProject Location Region / Governorate City Is the site located within Industrial Area Residential Area Commercial Area Mixed-Use Area Site Coordinates (if available)Type of Service Requested Is the site located within Compliance Assessment with Environmental Regulations Support in Obtaining Environmental Permit Environmental Classification (Category A, B, C) Other General Environmental Consultation Preparation / Review of Environmental Impact Assessment (EIA) Handling Environmental Violation or Notice Environmental Measurements (Air – Water – Noise – Soil) Preparation of Environmental Register Preparation of Environmental Management Plan (EMP)Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Ministry of Environment, Water and Agriculture Ministry of Industry Other National Center for Environmental Compliance (NCEC) Civil Defense MunicipalityCurrent Environmental Status of the Site Has an environmental permit been previously obtained? NO Yes Is there a previous Environmental Impact Assessment? NO YesAre there any environmental violations or observations? NO Yes If yes, please specifySources of Environmental Impact (if any)Are there any environmental violations or observations? Noise Hazardous waste Air emissions Industrial / sanitary wastewater Other Chemicals Solid waste OdorsAttached Documents (Optional)Attached Documents (Optional) Site plan Commercial registration Site layout / drawings Activity license Previous environmental studies Site photos Industrial / sanitary wastewater Air emissionsAdditional DetailsAdditional DetailsDeclarationI hereby declare that the information provided above is accurate and correct, and I agree to its use for the purpose of reviewing the request and contacting me regarding the requested service. I AgreeNamethe datesend
