Environmental Consultation Request Form Environmental Consultation Request Form Environmental Consultation Request FormFull name Company / Establishment Name (if any):Legal Status of the Establishment Individual Establishment Other Company Government Entity Commercial Registration Number City / Region Detailed Site AddressContact Information Contact Person NameJob Title Mobile number Email Address Preferred Method of Contact WhatsApp Email Phone Call Type of Activity Main Activity Type Educational Service Other Agricultural Medical Commercial Construction IndustrialOther (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 Commercial Area Mixed-Use Area Industrial Area Residential Area Site Coordinates (if available)Type of Service Requested Is the site located within Support in Obtaining Environmental Permit Environmental Classification (Category A, B, C) Handling Environmental Violation or Notice Preparation / Review of Environmental Impact Assessment (EIA) General Environmental Consultation Compliance Assessment with Environmental Regulations Preparation of Environmental Management Plan (EMP) Other Preparation of Environmental Register Environmental Measurements (Air – Water – Noise – Soil)Other (please specify)Relevant Regulatory Authority (if any)Relevant Regulatory Authority (if any) Ministry of Industry Municipality Other Ministry of Environment, Water and Agriculture Civil Defense National Center for Environmental Compliance (NCEC)Current Environmental Status of the Site Has an environmental permit been previously obtained? Yes NO Is there a previous Environmental Impact Assessment? Yes NOAre there any environmental violations or observations? Yes NO If yes, please specifySources of Environmental Impact (if any)Are there any environmental violations or observations? Hazardous waste Solid waste Noise Industrial / sanitary wastewater Other Chemicals Air emissions OdorsAttached Documents (Optional)Attached Documents (Optional) Activity license Site photos Previous environmental studies Commercial registration Site layout / drawings Air emissions Site plan Industrial / sanitary wastewaterAdditional 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
