Environmental Impact Assessment (EIA) Submission

1. Project Information

Project Title Project Proponent/Organization Project Location Project Description

2. Baseline Environmental Conditions

Physical Environment (topography, climate, soil, etc.) Biological Environment (flora, fauna, natural habitats) Socio-economic Environment (communities, livelihoods, infrastructure)

3. Identification and Evaluation of Impacts

Potential Positive Impacts Potential Adverse Impacts Significance of Impacts

4. Mitigation and Management Measures

Proposed Mitigation Measures Environmental Management Plan

5. Monitoring and Reporting

Monitoring Plan Reporting and Review Procedures

6. Stakeholder Consultation

Summary of Consultation Activities

7. Declaration

Name Position Date