FORM - A
Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
PART - I
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/GA/Others/155303/2022   (ii). Name of Project for which Forest Land is required : Diversion of 4.90 Ha of forest land for removal of ore rejects dumped on Sy. No. 23 part 1 of Dharbandora Village of in North Goa Division South Goa District in favour of Dr. Pramod M S Talaulicar ot   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 4.90 Ha of Forest Land for removal of ore rejects dump kept on Sy. No. 23/1   (iv). State : Goa   (v). Category of the Proposal : Others   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 6690   (viii). Area of forest land proposed for diversion(in ha.): 4.9   (ix). Non-forest land required for this project(in ha.): 0   (x). Total period for which the forest land is proposed to be diverted(in years): NIL
A-2. Details of User Agency
  (i). Name : DR PRAMOD M S TALAULICAR & OTHERS   (ii). Address1 : HIRA MAHAL DR DADA VAIDYA ROAD PANAJI GOA 403001   (iii). Address2 : NIL   (iv). State : Goa   (v). District : North Goa   (vi). Pin : 403001   (vii). Landmark : NIL   (viii). Email address : athiappangoa1@gmail.com   (ix). Landline Telephone No. : 91-832-   (x). Fax No. : 91-   (xi). Mobile No. : 9765235765   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Private
A-3. Details of Person Making Application
  (i). First Name: Dr PRAMOD   (ii). Middle Name: MADHAV SINAI   (iii). Last Name: TALAULICAR   (iv). Gender: NIL   (v). Designation: MANAGING PARTNER   (vi). Address 1: HIRA MAHAL DR DADA VAIDYA ROAD PANAJI GOA 403001   (vii). Address 2: NIL   (viii). State: Goa   (ix). District: North Goa   (x). Tehsil: NIL   (xi). Pin: 403001   (xii). Landmark: NIL   (xiii). Email Address: athiappangoa1@gmail.com   (xiv). Landline Telephone No.: 0-   (xv). Fax No.: NIL   (xvi). Mobile No.: 9822141706   (xvii). Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency:
B. Details of land required for the Project
B-1. Details of proposal seeking prior approval of Central Government under the Act for diversion of forest land for the Project already submitted in the past
List of proposal submitted in Past
S.no Proposal Status. Proposal No. Moef File No. Area Proposed for Diversion(Ha.) Area Diverted(Ha.) Date of In-Principle Approval Date of Final Approval
NIL
B-2. Details of forest land proposed to be diverted
B-2.1 Details of Divisions involved
Details of Divisions involved
S.no Division Name Forest Land(ha.) Non-Forest Land(ha.)
1.North4.90
Total4.90
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.South Goa4.90
Total4.90
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Dharbandora4.90
Total 4.9 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1One4.90
Total 4.9 0
C. Maps of forest land proposed to be diverted
Division 1. : North
  (i). Area of forest land proposed to be diverted(in ha.) : 4.9   (ii). Nature of the Project: Non Linear   (a). No. of patches : One
Patch wise details
Patch No. Area of Patch(in ha.) Kml File of PatchesTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.4.9    View File
  (iii). Copy of Survey of India Toposheet indicating boundary of forest land proposed to be diverted:   (iv). Scanned copy of the Geo-referenced map of the forest land proposed to be diverted prepared by using GPS or Total Station:
D. Justification for locating the Project in forest land and details of alternatives examined:
  (i). Copy of note containing justification for locating the Project in forest land:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 30   (iii). Temporary Employment(Number of person-days): 60
F. Displacement of People due to the Project, if any
  (i). Whether Project involves displacement?: No
G. Details of Cost-Benefit analysis for the Project
  (i). Whether the Project requires Cost-Benefit analysis?: Yes   (a). Copy of Cost-Benefit analysis:
H. Status of Environmental Clearance
  (i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? : No
I. Status of Wildelife Clearance
  (i). Whether the Project or a part thereof is located in any Protected Area or their Eco sensitive zone? : No
J. Applicability of special provisions governing Scheduled Areas
  (i).Whether the Project or a part thereof is located in a Scheduled Area? : No
K. Status of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted
  (i). Whether the process for settlement of Rights under the Forest Rights Acts 2006 on the forest land proposed to be diverted has been completed? : Yes   (a). Copy of documentry evidence in support of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted:
L. Details of land identified for Compensatory Afforestation
  (i). Whether non-forest or Revenue forest land is required to be provided by User Agency?: No   (ii). Whether the area of non-forest land or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation is less than area of forest land proposed to be diverted ?: No   (iii) . Reason for not providing Non-Forest Land: Others
Additional information Details
Documents
S.No Documents
Remarks
1Affidavit copy of Ownership
2Affidavit copy statutory compliance
3Statement of Forest area proposed for diversion
4Certificate of Minimum Forest Land requirements
5Certificate of No Violation of FCA 1980
6Forest Right Act, 2006 Certificate
7Contour Map
8Form-A
9Geo-reference Map
10Notification of Goa State regarding minerals rejects
11Copy of lease deed
12Project details
13Copy of letter from Panchayat
14Copy of letter from Truck owner
15Copy of Survey Plan
16Copy of TopoSheet
17Letter to DCF
18Cost Benefit Analysis
19Certificate of Justification for locating the project in forest area
20Certificate of Ca & NPV
21Form I & XIV