Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
(To be filled up by User Agency)
A. General Details
A-1. Project Details
  (i). Proposal No. : FP/GA/ROAD/14950/2015   (ii). Name of Project for which Forest Land is required : Four Laning of NH-4A between KM 118/00 to 125/00   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : The land is required for the work of four laning of NH-4A(NH-748) betw, KM 118/00 to 125/00 including construction of high level four lane new Khandepar bridge at KM 118/800.   (iv). State : Goa   (v). Category of the Proposal : Road   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 17091   (viii). Area of forest land proposed for diversion(in ha.): 0.9959   (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 : PUBLIC WORKS DEPARTMENT   (ii). Address1 : EXECUTIVE ENGINEER WD XV(NH) PWD PONDA   (iii). Address2 : NIL   (iv). State : Goa   (v). District : North Goa   (vi). Pin : 403401   (vii). Landmark : GOVT BUILDING PONDA TISK   (viii). Email address :   (ix). Landline Telephone No. : 832-2313024   (x). Fax No. : 832-2313024   (xi). Mobile No. : 9370699881   (xii). Website (if any) :   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Mohan   (ii). Middle Name: S   (iii). Last Name: Karki   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: Executive Engineer WD XV(NH) PWD Ponda Goa   (vii). Address 2: NIL   (viii). State: Goa   (ix). District: North Goa   (x). Tehsil: Tiswadi   (xi). Pin: 403001   (xii). Landmark: NIL   (xiii). Email Address:   (xiv). Landline Telephone No.: 832-2313024   (xv). Fax No.: 08322313024   (xvi). Mobile No.: 9168694726   (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 Proposal Status. Proposal No. Moef File No. Area Proposed for Diversion(Ha.) Area Diverted(Ha.) Date of In-Principle Approval Date of Final Approval
B-2. Details of forest land proposed to be diverted
B-2.1 Details of Divisions involved
Details of Divisions involved Division Name Forest Land(ha.) Non-Forest Land(ha.)
B-2.2 Details of Districts involved
District wise breakup District Name Forest Land(ha.) Non-Forest Land(ha.)
1.North Goa0.99590
B-2.3 Village wise breakup
Villages wise breakup Village Forest Land(ha.) Non-Forest Land(ha.)
Total 0.9959 0
B-2.4 Component wise breakup
Component wise breakup Component Forest Land(ha.) Non-Forest Land(ha.)
Total 0.9959 0
C. Maps of forest land proposed to be diverted
Division 1. : North
  (i). Area of forest land proposed to be diverted(in ha.) : 0.9959   (ii). Nature of the Project: Linear   (b). No. of Segments : One
Segment wise details
Segments Segment Area(in ha.) Kml File of Segments
(To view KML file on google the same may be downloaded and then open if in google earth install in your computer).
1.0.9959    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:   (ii). Whether a copy of map indicating location of alternative examine is required to be provided: No   (a). Reason for not providing such map: NIL
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: No
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?: No
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? : No
L. Details of land identified for Compensatory Afforestation
  (i). Whether non-forest or Revenue forest land is required to be provided by User Agency?: Not Applicable   (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 ?: Not Applicable   (iii) . Reason for not providing Non-Forest Land: Not Applicable
Additional information Details
S.No Documents
1Project details
2Administrative Approval from PCE
3Certificate from village panchayat
4Certificate of demand that forest land is minimum
5Area statement for forest area required
6Certificate of no violation of provision of FCA
7Certificate to bear the cost of NPV of forest area diverted
8Checklist for proposal under FCA
9Appendix Form A part 1
10Undertaking to bear cost of compensatory afforestation
11Form 1 and 14
12Certificate stating non involvementof historical monuments in area
13Certificate of no voilation
14Technical Approval
15Inspection report
16Certificate that all annexure are in english
17Certificate of posession act
18Valuation report of trees
19Valuation report of standing trees
20Boundry Map
21Cost benefit analysis
22FRA Certificate for the work of four laning of NH-4A (NH-748)Khandepar Bridge(Updated copy: 19-08-2016)