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/SCH/120010/2021   (ii). Name of Project for which Forest Land is required : Construction of the School Building & Playgrounds for the existing High school, Abhinav Vidyamandir, Mollem-Goa established in 1978.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : The proposal is for the allotment of the land admeasuring 0.9060 Ha. for the construction of the School Building & the Playgrounds for the existing high school, Abhinav Vidyamandir, Mollem Goa in the newly created taluka of Dharbandoda in South Goa under the management of the applicant and is establ   (iv). State : Goa   (v). Category of the Proposal : School   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 150   (viii). Area of forest land proposed for diversion(in ha.): 0.906   (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): 99
A-2. Details of User Agency
  (i). Name : BHAUSAHEB BANDODKAR SHIKSHAN SAUNSTHA   (ii). Address1 : C/o V.S.LAAD HIGHER SECONDARY SCHOOL   (iii). Address2 : PILIEM, DHARBANDODA-GOA   (iv). State : Goa   (v). District : South Goa   (vi). Pin : 403406   (vii). Landmark : Behind Forest Depot,Tiska-Goa   (viii). Email address : prnadkarni@gmail.com   (ix). Landline Telephone No. : 832-2344022   (x). Fax No. : 832-   (xi). Mobile No. : 9326139252   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : Private
A-3. Details of Person Making Application
  (i). First Name: PANDURANG   (ii). Middle Name: RAUJI   (iii). Last Name: NADKARNI   (iv). Gender: Male   (v). Designation: Authorized Representative   (vi). Address 1: C/o V.S.Laad Higher Secondary School   (vii). Address 2: Piliem, Dharbandoda-Goa,403 406   (viii). State: Goa   (ix). District: South Goa   (x). Tehsil: Sanguem   (xi). Pin: 403406   (xii). Landmark: Behind Forest Depot, Tiska-Goa   (xiii). Email Address: prnadkarni@gmail.com   (xiv). Landline Telephone No.: 832-2344022   (xv). Fax No.: NIL   (xvi). Mobile No.: 9326139252   (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.North0.9060
Total0.9060
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.South Goa0.9060
Total0.9060
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Mollem-Goa0.9060
Total 0.906 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Constructions of School Building &Playgrounds0.90440
Total 0.9044 0
C. Maps of forest land proposed to be diverted
Division 1. : North
  (i). Area of forest land proposed to be diverted(in ha.) : 0.906   (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).
1.0.906    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: No Data   (ii). Whether a copy of map indicating location of alternative examine is required to be provided: No   (a). Reason for not providing such map: There is no such land in the vicinity due to Mahav
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 5   (iii). Temporary Employment(Number of person-days): 100
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? : 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
Documents
S.No Documents
Remarks
1Certificate of minimum use of land
2Statement showing the details of Forest Area
3Statement showing the details of Non-Forest Area
4Undertaking for payment of cost of Compensatory Afforestation
5Undertaking for payment of cost of Net Present Value of the Project
6Certificate of Non-violation of Forest ( Conservation Act ), 1980
7Cost Benefit Analysis
8Brief Note of the Project
9Form I & XIV of the proposed site
10Certificate in respect of any monuments of historical,religious, archaeological or recreational importance
11Copy of the letter dated 30th August, 2012 from Directorate of Education, Govt. of Goa regarding the requirement of the land for the construction of the School Building
12Certificate regarding the cost of the project to be borne by the management
13Site Plan of the proposed plot of land
14Topo Sheet of the plot of land
15Geo Reference Plan of the plot of land
16Survey Plan of the plot of land
17Project details
18Justification of the Project locating in the Forest Area
19Snap shot of KML file demarcation the Plot of land