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/GJ/ROAD/35014/2018   (ii). Name of Project for which Forest Land is required : Upgradation and Widening of Mehsana to Palanpur State Highway 41 to 6 Lane plus   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Upgradation of Mehsana (km 79+300) to Palanpur (km141+100), SH- 41 from 4-Lane to 6-Laning with paved shoulders and hard shoulders along with Pedestrian Path on LHS, Toe, Side Drain, Landscape, bus Stop with Busbay and Utility Zone, under Second Gujarat State Highway Project (GSHP II) R & BD, Govt.   (iv). State : Gujarat   (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) : 45000   (viii). Area of forest land proposed for diversion(in ha.): 211.27   (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 : PIU WORLD BANK PROJECTS GSHP II ROADS AND BUILDING DEPARTMENT GOVT OF GUJARAT   (ii). Address1 : Project Implementation Unit (PIU - World Bank Funded Projects), Roads and Building Department, Govt. of Gujarat, Nirman Bhavan,   (iii). Address2 : GF, Nirmanbhavan, Sector 10 A, Gandhinagar (Gujarat State)   (iv). State : Gujarat   (v). District : Gandhinagar   (vi). Pin : 382010   (vii). Landmark : Near New Sachivalaya Gate No. 4   (viii). Email address : se-piu-rnb@gujarat.gov.in   (ix). Landline Telephone No. : 79-23252986   (x). Fax No. : 79-   (xi). Mobile No. : 9825562693   (xii). Website (if any) : www.rnbgujarat.org   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: R   (ii). Middle Name: T   (iii). Last Name: Rohit   (iv). Gender: Male   (v). Designation: ExecutiveEngineer   (vi). Address 1: Project Implementation Unit PIU, World Bank Funded Project GSHP II, Roads and Building Department, Govt. of Gujarat, Ground Floor, Nirman Bhavan, Sector 10 A, Gandhinagar, Gujarat State   (vii). Address 2: NIL   (viii). State: Gujarat   (ix). District: Gandhinagar   (x). Tehsil: Gandhinagar   (xi). Pin: 382010   (xii). Landmark: Near New Sachivalaya   (xiii). Email Address: eo1-piu-rnd@gujarat.gov.in   (xiv). Landline Telephone No.: 79-23252987   (xv). Fax No.: NIL   (xvi). Mobile No.: 9727640000   (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.Mehsana SF97.290
2.Patan31.930
3.Banaskantha SF82.050
Total211.270
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Mahesana97.290
1.Patan31.930
3.Banaskantha82.050
Total211.270
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Palodar11.650
2Motidau8.110
3Bhandu18.630
4Bokarwada4.830
5Aithor4.340
6Unava11.490
7Unjha14.460
8Maktupur9.420
9Brahmanvada14.360
10Khali4.920
11Lalpur3.510
12Siddhpur17.050
13Sujanpur6.450
14Dharewada4.920
15Teniwada9.740
16Kotadi2.150
17Rajosana4.740
18Chhapi1.780
19Mahi4.490
20Bharkewada6.640
21Majadar3.740
22Sherpura3.730
23Kanodar10.890
24Jagana16.450
25Esbipura4.360
26Palanpur rural8.420
Total 211.27 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Mehsana (km 79.300) to Palanpur (km 141.100) SH 41211.269999999970
Total 211.26999999997 0
C. Maps of forest land proposed to be diverted
Division 1. : Mehsana SF
  (i). Area of forest land proposed to be diverted(in ha.) : 97.29   (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).
1.97.29    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:
Division 2. : Patan
  (i). Area of forest land proposed to be diverted(in ha.) : 31.93   (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).
1.31.93    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:
Division 3. : Banaskantha SF
  (i). Area of forest land proposed to be diverted(in ha.) : 82.05   (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).
1.82.05    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: Not Required
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 250   (iii). Temporary Employment(Number of person-days): 450
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: Linear or 'strip' plantation declared as protected forest along with road/rail/canal sides for widening or expansion of road/rail/canal
Additional information Details
Documents
S.No Documents
Remarks
1The detailed description of the Mehsana Palanpur (SH 41) project.
2The notifications for villages having protected forests along the corridor (road /State Highways).
3Undertaking for Net Present value (NPV)
4FRA Certificate by DM and Collector of concerned districts 3 Nos